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Efficacy of 3D evaluation of unruptured paraclinoid aneurysms within Leksell GammaPlan® for determination of their intradural localization. J Clin Neurosci 2023; 108:76-83. [PMID: 36623441 DOI: 10.1016/j.jocn.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/27/2022] [Accepted: 12/02/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Determination of the intradural unruptured paraclinoid aneurysm localization is difficult, but critical for selection of the optimal treatment strategy. OBJECTIVE To assess efficacy of the three-dimensional (3D) evaluation of unruptured paraclinoid aneurysms within Leksell GammaPlan® (LGP; Elekta AB; Stockholm, Sweden) for determination of their intradural localization. METHODS Overall, 125 incidentally diagnosed unruptured paraclinoid aneurysms in 118 patients (mean age, 55 years) underwent 3D evaluation of their localization within LGP using post-contrast thin-slice constructive interference in steady state (CISS) images, which in 41 cases were additionally co-registered and fused with the axial computed tomography angiography (CTA) source images. RESULTS According to the evaluation within LGP, paraclinoid aneurysms were considered intradural, transitional, and extradural in 75, 25, and 25 cases respectively. Overall, 51 of 75 aneurysms deemed to be intradural, underwent microsurgical management, and intraoperative visual inspection confirmed their intradural localization in 45 cases, whereas it was transitional in 3, and extradural in 3. If during preoperative 3D evaluation within LGP only post-contrast CISS images were used, prediction of the pure intradural localization of aneurysm was correct in 88 % of cases (95 % CI: 79-97 %), and of the pure or partial (i.e., transitional) intradural localization in 94 % of cases (95 % CI: 88-100 %), whereas it was 100 % if co-registration and fusion of the contrast-enhanced CISS and CTA source images was done. CONCLUSION Intradural localization of the unruptured paraclinoid aneurysms may be effectively predicted based on their 3D evaluation within LGP using post-contrast thin-slice CISS and CTA source images, which may help with clinical decision-making.
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Three-Dimensional Constructive Interference in Steady State (3D CISS) Imaging and Clinical Applications in Brain Pathology. Biomedicines 2022; 10:biomedicines10112997. [PMID: 36428564 PMCID: PMC9687637 DOI: 10.3390/biomedicines10112997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Three-dimensional constructive interference in steady state (3D CISS) is a steady-state gradient-echo sequence in magnetic resonance imaging (MRI) that has been used in an increasing number of applications in the study of brain disease in recent years. Owing to the very high spatial resolution, the strong hyperintensity of the cerebrospinal fluid signal and the high contrast-to-noise ratio, 3D CISS can be employed in a wide range of scenarios, ranging from the traditional study of cranial nerves, the ventricular system, the subarachnoid cisterns and related pathology to more recently discussed applications, such as the fundamental role it can assume in the setting of acute ischemic stroke, vascular malformations, infections and several brain tumors. In this review, after briefly summarizing its fundamental physical principles, we examine in detail the various applications of 3D CISS in brain imaging, providing numerous representative cases, so as to help radiologists improve its use in imaging protocols in daily clinical practice.
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The Intersection Between the Oculomotor Nerve and the Internal Carotid Artery to Distinguish Extracavernous and Intracavernous Paraclinoid Aneurysms Using Anatomic Dissections-A New 3T Magnetic Resonance Imaging Protocol Confirmed by Three-Dimensionally Printed Biomodels. World Neurosurg 2022; 167:e475-e506. [PMID: 35970294 DOI: 10.1016/j.wneu.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the relationship between the oculomotor nerve (CNIII) and the internal carotid artery (ICA) as a new anatomic-radiologic landmark for distinguishing the exact location of a paraclinoid intracranial aneurysm (IA). METHODS Microanatomic dissections were performed in 20 cavernous sinuses to evaluate the ICA paraclinoid region. Based on anatomic observations, a new magnetic resonance (MRI) protocol to classify paraclinoid aneurysms was proposed. MRI of 42 IAs from 34 patients was independently analyzed and classified as intracavernous, extracavernous, or transitional by 2 neuroradiologists. To validate the proposed MRI protocol, each IA was classified by a three-dimensionally (3D) printed biomodel and agreement with the radiologic classifications was evaluated. Of 42 IAs, 23 undergoing microsurgeries were also classified by direct visualization. RESULTS We observed that the true cavernous sinus roof is defined by the carotid-oculomotor membrane, which has an intimate relationship with the intersection between the superior limit of the CNIII and the ICA. Based on this intersection, all 42 IAs were radiologically classified and agreement with the 3D printed biomodels was observed in 95% IAs. Concordance tests showed a statistically significant (P < 0.05) agreement between the classifications. All 23 IAs treated had the radiologic and 3D biomodel classification confirmed. CONCLUSIONS The intersection between the ICA and the CNIII, which crosses it transversely in its entire diameter, is a reliable anatomic-radiologic landmark to correctly classify paraclinoid aneurysms. Through a new MRI protocol, it is possible to radiologically identify this intersection and to easily distinguish the intracavernous and extracavernous ICA paraclinoid aneurysms.
