Fusion of magnetic resonance angiography and cisternography in acute ischemic stroke reveals the vessel anatomy ahead of the clot: a technical note to see beyond obstacles.

We describe how the fusion process between magnetic resonance angiography (MRA) and cisternography (MRC) promptly reveals vessel anatomy ahead of the clot, in patients affected by acute anterior circulation large vessel occlusion. This technique showed in 100% of subjects (n = 22) a clear tracing of vessel anatomy before and beyond the clot. The duration of the whole process is short and could be considered safe since no outcome differences have been found when compared with a control group (n = 23). This technique could play a relevant role in guiding endovascular therapy, especially in unexpected unfavorable anatomical arteries configurations.

Diagnostic Value of Radioisotope Cisternography Using 111In-DTPA in a Patient with Rhinorrhea and Purulent Meningitis.

Cerebrospinal fluid (CSF) leakage is a rare condition. Prompt diagnosis and early treatment of CSF leakage minimizes the risk of severe complications such as bacterial meningitis. Different diagnostic modalities are used to detect the site of CSF leakage but often with unreliable results. The literature offers limited evidence-based guidance on the diagnostic approach for rhinorrhea. Correct localization of the defect is the mainstay for successful surgical treatment. Herein, we describe a case of recurrent meningitis due to cranio-nasal fistula and rhinorrhea successfully localized with radioisotope cisternography (RIC). We provide a detailed and practical overview of the RIC procedure and compare different imaging modalities used to detect the site of CSF leakage.

Feasibility of 3D T1W sequences in contrast-material enhanced MR cisternography at 3T.

BACKGROUND: We investigated the diagnostic values and artifact severities of 3D-T1W sequences in the diagnosis of cerebrospinal fluid (CSF) leakage. METHODS: We retrospectively reviewed 3-tesla contrast-material enhanced MR cisternography exams of 22 patients with suspected CSF leakage in 4 years. The presence of the artifacts on 3D-T1W data was evaluated using a 4-point scale (0: none; 1: minimal; 2: moderate; 3: prominent). Agreements between CSF leakage results of the 3D-T1W sequences and consensus decisions were evaluated via kappa values. Artifact scores were analyzed by Fisher's exact test. RESULTS: The most compatible techniques with the consensus diagnoses were fat-saturated 3D-T1W-SPACE and 3D-T1W-VIBE sequences. The most artifact containing the 3D-T1W sequence was 3D-MPRAGE. DISCUSSION: 3D-SPACE and 3D-VIBE are more successful in evaluating CSF leakages compared to 3D-MPRAGE. 3D-SPACE has lower artifact scores compared to 3D-VIBE and 3D-MPRAGE sequences.

Intrathecal use of gadobutrol for gadolinium-enhanced MR cisternography in the evaluation of patients with otorhinorrhea.

PURPOSE: Intrathecal gadolinium-enhanced MR cisternography (IGE-MRC) has a high sensitivity to detect accurate localization of cerebrospinal fluid (CSF) leakage in otorhinorrhea patients. Our purpose in this study was to describe our experience in analyzing clinically suspected CSF leakage by IGE-MRC by using gadobutrol with emphasis on its safety and diagnostic performance. METHODS: We retrospectively reviewed our imaging and clinical database for the evaluation of patients admitted to our clinic with complaints of otorhinorrhea between 2017 and 2019. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the follow-up. RESULTS: Of the 85 patients included in the retrospective analysis, 82 (96.5%) had rhinorrhea and 3 (3.5%) had otorrhea. Overall, 29 patients (34.1% of all patients) underwent operation for repair of the CSF leakage site. Beta-transferrin test was available and positive in 33 patients (38.8%). Five (5.9%) patients complained headaches after the procedure and complaints were resolved with increased water intake. Postprocedurally, 3 patients (3.5%) had vertigo and 1 patient (1.2%) complained nausea but spontaneous regression were observed in a few hours. None of the patients experienced a significant complication or adverse reaction during follow-up period. Sixty-seven patients (78.8%) had medical record and telephone follow-up. Mean follow-up duration with call was 14.2 months. CONCLUSION: IGE-MRC is a minimally invasive and highly sensitive imaging technique. The current results during our follow-up demonstrate the relative safety and feasibility of IGE-MRC by using gadobutrol to evaluate CSF leakage.

Cerebrospinal fluid and optic nerve sheath compartment syndrome: A common pathophysiological mechanism in five different cases?

