Aneurysmal Bone Cyst of Skull

An aneurysmal bone cyst is a benign lesion usually involving the long bones, vertebrae including odontoid, hypoid and mandible. Skull is a rare site for aneurysmal bone cyst. Only 3% occur in the cranium and sites of involvement include temporal, occipital, orbital, frontal, parietal, ethmoids and sphenoid bones in order of frequency. We report two cases of aneurysmal bone cysts in occipital bone and maxilla. We discuss the radiological features, surgical findings and emphasize the role of endovascular management in these lesions.

Endovascular Treatment of Intracranial Aneurysms: Long-Term Follow-up

Endovascular treatment of intracranial aneurysms is increasingly used and has evolved as an alternative to surgical clipping. However, its long-term efficacy has yet to be established. This retrospective hospital based (tertiary teaching hospital) study aimed to identify factors that might be important in predicting initial efficacy of this treatment and a long-term follow-up to study the clinical and angiographic results of treated aneurysms. A total of 80 aneurysms in 78 patients were treated and analyzed, and the percentage of occlusion calculated. Overall, 51/80 (64 %) cases were treated with selective endovascular coil occlusion and 29/80 (36 %) by parent artery occlusion. The shape of the aneurysm rest was noted on the immediate post treatment and follow-up angiograms. Immediate and follow-up clinical status was also noted using the Glasgow outcome scale. The clinical and radiological changes on follow-up were assessed and possible factors involved were analyzed. Of the 50 patients of intracranial aneurysms that underwent selective aneurysm coiling, good immediate outcome (Glasgow outcome scale 1 and 2) was seen in 36/50 (72 %) cases. Narrow necked aneurysms showed a good immediate result (90–100 % packing) in all cases 28/28 (100 %). Amongst the wide necked aneurysms, good packing (90–100 %) was achieved in 17/23 (73 %) cases. Amongst the cases treated with parent artery occlusion, complete occlusion was noted in 20/29 (69 %) cases. No subarachnoid hemorrhage was seen in any of the followed up cases of coiled aneurysms. A statistically significant relationship was noted between aneurysm neck size and immediate angiographic outcome. Long-term angiographic recurrences were found more often in large aneurysms. Endovascular treatment of intracranial aneurysms is a safe and effective treatment modality that offers protection from recurrent subarachnoid hemorrhage.

Anomalous origins of bilateral vertebral arteries in a child with Down syndrome and Moyamoya disease. A case report

Variations in vertebral artery origin and course are well-described in the literature. The origin of right vertebral artery from the right common carotid artery is an extremely rare variant. We describe a unique case of a child with Down syndrome with variant origins of bilateral vertebral artery, an aberrant right subclavian artery and concomitant Moyamoya disease of intracranial circulation. The presence of variations of the origin and course of craniocervical arteries might have profound implications in angiographic and surgical procedures and hence it is of great importance to be aware of such a possibility.

Role of diffusion tensor imaging in differentiating subtypes of meningiomas

PURPOSE

Meningiomas are the most common extraaxial intracranial type of tumor, and their management and prognosis depend on their grade and histology. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are two new imaging techniques that have proved helpful in elucidating the microarchitecture of brain tumors. The aim of the present study was to assess the role of diffusion and diffusion tensor metrics in the identification and classification of meningioma grades and subtypes.

METHODS AND MATERIALS

A total of 21 consecutive patients with meningioma were included in this retrospective study, of whom 16 had benign meningiomas (three fibroblastic, 11 transitional/mixed, two meningothelial) and five had atypical meningiomas. Tumor mean diffusivity (Dav), fractional anisotropy (FA), linear anisotropy (CL), planar anisotropy (CP), spherical anisotropy (CS) and eigenvalues (e1, e2, e3) were measured in all cases, and differences in diffusion tensor metrics between atypical, fibroblastic and other benign (transitional, meningothelial) meningiomas were statistically analyzed using the Mann-Whitney test.

RESULTS

No statistically significant differences were found among the mean Dav values for atypical, fibroblastic and other benign meningiomas. Both atypical and fibroblastic meningiomas showed significantly higher mean FA values and lower mean CS values compared with other meningiomas (P<0.01), but no statistically significant difference in these values between each other. Atypical meningiomas showed higher CL values compared with fibroblastic and other benign meningiomas but, again, the difference was not statistically significant. Both atypical and fibroblastic meningiomas showed statistically significantly higher CP values and lower e3 values compared with transitional meningiomas (P<0.01).

CONCLUSION

These results suggest that diffusion tensor metrics may be helpful in the differentiation of atypical, fibroblastic and other benign meningiomas.