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Scerbak J, Lapteva O, Sahin OS, Ksanas U, Barkauskiene A, Lengvenis G, Ozaydin B, Cikla U, Baskaya MK. Identification of the Distal Dural Ring and Definition of Paraclinoid Aneurysms According to Bony Landmarks on 3-Dimensional Computed Tomography Angiography: A Cadaveric and Radiological Study. Oper Neurosurg (Hagerstown) 2020; 19:319-329. [PMID: 32022234 DOI: 10.1093/ons/opz417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 12/01/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Determining if paraclinoid aneurysms are intradural or extradural is critical for surgical planning. OBJECTIVE To create an easily reproducible diagnostic method based on bony anatomy that precisely locates the distal dural ring (DDR) to determine the position of paraclinoid aneurysms as intradural, transitional, or extradural. METHODS Bilateral anatomic dissections of 10 cadaveric heads (20 sides) were performed to evaluate DDR anatomy. We observed a plane that reflects the position of the DDR passes through 4 bony landmarks: 1) The anterior clinoid-internal carotid artery intersection, 2) the optic strut, 3) the optico-carotid elevation, and 4) the base of the posterior clinoid process. This landmark-based plane can thus define the location of the DDR using 3-dimensional computed tomography angiography (CTA). This was confirmed in 27 surgical patients with intradural/transitional aneurysms and 7 patients with extradural aneurysms confirmed with magnetic resonance imaging (MRI). The DDR plane method easily classified aneurysm locations as intradural (above the DDR plane), extradural (below the DDR plane), or transitional (the DDR plane crosses the aneurysm). The aneurysm's location was subsequently confirmed intraoperatively or with MRI. RESULTS The DDR plane method determined if paraclinoid aneurysms were intradural, transitional, or extradural in all 34 cases examined. The visibility of the anatomic features that define the DDR plane was also verified in 82% to 89% of CTA images from 100 patients. CONCLUSION The DDR plane method provides a useful diagnostic tool to evaluate the position of the DDR and determine the anatomic location of paraclinoid aneurysms.
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Affiliation(s)
| | - Ona Lapteva
- University of Wisconsin Hospital, Madison, Wisconsin
| | - Omer S Sahin
- University of Wisconsin Hospital, Madison, Wisconsin
| | - Ugnius Ksanas
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Givi Lengvenis
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Burak Ozaydin
- University of Wisconsin Hospital, Madison, Wisconsin
| | - Ulas Cikla
- University of Wisconsin Hospital, Madison, Wisconsin
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5
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Lefevre E, Apra C, Chodraui-Filho SF, Chauvet D, Smajda S, Piotin M, Fahed R. Reliability of Bony Landmarks to Predict Intradural Location of Paraclinoid Aneurysms. Clin Neuroradiol 2020; 30:843-848. [PMID: 32170338 DOI: 10.1007/s00062-020-00896-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE When dealing with paraclinoid carotid aneurysms, the distinction between intradural and extradural location is a major component for decision-making as only intradural aneurysms carry a risk of subarachnoid hemorrhage (SAH). The aim of this study was to test the accuracy and reliability of computed tomography (CT) bony landmarks for the distinction between intradural and extradural paraclinoid aneurysms. METHODS All patients referred to this institution for a single paraclinoid aneurysm were retrospectively identified. The study included only the patients who presented with diffuse SAH, thus proving the intradural location of the aneurysm. The preoperative images were assessed by two physicians in order to locate the aneurysms using the tuberculum sellae (TS) and the optic strut (OS) landmarks. RESULTS A total of 15 patients were included in the study. There were 4 cases (27%) of disagreement with the OS bony landmark and no cases of disagreement with the TS landmark. No aneurysm was consensually considered as extradural by both readers with both bony landmarks; however, five aneurysms (33%) were considered to be extradural by at least one of the physicians with at least one of the two bony landmarks. CONCLUSION The results of the study showed several disagreements when using the OS landmark. More importantly, several aneurysms were considered as extradural with at least one of these two CT bony landmarks, even though they were all associated with an SAH. More reliable and accurate landmarks are warranted.
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Affiliation(s)
- Etienne Lefevre
- Neurosurgery Department, Rothschild Foundation Hospital, 75019, Paris, France. .,Interventional Neuroradiology Department, Rothschild Foundation Hospital, 75019, Paris, France.
| | - Caroline Apra
- Neurosurgery Department, Rothschild Foundation Hospital, 75019, Paris, France
| | | | - Dorian Chauvet
- Neurosurgery Department, Rothschild Foundation Hospital, 75019, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, 75019, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, 75019, Paris, France
| | - Robert Fahed
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, 75019, Paris, France
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Kalluri AG, Sukumaran M, Nazari P, Golnari P, Ansari SA, Hurley MC, Shaibani A, Jahromi BS, Potts MB. Retrospective review of 290 small carotid cave aneurysms over 17 years. J Neurosurg 2019; 133:1473-1477. [PMID: 31628282 DOI: 10.3171/2019.7.jns191471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The carotid cave is a unique intradural region located along the medial aspect of the internal carotid artery. Small carotid cave aneurysms confined within this space are bound by the carotid sulcus of the sphenoid bone and are thought to have a low risk of rupture or growth. However, there is a lack of data on the natural history of this subset of aneurysms. METHODS The authors present a retrospective case series of 290 small (≤ 4 mm) carotid cave aneurysms evaluated and managed at their institution between January 2000 and June 2017. RESULTS No patient presented with a subarachnoid hemorrhage attributable to a carotid cave aneurysm, and there were no instances of aneurysm rupture or growth during 911.0 aneurysm-years of clinical follow-up or 726.3 aneurysm-years of imaging follow-up, respectively. CONCLUSIONS This series demonstrates the benign nature of small carotid cave aneurysms.