IMPORTANCE: Optic nerve (ON) dysfunction is a common feature of different diseases. The pathophysiology is not yet fully understood. BACKGROUND: This study describes five patients with ON sheath (ONS) compartment syndrome (ONSCS) and contributes to the hypothesis that impaired cerebrospinal fluid (CSF) flow can play a role in the development of ON dysfunction. DESIGN: Retrospective case series. PARTICIPANTS: Five patients with ONSCS were included in the study. METHODS: Elaboration of medical histories and clinical and diagnostic findings over a long time period was carried out by analysing medical records and by a detailed medical consultation. MAIN OUTCOME MEASURES: The main outcome measures include clinical history; visual acuity; field, intraocular and CSF pressures; and contrast-loaded computed tomographic (CT) cisternography. RESULTS: Compartmentation of the ONS demonstrated by contrast-loaded CT cisternography was the consistent finding in all five patients who demonstrated findings of ON dysfunction. The aetiologies varied and included meningitis, papilloedema, sphenoid wing meningioma, disc herniation and normal-tension glaucoma. CONCLUSION AND RELEVANCE: Compartmentation of the ONS with consecutively impaired CSF dynamics within the ON subarachnoid space can lead to ON dysfunction. Different aetiologies can cause the development of ONSCS.

Imaging of the Spontaneous Low Cerebrospinal Fluid Pressure Headache: A Review.

Spontaneous intracranial hypotension (SIH) is a significant cause of chronic, postural headaches. Spontaneous intracranial hypotension is generally believed to be associated with cerebrospinal fluid (CSF) leaks, and these leaks can be posttraumatic, iatrogenic, or idiopathic in origin. An integral part of the management of patients with this condition consists of localizing and stopping the leaks. Radiologists play a central role in the workup of this condition detecting leaks using computed tomography, magnetic resonance imaging, or nuclear imaging. In this article, we briefly review SIH and the various imaging modalities, which can be used to identify and localize a spontaneous CSF leak.

The Added Value of Magnetic Resonance Imaging Cisternography and Ventriculography as a Diagnostic Aid in Pediatric Hydrocephalus.

BACKGROUND: Magnetic resonance imaging (MRI) is the "gold standard" method for the evaluation of hydrocephalus. However, diagnosing an obstruction in the ventricular or subarachnoid spaces may pose a challenge for standard diagnostic sequences. In this study, we describe our experience with MRI cisternography (MRIC) or ventriculography (MRIV) for diagnosing or excluding intra- and extraventricular obstructions. Such a differentiation may have a significant impact on choosing the optimal surgical solution. METHODS: We retrospectively collected data on patients undergoing MRIC/MRIV for diagnosing or excluding obstructions in patients with ventriculomegaly. All patients had MRI suggesting an obstruction, but without a clear cause. RESULTS: Five children aged 1-17 years were included (3 females). Four underwent an MRIV, and 1 underwent an MRIC. Three children presented with headaches and had a suspected prior endoscopic third ventriculostomy (ETV) failure, and 2 presented with macrocephalus and increasing head circumferences. MRIV showed a patent ETV stoma in 2 cases, one of which had a T2 SPACE MRI showing no flow void through the stoma, and a closed stoma in 1 case with a flow void above and below the stoma on T2 SPACE MRI. MRIV and MRIC differentiated between two cases with panventriculomegaly, one of which had an obstruction at the level of the Liliequist membrane, and another with no identifiable obstruction. CONCLUSIONS: MRIC and MRIV have a complementary role to MRI in assessing selected patients with hydrocephalus suspected of being secondary to an obstruction, but with no clear obstruction location.

Intrathecal gadolinium-enhanced MR cisternography in patients with otorhinorrhea: 10-year experience of a tertiary referral center.