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Affiliation(s)
- Aravind G Kalluri
- Departments of1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Madhav Sukumaran
- Departments of1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Pouya Nazari
- Departments of1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Pedram Golnari
- Departments of1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Sameer A Ansari
- Departments of1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Michael C Hurley
- Departments of1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Ali Shaibani
- Departments of1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Babak S Jahromi
- Departments of1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Matthew B Potts
- Departments of1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
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Distance Between the Falciform Ligament and Distal Dural Ring as a Surgical Landmark for the Treatment of Paraclinoid Aneurysms. World Neurosurg 2019; 124:e498-e502. [PMID: 30615993 DOI: 10.1016/j.wneu.2018.12.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE It is difficult to completely comprehend the anatomy of the structures surrounding the paraclinoid region before aneurysm and tumor treatment therein. When treating paraclinoid aneurysms, it is important to determine the location of the aneurysm as intradural or extradural. Thus, accurate prediction of the position of the distal dural ring (DDR) is necessary. To this end, we focused on the falciform ligament (FL), which is easily visualized on images based on its anatomic features. We measured the distance between the FL and the DDR in patients undergoing paraclinoid aneurysm operations. METHODS Between January 2017 and July 2018, 15 patients who underwent clipping for paraclinoid aneurysm treatment were retrospectively identified. The distance between the FL and the DDR was measured using a microscale at the time of the operation. RESULTS The patients comprised 14 women and 1 man. The mean aneurysm diameter was 7.29 ± 2.21 mm and the median size was 6.5 mm. Eleven of the aneurysms were on the left and 4 were on the right side. The mean distance between the FL and the DDR was 3.50 ± 0.17 mm and the median distance was 3.50 mm. The distance between the FL and the DDR was almost the same across cases (3.5 mm). CONCLUSIONS The position of the FL can be easily predicted using preoperative three-dimensional computed tomography angiography based on its anatomic features. In this study, the DDR was located 3.5 mm proximal to the FL along the internal carotid artery. This information is useful for predicting the position of the DDR.
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Matsumoto K, Yokota H, Mukai H, Masuda Y, Uno T, Miyati T. Merging images with different central frequencies reduces banding artifacts in balanced steady-state free precession magnetic resonance cisternography. J Appl Clin Med Phys 2018; 19:234-243. [PMID: 30288917 PMCID: PMC6236844 DOI: 10.1002/acm2.12468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/25/2018] [Accepted: 09/09/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to evaluate the utility of merged balanced steady‐state free precession (bSSFP) magnetic resonance cisternography images. Materials and Methods Twenty ears of 10 healthy volunteers (six men, four women; mean age ± standard deviation, 26.7 ± 1.6 yr) and 10 patients (two men, eight women; mean age, 46.3 ± 10.9 yr) with neoplasm around the sella turcica were included. Two different devices (A and B) were used to confirm the versatility of our method for MR devices with different local magnetic field homogeneity. Images with different central frequencies (±10, ±20, ±30, ±40, and ±50 Hz) were merged with the maximum magnitude of corresponding pixels from the images acquired using both devices. Two neuroradiologists visually graded the image quality of 11 sites in the inner ear and three sites around the sella turcica (scale: 0–2) and compared the quality with that of the corresponding basic image (0 Hz). Results The image quality was better in merged images of the vestibule, superior semicircular canal (SCC), posterior SCC, and horizontal SCC (P = 0.005 to 0.020 mainly at ±40 and ±50 Hz on devices A and B), as well as in merged images of the sella turcica and right cavernous sinus (±50 Hz, P = 0.003 and 0.020 on device B, respectively), than it was in the corresponding basic images. Conclusions The maximum magnitude merging of images with different central frequencies makes it possible to reduce banding artifacts on bSSFP images without the need for special pulse sequences and image processing programs.
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Affiliation(s)
- Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hajime Yokota
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Mukai
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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Liao CH, Lin CJ, Lin CF, Huang HY, Chen MH, Hsu SPC, Shih YH. Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography. J Neurosurg 2016; 125:275-82. [DOI: 10.3171/2015.7.jns151046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE
The treatment of paraclinoid aneurysms remains challenging. It is important to determine the exact location of the paraclinoid aneurysm when considering treatment options. The authors herein evaluated the effectiveness of using the optic strut (OS) and tuberculum sellae (TS) as radiographic landmarks for distinguishing between intradural and extradural paraclinoid aneurysms on source images from CT angiography (CTA).
METHODS
Between January 2010 and September 2013, a total of 49 surgical patients with the preoperative diagnoses of paraclinoid aneurysm and 1 symptomatic cavernous-clinoid aneurysm were retrospectively identified. With the source images from CTA, the OS and the TS were used as landmarks to predict the location of the paraclinoid aneurysm and its relation to the distal dural ring (DDR). The operative findings were examined to confirm the definitive location of the paraclinoid aneurysm. Statistical analysis was performed to determine the diagnostic effectiveness of the landmarks.
RESULTS
Nineteen patients without preoperative CTA were excluded. The remaining 30 patients comprised the current study. The intraoperative findings confirmed 12 intradural, 12 transitional, and 6 extradural paraclinoid aneurysms, the diagnoses of which were significantly related to the type of aneurysm (p < 0.05) but not factors like sex, age, laterality of aneurysm, or relation of the aneurysm to the ophthalmic artery on digital subtraction angiography. To measure agreement with the correct diagnosis, the OS as a reference point was far superior to the TS (Cohen's kappa coefficients 0.462 and 0.138 for the OS and the TS, respectively). For paraclinoid aneurysms of the medial or posterior type, using the base of the OS as a reference point tended to overestimate intradural paraclinoid aneurysms. The receiver operating characteristic curve indicated that if the aneurysmal neck traverses the axial plane 2 mm above the base of the OS, the aneurysm is most likely to grow across the DDR and present as a transitional aneurysm (sensitivity 0.806; specificity 0.792).