PURPOSE: Despite a considerable amount of literature that has been published about the use of intrathecal gadolinium-enhanced MR cisternography (IGE-MRC), there is still relatively lack of evidence as to its long-term effects. Our purpose in this study was twofold: firstly, to assess the long-term safety of the IGE-MRC; secondly, to evaluate the diagnostic performance of IGE-MRC for detecting cerebrospinal fluid (CSF) leak in otorhinorrhea patients. METHODS: We retrospectively reviewed our imaging and clinical database for the patients admitted to our department for the evaluation of their otorhinorrhea between 2008 and 2017. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the long-term follow-up. RESULTS: The retrospective review yielded 166 patients. Rhinorrhea was present in 150 (90.4%) patients and otorrhea in 16 (9.6%) patients. Overall, 67 patients (40.5% of all patients) underwent operation for repair of the CSF leak site. Beta-transferrin test was available and positive in 57 (34.3%) patients. Overall sensitivity of IGE-MRC and paranasal high-resolution CT (HRCT) was 89.3 and 72%, respectively. Within the first 24 h after the procedure, none of the patients experienced a significant complication or adverse reaction. Ninety-nine patients (59.6%) had medical record and telephone follow-up. The mean follow-up duration with call was 37.1 months. Three (3%) patients complained about severe headache 3-4 weeks after the procedure. CONCLUSIONS: IGE-MRC is a minimally invasive and highly sensitive imaging technique. No adverse side effect during our long-term follow-up might strengthen and support the safety of IGE-MRC.

[A modern approach to the diagnosis of nasal liquorrhea]. / Sovremennyi podkhod k diagnostike nazal'noi likvorei.

Nasal liquorrhea is cerebrospinal fluid leakage from cerebrospinal fluid spaces of the cerebral cavity into the nasal cavity or paranasal sinuses due to congenital or acquired abnormalities of the skull base bones and meninges of various etiologies. The severity of liquorrhea varies from hidden manifestations to profuse leakage of cerebrospinal fluid from the nasal cavity. The diagnosis of overt nasal liquorrhea is not problematic, but the diagnosis of latent liquorrhea is a challenge. In this case, the disease leads to potentially fatal complications, such as meningitis (the risk amounts to 10-37%), pneumocephaly, pneumonia, etc. These peculiarites give rise to two main tasks: early diagnosis confirming liquorrhea and accurate identification of the CSF fistula location when planning further surgical management. PURPOSE: The study purpose was to review and comparatively analyze all modern methods of diagnosing nasal liquorrhea as well as to substantiate the most effective and promising approaches and algorithms. MATERIAL AND METHODS: The study included papers in English and Russian found in the Pubmed database and related to the diagnosis of basal liquorrhea of different etiology and localization. RESULTS: This review demonstrates that diagnostic tests vary widely in sensitivity, specificity, accuracy, invasiveness, and cost. Given all the criteria, detection of beta-2 transferrin or beta-trace protein is the best method for confirming nasal liquorrhea, and high-resolution computed tomography is the best technique for localization of the abnormality. CONCLUSION: Based on the review, we suggest a diagnostic algorithm for nasal liquorrhea. However, the evidence presented in this review is unfortunately not very reliable, which indicates the existing need for more accurate studies.

[Experience of treating patients with lateral sphenoid sinus recess CSF leak]. / Nash opyt lecheniia patsientov s nazal'noi likvoreei iz lateral'nogo karmana klinovidnoi pazukhi.

According to various authors, the rate of sphenoid sinus defects ranges from 15 to 26%. In the sphenoid sinus, the most common defect localization is the lateral recess - 35.3%. Regardless of the etiology and pathogenesis of lateral sphenoid sinus recess cerebrospinal fluid (CSF) leak, the treatment approach is aimed at plastic closure of the defect. Surgery in this area is associated with a high rate of recurrences (25%) due to a complex anatomical landscape and inapplicability of a direct approach. PURPOSE: The study purpose was to analyze our own experience in treating patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess and, based on the obtained results, develop an algorithm for the treatment of this pathology. MATERIAL AND METHODS: We retrospectively reviewed a series of 89 patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess who were treated at the Burdenko Neurosurgical Institute in the period between 2001 and 2017. The demographic characteristics of patients, clinical data, and aspects of surgical treatment were analyzed. Treatment outcomes were assessed based on analysis of recurrences and postoperative complications. The obtained data were compared to the literature data. RESULTS: In the series of 89 patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess, the mean age was 49 years. Surgery through the transsphenoid approach was performed in 89 (74%) patients. There were 25 (28%) recurrences in this group. Nine (7%) patients underwent repair of a complex skull base defect using the transethmoidal approach; there were 3 (33%) recurrences. The transpterygoid approach was used in 22 (17%) patients; there were 3 (14%) recurrences in this group. CONCLUSION: Endoscopic endonasal repair is an effective technique for treating complex skull base defects in the lateral sphenoid sinus recess. The choice of an approach to the defect depends on the degree of pneumatization of the sphenoid sinus, surgeon's experience, and availability of the necessary equipment and tools. The endoscopic transpterygoid approach is advisable to use in cases of excessive pneumatisation of the sinus with developed lateral processes and recurrent nasal CSF leak. This enables visualization of the defect edges in this hard-to-reach area and adequate repair.