CONCLUSIONS
High-resolution thin-cut CTA is a fast and crucial tool for diagnosing paraclinoid aneurysms. The OS serves as an effective landmark in CTA source images for distinguishing between intradural and extradural paraclinoid aneurysms. The DDR is supposed to be located 2 mm above the base of the OS in axial planes.
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Affiliation(s)
| | - Chung-Jung Lin
- 2Radiology and
- 3National Yang Ming University, School of Medicine, Taipei, Taiwan, Republic of China
| | - Chun-Fu Lin
- Departments of 1Neurosurgery, Neurological Institute, and
- 3National Yang Ming University, School of Medicine, Taipei, Taiwan, Republic of China
| | - Hsin-Yi Huang
- 4Biostatistics Task Force (under Department of Medical Research and Education), Taipei Veterans General Hospital; and
| | - Min-Hsiung Chen
- Departments of 1Neurosurgery, Neurological Institute, and
- 3National Yang Ming University, School of Medicine, Taipei, Taiwan, Republic of China
| | - Sanford P. C. Hsu
- Departments of 1Neurosurgery, Neurological Institute, and
- 3National Yang Ming University, School of Medicine, Taipei, Taiwan, Republic of China
| | - Yang-Hsin Shih
- Departments of 1Neurosurgery, Neurological Institute, and
- 3National Yang Ming University, School of Medicine, Taipei, Taiwan, Republic of China
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Yoon SJ, Shin NY, Lee JW, Huh SK, Park KY. Localization and Treatment of Unruptured Paraclinoid Aneurysms: A Proton Density MRI-based Study. J Cerebrovasc Endovasc Neurosurg 2015; 17:180-4. [PMID: 26523253 PMCID: PMC4626340 DOI: 10.7461/jcen.2015.17.3.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/01/2015] [Accepted: 08/21/2015] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to evaluate the usefulness of proton density magnetic resonance (PD MR) imaging for localization of paraclinoid internal carotid artery aneurysms. Materials and Methods From April 2014 to April 2015, 76 unruptured paraclinoid aneurysms in 66 patients were evaluated using PD MR and angiography (CT/MR angiography or digital subtraction angiography). The locations (extradural, transdural, intradural) in relation to the distal dural ring (DDR) and projection (superior, inferior/posterior, medial, lateral) of the aneurysms were assessed and compared. Results The most common location of paraclinoid aneurysms was extradural (n = 48, 63.2%), followed by intradural (n = 18, 23.7%), and transdural (n = 10, 13.2%). In the medial projection group (n = 49, 64.5%), 31 were extradural (63.3%), 5 were transdural (10.2%), and 13 were intradural (26.5%). In the inferior/posterior projection group (n = 19, 25.0%), there were 14 extradural (73.7%), 4 transdural (21.0%), and 1 intradural (5.3%). In the superior (n = 4, 5.3%)/lateral (n = 4, 5.3%) projection groups, there were 0/3 extradural (0/75.0%), 1/0 transdural (25.0/0%), and 3/1 intradural (75.0/25.0%). Conclusion PD MR showed sufficient contrast difference to distinguish paraclinoid aneurysms from surrounding dural structures.
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Affiliation(s)
- Seon Jin Yoon
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Na-Young Shin
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae Whan Lee
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Kon Huh
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Young Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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11
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Carlson AP, Loveren HRV, Youssef AS, Agazzi S. Junctional Internal Carotid Artery Aneurysms: The Schrödinger's Cat of Vascular Neurosurgery. J Neurol Surg B Skull Base 2015; 76:150-6. [PMID: 25844299 DOI: 10.1055/s-0034-1396596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 06/25/2014] [Indexed: 10/24/2022] Open
Abstract
Objectives Despite advances in neuroimaging, it is not always definitive whether a paraclinoid aneurysm is intradural or entirely extradural. We illustrate the potential use of surgical exploration in these aneurysms that we refer to as "junctional" aneurysms. Methods Retrospective review of eight patients with unruptured aneurysms who underwent a planned surgical exploration of a junctional aneurysm. Results Of the eight patients, three underwent exploration of the aneurysm during surgery for a different aneurysm. All three of these were found to be extradural. Five patients underwent a craniotomy for the exclusive purpose of clarifying the location of the aneurysm. Two of these cases were found to be intradural and were clipped. Two cases were found to be extradural. In one patient, the initially extradural aneurysm was converted into an intradural aneurysm during removal of the anterior clinoid process, necessitating surgical clipping. One transient third nerve palsy was observed. Discussion Until further progress in neuroimaging allows clinicians to determine unequivocally the exact anatomical location of a paraclinoid aneurysm, we advocate the use of the term junctional aneurysm to reflect the clinical uncertainty inherent in management decisions made regarding these aneurysms. We have illustrated a strategy of surgical exploration in select patients.
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Affiliation(s)
- Andrew P Carlson
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States ; Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
| | - Harry R van Loveren
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
| | - A Samy Youssef
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
| | - Siviero Agazzi
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
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12
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Welch BG, Batjer HH. Cavernous Carotid Aneurysms: You Can But Should You? World Neurosurg 2014; 82:996-7. [PMID: 24954259 DOI: 10.1016/j.wneu.2014.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Babu G Welch
- Department of Neurological Surgery, The University of Texas Southwestern, Dallas, Texas, USA; Department of Radiology, The University of Texas Southwestern, Dallas, Texas, USA
| | - H Hunt Batjer
- Department of Neurological Surgery, The University of Texas Southwestern, Dallas, Texas, USA.
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13
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Kanayama S, Hara T, Hamada Y, Matsumaru Y. Potential of 80-kV high-resolution cone-beam CT imaging combined with an optimized protocol for neurological surgery. Neuroradiology 2014; 57:155-62. [PMID: 25370477 DOI: 10.1007/s00234-014-1447-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/28/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION With the development of computed tomography (CT) and magnetic resonance imaging (MRI), the use of conventional X-ray angiography including digital subtraction angiography (DSA) for diagnosis has decreased, as it is an invasive technique with a risk of neurological complications. However, X-ray angiography imaging technologies have progressed markedly, along with the development of endovascular treatments. A newly developed angiography technique using cone-beam CT (CBCT) technology provides higher spatial resolution than conventional CT. Herein, we describe the potential of this technology for neurosurgical operations with reference to clinical cases. METHODS Two hundred twenty-five patients who received 80-kV high-resolution CBCT from July 2011 to June 2014 for preoperative examinations were included in this study. For pathognomonical cases, images were taken with suitable reconstruction modes and contrast protocols. Cases were compared with intraoperative findings or images from other modalities. RESULTS We observed the following pathognomonical types: (1) imaging of the distal dural ring (DDR) and the surrounding structure for paraclinoid aneurysms, (2) imaging of thin blood vessels, and (3) imaging of both brain tumors and their surrounding anatomy. Our devised 80-kV high-resolution CBCT imaging system provided clear visualization of detailed anatomy when compared with other modalities in almost all cases. Only two cases provided poor visualization due to movement artifact. CONCLUSION Eighty-kilovolt high-resolution CBCT has the potential to provide detailed anatomy for neurosurgical operations when utilizing suitable modes and contrast protocols.
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Affiliation(s)
- Seisaku Kanayama
- Department of Neurosurgery, Toranomon Hospital, 2-2-2 Minatoku Toranomon, Tokyo, 105-8470, Japan,
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Ahn SJ, Yoo MR, Suh SH, Lee SK, Lee KS, Son EJ, Chung TS. Gadolinium enhanced 3D proton density driven equilibrium MR imaging in the evaluation of cisternal tumor and associated structures: comparison with balanced fast-field-echo sequence. PLoS One 2014; 9:e103215. [PMID: 25051459 PMCID: PMC4106890 DOI: 10.1371/journal.pone.0103215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/28/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives Although Gadolinium enhanced bFFE is commonly used to evaluate cisternal tumors, banding artifact may interrupt interpretation and adjacent nerve and vessels differentiation is known to be difficult. We analyzed the qualities of Gd enhanced 3D PDDE in the evaluation of cisternal tumors, comparing with bFFE. Material and Methods Forty five cisternal tumors (33 schwannoma and 12 meningioma) on both bFFE and PDDE were retrospectively reviewed. For quantitative analysis, contrast ratios of CSF to tumor and tumor to parenchyma (CRC/T and CRT/P) on both sequences were compared by paired t-test. For qualitative analysis, the readers gauged the qualities of the two MR sequences with respect to the degree of demarcating cisternal structures (tumor, basilar artery, AICA, trigeminal nerve, facial nerve and vestibulocochlear nerve). Results In quantitative analysis, CRC/T and CRT/P on 3D PDDE was significantly lower than that of 3D bFFE (p<0.01). In qualitative analysis, basilar artery, AICA, facial nerve and vestibulocochlear nerves were significantly better demarcated on 3D PDDE than on bFFE (p<0.01). The degree of demarcation of tumor on 3D PDDE was not significantly different with that on 3D bFFE (p = 0.13). Conclusion Although the contrast between tumor and the surrounding structures are reduced, Gd enhanced 3D PDDE provides better demarcation of cranial nerves and major vessels adjacent to cisternal tumors than Gd enhanced bFFE
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Affiliation(s)
- Sung Jun Ahn
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mi Ri Yoo
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Suh
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Koo Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Sung Lee
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Jin Son
- Department of Otorhinolarygology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Sub Chung
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Shapiro M, Becske T, Riina HA, Raz E, Zumofen D, Jafar JJ, Huang PP, Nelson PK. Toward an endovascular internal carotid artery classification system. AJNR Am J Neuroradiol 2013; 35:230-6. [PMID: 23928138 DOI: 10.3174/ajnr.a3666] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Does the world need another ICA classification scheme? We believe so. The purpose of proposed angiography-driven classification is to optimize description of the carotid artery from the endovascular perspective. A review of existing, predominantly surgically-driven classifications is performed, and a new scheme, based on the study of NYU aneurysm angiographic and cross-sectional databases is proposed. Seven segments - cervical, petrous, cavernous, paraophthlamic, posterior communicating, choroidal, and terminus - are named. This nomenclature recognizes intrinsic uncertainty in precise angiographic and cross-sectional localization of aneurysms adjacent to the dural rings, regarding all lesions distal to the cavernous segment as potentially intradural. Rather than subdividing various transitional, ophthalmic, and hypophyseal aneurysm subtypes, as necessitated by their varied surgical approaches and risks, the proposed classification emphasizes their common endovascular treatment features, while recognizing that many complex, trans-segmental, and fusiform aneurysms not readily classifiable into presently available, saccular aneurysm-driven schemes, are being increasingly addressed by endovascular means. We believe this classification may find utility in standardizing nomenclature for outcome tracking, treatment trials and physician communication.