The utility of radioisotope cisternography in low CSF/volume syndromes compared to myelography.

Objective The objective of this report is to compare computed tomography (CT) and magnetic resonance (MR) myelography with radioisotope cisternography (RC) for detection of spinal cerebrospinal (CSF) leaks. Methods We retrospectively reviewed 12 spontaneous intracranial hypotension (SIH) patients; CT and RC were performed simultaneously. Three patients had MR myelography. Results CT and/or MR myelography identified CSF leaks in four of 12 patients. RC detected spinal leaks in all three patients confirmed by CT myelography; RC identified the CSF leak location in two of three cases, and these were due to osteophytic spicules and/or discs. RC showed only enlarged perineural activity. Only intrathecal gadolinium MR myelography clearly identified a slow leak from a perineural cyst. In eight remaining cases, the leak site was unknown; however, two of these showed indirect signs of CSF leak on RC. CSF slow leaks from perineural cysts were the most common presumed etiology; and the cysts were best visualized on myelography. Conclusion RC is comparable to CT myelography but has spatial limitations and should be limited to atypical cases.

MULTIDETECTOR COMPUTED TOMOGRAPHIC AND LOW-FIELD MAGNETIC RESONANCE IMAGING ANATOMY OF THE QUADRIGEMINAL CISTERN AND CHARACTERIZATION OF SUPRACOLLICULAR FLUID ACCUMULATIONS IN DOGS.

Focal fluid accumulations in the supracollicular region are commonly termed quadrigeminal cysts and may be either subclinical or associated with neurologic deficits in dogs. Little published information is available on normal imaging anatomy and anatomic relationships for the canine quadrigeminal cistern. Objectives of this observational, cross-sectional study were to describe normal quadrigeminal cistern anatomy and determine the prevalence and characteristics of supracollicular fluid accumulations in dogs. Normal descriptions were accomplished using computed tomographic (CT) cisternography in one canine cadaver, and CT and magnetic resonance imaging (MRI) studies of the brain in four prospectively recruited dogs with no evidence of intracranial disease. Prevalence and characteristics descriptions were accomplished using a retrospective review of brain CT or MRI studies performed during the period of 2005-2015. The normal quadrigeminal cistern consistently exhibited a complex H shape and was separated from the third ventricle by a thin membrane. Prevalence of supracollicular fluid accumulations (SFAs) was 2.19% among CT studies (n = 4427) and 2.2% among MRI studies (n = 626). Dogs with SFA were significantly younger than control dogs (P < 0.0001). Shih-tzu (OR = 111.6), Chihuahua (OR = 81.1), and Maltese (OR = 27.6) breed dogs were predisposed (P < 0.0001). Among dogs with SFAs, the following three patterns were defined: (1) third ventricle (49.54%), (2) quadrigeminal cistern (13.51%), and (3) both third ventricle and quadrigeminal cistern (36.93%). Authors recommend that the term supracollicular fluid accumulation (SFA) should be used rather than the term quadrigeminal cyst to describe these focal fluid accumulations in dogs.

Radioisotope cisternography in spontaneous CSF leaks: interpretations and misinterpretations.

A broadening of the clinical and imaging features of the spontaneous cerebrospinal fluid (CSF) leaks is now well recognized, far beyond what was thought only two decades ago. This has resulted in increasing number of patients with atypical and unusual features who, not unexpectedly, are directed to headache specialists and tertiary referral centers. In many cases, obviously the fundamental question of presence or absence of CSF leak will need to be addressed prior to proceeding with further and often more involved, more invasive, and more costly diagnostic and therapeutic considerations. Radioisotope cisternography often proves to be very helpful in these situations by demonstrating reliable, although indirect, evidences of CSF leak while it is less helpful in directly identifying the exact site of the CSF leakage. In this overview article, the expectations from and the limitations of this diagnostic method are described along with some personal observations in the past 25 years.

Research article: clinical characteristics of isolated anterior cerebral artery territory infarction due to arterial dissection.

BACKGROUND: Isolated brain infarction in the anterior cerebral artery (ACA) territory is rare, and its etiology has not yet been fully elucidated. Thus, we aimed to determine the etiologic and clinical characteristics of patients with isolated ACA territory infarction due to arterial dissection. METHODS: Of 2315 patients with acute cerebral infarction admitted to our hospital between April 2007 and September 2013, 34 patients (1.5%; 28 men, 6 women; mean age, 65 ± 15 years) suffered isolated ACA territory infarction. We performed cranial magnetic resonance (MR) imaging and MR angiography for all the patients. Whenever possible, we also performed 3-dimensional computed tomography angiography, digital subtraction angiography, and MR cisternography to diagnose the stroke subtype. RESULTS: The stroke subtypes of the 34 patients with isolated ACA territory infarction were atherothrombotic infarction, cardioembolic infarction, arterial dissection, and unclassified in 11 patients (32%), 11 patients (32%), 11 patients (32%), and 1 patient (3%), respectively. The mean ages at onset were 48 ± 9 and 72 ± 11 years in the dissection and nondissection groups, respectively (P < .001). Headaches were present at onset in 4 patients (36%) and 1 patient (4%) with and without dissection, respectively (P = .026). Blood pressure at onset was significantly higher among patients with dissection (systolic, 179 ± 34 mm Hg; diastolic, 102 ± 17 mm Hg) than among patients without dissection (systolic, 155 ± 30 mm Hg; diastolic, 86 ± 21 mm Hg; P < .05), and d-dimer values were significantly lower among patients with dissection (P = .034). Favorable clinical outcome (modified Rankin Scale score, 0-2) at discharge was achieved in 9 patients (82%) and 10 patients (43%) with and without dissection, respectively (P = .035). CONCLUSIONS: Patients with isolated ACA territory infarction demonstrated a relatively high frequency of dissection (32%). Patients with dissection were younger, had a higher frequency of headaches, and demonstrated more favorable prognoses than patients without dissection.

Fusiform dilatation of the outer contour of a dissected anterior cerebral artery revealed by magnetic resonance cisternography in a patient with simultaneous cerebral infarction and subarachnoid hemorrhage.

A 46-year-old man presented with right hemiparesis. Cranial magnetic resonance (MR) imaging revealed both an acute cerebral infarction in the territory of the left anterior cerebral artery (ACA) and a thin subarachnoid hemorrhage in the left superior frontal sulcus. MR angiography revealed stenosis at the A2 segment of the left ACA. MR cisternography was, therefore, performed on day 12 after admission using sagittal, 3-dimensional, heavily T2-weighted images. Fusiform dilatation of the outer contour was confirmed by MR cisternography at the region of narrowing identified by MR angiography. This case indicates that the combination of MR cisternography and angiography can be useful for detecting ACA dissection.

A case of anterior cerebral artery dissection caused by scuba diving.

A 51-year-old man was admitted with right hemiparesis during scuba diving, without headache. Brain magnetic resonance (MR) imaging depicted high-intensity areas in the left superior frontal and cingulate gyri on diffusion-weighted imaging. Dissection of the anterior cerebral artery (ACA) was detected using axial MR angiography and 3-dimensional MR cisternography. Dissection of the ACA during and after scuba diving has not been reported before. Dissection of the arteries should be included in the differential diagnosis when neurologic symptoms occur both during and after scuba diving, even if the patient does not experience headache. Furthermore, the combination of MR cisternography and MR angiography is useful to detect ACA dissection.

Diagnostic efficacy of contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging in idiopathic cerebrospinal fluid rhinorrhea.

We report a case of a 50-year-old woman in which contrast-enhanced fluid-attenuated inversion recovery (FLAIR) was used for the diagnosis of idiopathic cerebrospinal fluid rhinorrhea. The pre- and postcontrast FLAIR subtraction images showed a contrasted protrusion of the right olfactory cleft canal, highlighting the potential practicality and effectiveness of using pre- and postcontrast FLAIR subtraction images in diagnosing idiopathic cerebrospinal fluid rhinorrhea, in conjunction with conventional high-resolution computed tomography and magnetic resonance cisternography. The successful diagnosis of cerebrospinal fluid rhinorrhea allowed for treatment through endoscopic nasal surgery to close the fistula with a positive clinical outcome.

Intrasphenoidal cephalocoeles: Knowing the less known.