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Affiliation(s)
- M Shapiro
- From the Department of Radiology (M.S., T.B., H.A.R., E.R., D.Z., P.K.N.), Bernard and Irene Schwartz Neurointerventional Radiology Section
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Akiyama Y, Okada T, Hayashi N, Yokoi T. Infraoptic course of the anterior cerebral artery originating from the extradural internal carotid artery associated with contralateral internal carotid artery agenesis and multiple intracerebral aneurysms. Neurol Med Chir (Tokyo) 2013; 50:984-7. [PMID: 21123981 DOI: 10.2176/nmc.50.984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 63-year-old woman presented with infraoptic course of the anterior cerebral artery (ACA) originating from the extradural internal carotid artery (ICA) associated with contralateral ICA agenesis and multiple intracerebral aneurysms. The extradural origin of the infraoptic course of ACA was identified with constructive interference in steady state magnetic resonance (MR) imaging, and confirmed at surgery. The aneurysms were successfully clipped and embolized with coils. The anomalous artery of this rare anomaly almost always arises from the intradural ICA. MR imaging is useful for evaluating the anatomical details of this anomaly.
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Endoscopic third ventriculostomy associated 3D-construcive inference steady state MRI for obstructed hydrocephalus: A retrospective study. Clin Neurol Neurosurg 2013; 115:896-901. [DOI: 10.1016/j.clineuro.2012.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/19/2012] [Accepted: 08/25/2012] [Indexed: 11/19/2022]
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TENJIN H, TANIGAWA S, TAKADOU M, OGAWA T, MANDAI A, NANTO M, OSAKA Y, NAKAHARA Y, UMEDA M, HIGUCHI T. Relationship Between Preoperative Magnetic Resonance Imaging and Surgical Findings: Aneurysm Wall Thickness on High-Resolution T 1-Weighted Imaging and Contact With Surrounding Tissue on Steady-State Free Precession Imaging. Neurol Med Chir (Tokyo) 2013; 53:336-42. [DOI: 10.2176/nmc.53.336] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hiroshi TENJIN
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | | | | | - Takahiro OGAWA
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | - Ayako MANDAI
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | - Masataka NANTO
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | - Yasuhiko OSAKA
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | | | - Masahiro UMEDA
- Department of Medical Informatics, Meiji University of Integrative Medicine
| | - Toshihiro HIGUCHI
- Department of Neurosurgery, Meiji University of Integrative Medicine
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19
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Kaku Y, Morioka M, Ohmori Y, Kawano T, Kai Y, Fukuoka H, Hirai T, Yamashita Y, Kuratsu JI. Outer-diameter narrowing of the internal carotid and middle cerebral arteries in moyamoya disease detected on 3D constructive interference in steady-state MR image: is arterial constrictive remodeling a major pathogenesis? Acta Neurochir (Wien) 2012; 154:2151-7. [PMID: 22935819 DOI: 10.1007/s00701-012-1472-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 08/05/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND To obtain information on affected vessels in moyamoya disease (MMD), we analyzed the vascular morphological characteristics of MMD using three-dimensional (3D) constructive interference in steady-state (CISS) magnetic resonance imaging (MRI). METHODS The population of this 3D-CISS MRI study consisted of 51 patients with MMD: 16 patients with atherosclerotic middle cerebral artery (MCA) stenosis or occlusion, 42 MRI control patients, and 28 control digital subtraction angiography (DSA) patients. We measured the outer diameters of the terminal portion of the internal carotid artery (ICA) and the proximal portion of the MCA (M1 portion). We evaluated the inner diameter as the relative value (%) obtained from magnified DSA images and analyzed these data. RESULTS The outer diameters of the ICA and M1 portions were significantly smaller in the MMD group than in the other two groups, while the M1 outer diameter of the atherosclerosis group was not significantly different compared to the control (ICA: MMD, 2.61 ± 0.46 mm vs. control, 4.04 ± 0.50 mm and M1: MMD, 1.92 ± 0.43 mm vs. control, 3.34 ± 0.54 mm vs. atherosclerosis, 3.45 ± 0.56 mm). Furthermore, in MMD patients, the outer diameter was unrelated to the progression of the luminal stenosis grade estimated by DSA. CONCLUSIONS This is the first report that the outer diameters of both the ICA and M1 decrease in MMD patients. Our findings suggest that the vascular constrictive changes of the affected arteries are an important phenomenon reflecting MMD pathology.
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Affiliation(s)
- Yasuyuki Kaku
- Department of Neurosurgery, School of Medicine, Kumamoto University, Japan
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Watanabe K, Kakeda S, Yamamoto J, Watanabe R, Nishimura J, Ohnari N, Nishizawa S, Korogi Y. Delineation of Optic Nerves and Chiasm in Close Proximity to Large Suprasellar Tumors with Contrast-enhanced FIESTA MR Imaging. Radiology 2012; 264:852-8. [DOI: 10.1148/radiol.12111363] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Watanabe Y, Makidono A, Nakamura M, Saida Y. 3D MR cisternography to identify distal dural rings: comparison of 3D-CISS and 3D-SPACE sequences. Magn Reson Med Sci 2011; 10:29-32. [PMID: 21441725 DOI: 10.2463/mrms.10.29] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The distal dural ring (DDR) is an anatomical landmark used to distinguish intra- and extradural aneurysms. We investigated identification of the DDR using 2 three-dimensional (3D) magnetic resonance (MR) cisternography sequences--3D constructive interference in steady state (CISS) and 3D sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE)--at 3.0 tesla. METHODS Ten healthy adult volunteers underwent imaging with 3D-CISS, 3D-SPACE, and time-of-flight (TOF) MR angiography (TOF-MRA) sequences at 3.0T. We analyzed DDR identification and internal carotid artery (ICA) signal intensity and classified the shape of the carotid cave. RESULTS We identified the DDR using both 3D-SPACE and 3D-CISS, with no significant difference between the sequences. Visualization of the outline of the ICA in the cavernous sinus (CS) was significantly clearer with 3D-SPACE than 3D-CISS. In the CS and petrous portions, signal intensity was lower with 3D-SPACE, and the flow void was poor with 3D-CISS in some subjects. CONCLUSION We identified the DDR with both 3D-SPACE and 3D-CISS, but the superior contrast of the ICA in the CS using 3D-SPACE suggests the superiority of this sequence for evaluating the DDR.
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Affiliation(s)
- Yoshiyuki Watanabe
- Department of Radiology, Osaka University Postgraduate School of Medicine, Suita, Japan.
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Linn J, Peters F, Lummel N, Schankin C, Rachinger W, Brueckmann H, Yousry I. Detailed imaging of the normal anatomy and pathologic conditions of the cavernous region at 3 Tesla using a contrast-enhanced MR angiography. Neuroradiology 2011; 53:947-54. [PMID: 21271242 DOI: 10.1007/s00234-011-0837-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/10/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the potential of a high-resolution contrast-enhanced magnetic resonance angiography (CE-MRA) at 3 Tesla for the delineation of the cavernous sinus (CS) anatomy both under normal and under pathological conditions. METHODS Fifteen patients without pathologies in the CS and ten patients with pituitary adenomas were included. The CE-MRA was performed on a 3-Tesla scanner and analyzed collaboratively by two readers. The cranial nerves (CNs) within the CS, namely CNIII, CNIV, CNV1, CNV2, and CNVI, were identified in both patient groups. In the adenoma patients it was also assessed whether and to which extend the adenoma invaded the CS and the spatial relationship between tumor and CNs was determined. RESULTS In the patients with normal CS anatomy, CNIII could be identified in 100%, CNIV in 86.7%, and CNV1, CNV2, as well as CNVI in 100% of analyzed sides. Pituitary adenomas invaded the CS unilaterally (right side) in four patients, and bilaterally in six patients. In patients with adenomas, the CN could be identified and differentiated from the tumor in the following percentages: CNIII in 100%, CNIV in 70%, both CNV1 and CNV2 in 90%, and CNVI in 100%. In all these cases, the tumor-nerve spatial relationship could be visualized. CONCLUSIONS 3-Tesla CE-MRA allows detailed imaging of the complex anatomy of the CS and its structures. In adenoma patients, it clearly visualizes the spatial relationship between tumor and CNs, and thus might be helpful to optimize presurgical planning.
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Affiliation(s)
- Jennifer Linn
- Department of Neuroradiology, University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Javalkar V, Banerjee AD, Nanda A. Paraclinoid carotid aneurysms. J Clin Neurosci 2011; 18:13-22. [PMID: 21126877 DOI: 10.1016/j.jocn.2010.06.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 06/15/2010] [Accepted: 06/20/2010] [Indexed: 02/07/2023]
Affiliation(s)
- Vijayakumar Javalkar
- Department of Neurosurgery, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, Louisiana 71103, USA
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Fujii Y, Nakada T. Diagnostic neuroimaging by magnetic resonance imaging: update. Neurol Med Chir (Tokyo) 2010; 50:833-8. [PMID: 20885117 DOI: 10.2176/nmc.50.833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Magnetic resonance (MR) imaging remains the most versatile technique in diagnostic imaging. In addition to conventional imaging sequences such as T(1)-weighted imaging, T(2)-weighted imaging, or fluid-attenuated inversion recovery imaging, various techniques specific for certain pathological conditions are being continuously introduced. Pulse sequences for various imaging contrasts are becoming mature, and studies on high (3 T), or even ultra-high (7 T) field systems are emerging as a golden standard for neurosurgical practices. MR spectroscopic imaging capable of providing a pictorial display of the chemical properties of the brain and microscopic imaging providing images with significantly high anatomical resolution equivalent to histological preparations are now becoming essential for presurgical evaluation.
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Affiliation(s)
- Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, University of Niigata, 757 Asahimachi-dori 1, Niigata, Japan.
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Dural attachment of intracranial meningiomas: evaluation with contrast-enhanced three-dimensional fast imaging with steady-state acquisition (FIESTA) at 3 T. Neuroradiology 2010; 53:413-23. [DOI: 10.1007/s00234-010-0751-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
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Yagi A, Sato N, Takahashi A, Morita H, Amanuma M, Endo K, Takeuchi K. Added value of contrast-enhanced CISS imaging in relation to conventional MR images for the evaluation of intracavernous cranial nerve lesions. Neuroradiology 2010; 52:1101-9. [PMID: 20383633 DOI: 10.1007/s00234-010-0690-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 03/18/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The normal cranial nerves (CNs) of the cavernous sinus can be clearly demonstrated using contrast-enhanced constructive interference in steady-state (CISS) magnetic resonance imaging (MRI). This study used the method to evaluate pathological CNs III, IV, V(1), V(2), and VI in cavernous sinuses affected by inflammatory and neoplastic diseases. METHODS MR images from 17 patients with diseases involving the cavernous sinuses and/or causing neuropathy in CNs III-VI were retrospectively evaluated. The patients were divided into inflammatory (n=11) and neoplastic (n=6) groups. We defined CNs as abnormal when they exhibited enlargement or enhancement. CNs were evaluated using both contrast-enhanced CISS and T1-weighted MRI. RESULTS In the inflammatory group, abnormal CNs were identified by contrast-enhanced CISS MRI in 13 of 25 symptomatic CNs (52%) in eight patients, but in only two CNs (8%) in two patients by contrast-enhanced T1-weighted MRI. In the neoplastic group, both sequences of contrast-enhanced CISS and T1-weighted MRI detected abnormalities in the same three of eight symptomatic CNs (37.5%), i.e., the three CNs were all in the same patient with adenoid cystic carcinoma. CONCLUSION Contrast-enhanced CISS MRI is useful for detecting CN abnormalities in inflammatory pathological conditions of the cavernous sinuses.
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Affiliation(s)
- Akiko Yagi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University School of Medicine, Gunma, Japan
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Lee D, Kim TH, Kim BS, Ihn YK, Won YD, Chung J, Shin YS, Lee KS. Imaging of Distal Dural Ring Plane and Paraclinoid Internal Carotid Artery Aneurysms with 3D Rotational Angiography. Neurointervention 2010. [DOI: 10.5469/neuroint.2010.5.2.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Dongwoo Lee
- Department of Neurosurgery, Cheju Halla Hospital, Jejudo, Korea
| | - Tae-Hyung Kim
- Department of Radiology, The Catholic University of Korea, Korea
| | - Bum-Soo Kim
- Department of Radiology, The Catholic University of Korea, Korea
| | - Yeon-Kwon Ihn
- Department of Radiology, The Catholic University of Korea, Korea
| | - Yoo Dong Won
- Department of Radiology, The Catholic University of Korea, Korea
| | - Joonho Chung
- Department of Neurosurgery, Inha University School of Medicine, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, The Catholic University of Korea, Korea
| | - Kwan Sung Lee
- Department of Neurosurgery, The Catholic University of Korea, Korea
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Dinçer A, Kohan S, Ozek MM. Is all "communicating" hydrocephalus really communicating? Prospective study on the value of 3D-constructive interference in steady state sequence at 3T. AJNR Am J Neuroradiol 2009; 30:1898-906. [PMID: 19643921 DOI: 10.3174/ajnr.a1726] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 3D-constructive interference in steady state (3D-CISS) sequence has been used to assess the CSF pathways. The aim of this study was to investigate the additive value of 3D-CISS compared with conventional sequences in the diagnosis of obstructive membranes in hydrocephalus. MATERIALS AND METHODS A total of 134 patients with hydrocephalus underwent MR imaging examination with a 3T unit consisting of turbo spin-echo, 3D-CISS, and cine phase-contrast (cine PC) sequences. 3D-CISS was used to assess obstructive membranes in CSF pathways compared with other sequences. Cine PC, follow-up imaging, and surgical findings were used to confirm obstructive membranes. RESULTS Comparing the number of noncommunicating cases by using the conventional and 3D-CISS images, we found 26 new cases (19.4%) of 134 cases that were previously misdiagnosed as communicating hydrocephalus by conventional images. 3D-CISS sequence identified obstructive membranes invisible in other sequences, which facilitated selection of neuroendoscopy in the treatment of 31 patients (23.1%) in total who would have been otherwise treated with shunt insertion. These patients included 26 newly diagnosed noncommunicating cases after demonstration of intraventricular and/or fourth ventricular outlet membranes and 5 cases of communicating hydrocephalus with obstructing cisternal membranes. There were obstructions of the foramina of Luschka in 22 of 26 newly found noncommunicating cases. CONCLUSIONS Conventional sequences are insensitive to obstructive membranes in CSF pathways, especially in the fourth ventricular exit foramina and the basal cisterns. 3D-CISS sequence, revealing these obstructive membranes, can alter patient treatment and prognosis.
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Affiliation(s)
- A Dinçer
- Acibadem University, School of Medicine, Department of Radiology, Istanbul, Turkey.
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Figueiredo EG, Tavares WM, Rhoton AL, De Oliveira E. Surgical nuances of giant paraclinoid aneurysms. Neurosurg Rev 2009; 33:27-36. [PMID: 19760439 DOI: 10.1007/s10143-009-0224-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 05/20/2009] [Accepted: 07/05/2009] [Indexed: 12/14/2022]
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Watanabe Y, Nakazawa T, Yamada N, Higashi M, Hishikawa T, Miyamoto S, Naito H. Identification of the distal dural ring with use of fusion images with 3D-MR cisternography and MR angiography: application to paraclinoid aneurysms. AJNR Am J Neuroradiol 2009; 30:845-50. [PMID: 19147723 DOI: 10.3174/ajnr.a1440] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The distal dural ring (DDR) represents the anatomic border between the extradural and intradural internal carotid arteries (ICAs). The purpose of this study was to examine whether 3D-MR cisternography and MR angiography (MRA) fusion images can identify the boundary between the CSF and the cavernous sinus, which might represent the DDR. MATERIALS AND METHODS Thirty-six consecutive patients with 39 ICA aneurysms were examined with use of MR fusion images with 3D-cisternography and MRA on a 1.5T unit. Two neuroradiologists evaluated the configuration of the carotid cave and the location of the aneurysms on fusion images and classified them as intradural, transdural, and extradural aneurysms. RESULTS The borderline between the CSF and the cavernous sinus was visualized on fusion images in all patients. The carotid cave configuration in 72 ICAs was classified as having no dent (n = 31), a shallow dent (n = 27), and a deep dent (n = 14). The MR fusion images led to the classification of 39 ICA aneurysms as 21 intradural, 6 transdural, and 12 extradural. The interobserver agreement of MR fusion images was excellent (kappa = 0.80). CONCLUSIONS Fusion images with 3D-cisternography and MRA yielded clear visualization of the boundary between the suprasellar cistern and cavernous sinus indicating the DDR. This imaging technique may provide additional information in consideration of a treatment option for paraclinoid aneurysms.
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Affiliation(s)
- Y Watanabe
- Department of Radiology, National Cardiovascular Center, Osaka, Japan.
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