Intrasphenoidal encephalocoeles are acquired or congenital herniations of meninges and brain parenchyma through a structural sphenoid bone defect. Acquired causes are most common, either iatrogenic, post-traumatic, or spontaneous. However, defects in the lateral wall of the sphenoid sinus are uncommon and cephalocoeles through them relatively underexplored in current literature, warranting dedicated attention to unravel their complexities. Congenital causes such as persistence of Sternberg's canal, which can lead to lateral cephalocoeles, is a rare entity, seen in two of the presented cases, based on the location of the defect with respect to the line connecting the foramen rotundum and the vidian canal (VR line). Three cases of intrasphenoidal cephalocoeles are presented; two patients presented with watery nasal discharge without prior trauma or surgery and the third case was incidentally detected in an elderly patient with intraparenchymal haemorrhage. Imaging with CT cisternography and brain MR were performed to ascertain the exact location of the leak and confirm the presence of herniated brain tissue via the defects. Patients were evaluated by otolaryngology for transnasal endoscopic repair, which was deemed unfeasible, and referred to neurosurgery for transcranial duroplasty. Contribution: These cases provide crucial insights into the aetiology of lateral intrasphenoidal cephalocoeles, offering a practical system to classify cerebrospinal fluid (CSF) leaks based on the bony defect location. The three illustrative cases and emphasis on advanced imaging modalities refine the knowledge of their aetiology, clinical presentation and management, which hold direct clinical relevance for accurate diagnosis and tailored management of these rare anomalies.

An anatomical study of the subarachnoid space surrounding the trigeminal ganglion in horses-in preparation for a controlled glycerol rhizotomy in equids.

Introduction: Equine trigeminal-mediated headshaking is a painful neuropathic disorder comparable to trigeminal neuralgia in humans. The selective destruction of pain fibers within the trigeminal ganglion, called rhizotomy, is the surgical treatment of choice for idiopathic trigeminal neuralgia refractory to medical treatment in humans. The human trigeminal ganglion is enclosed by a dural recess called the Meckel's or trigeminal cave, in which the ganglion is surrounded by a cerebrospinal fluid (CSF)-filled subarachnoid space. During glycerol rhizotomy, glycerol is percutaneously injected in this CSF-filled space. Until now, information about the anatomy of the dural recess and the subarachnoid space surrounding the trigeminal ganglion is lacking in horses. The aim of this study was to explore if a CSF-filled subarachnoid space around the trigeminal ganglion exists in horses. Materials and methods: Six equine cadaver heads were investigated for CSF accumulation around the ganglion with a 3 Tesla MRI. After anatomical dissection to expose the trigeminal root, a polymer-based radiopaque contrast agent was injected through the porus trigeminus into the subarachnoid space (cisternography). The exact delineation and the volume of the contrast agent accumulation were determined on subsequent micro-computed tomographic scans and segmentation. Finally, the distribution of the contrast agent within the subarachnoid space was examined histologically in three specimens. Results: In all 12 specimens included in this study, the trigeminal ganglion was surrounded by a subarachnoid space forming a trigeminal cistern. The mean volume of the trigeminal cave in this study was 0.31 mL (±SD: 0.11 mL). Distribution of the contrast agent along the peripheral nerves (i.e., ophthalmic, maxillary and/or mandibular nerve) was observed in 7 out of 12 specimens. Discussion/conclusion: A subarachnoid space surrounding the trigeminal ganglion exists in the horse and could be targeted for glycerol rhizotomy in horses suffering from trigeminal-mediated headshaking. However, the clinical relevance of contrast agent distribution along the peripheral nerves remains to be assessed.

Imaging Update of Congenital Hearing Loss: A Recent Insight Imaging Including 3D MRI Cisternography Prior to Cochlear Implant.

SNHL in children is an important issue. Cochlear implant is a highly technological device that is surgically inserted in the cochlea to solve this issue. To evaluate types of anomalies of the inner ear in children with sensorineural hearing loss in a tertiary care hospital and confirm that the routine MRI, MR cisternography and HRCT provides the surgeon with the imaging finding and criteria of patients candidates for CI. Patients and method: 600 patients with SNHL underwent HRCT and MRI. CT examinations were normal in 457 patients (76.2%) and 143 patients (23.8%) with inner ear anomalies. MRI examinations were normal in 440 patients (73.3%) and had inner ear anomalies in 160 patients (26.7%). 3D bFFE and 3D DRIVE was summarized. The 3D bFFE sequence was statistically significantly better than the 3D DRIVE for the demonstration of the cochlear vestibule. Superior, inferior vestibular nerves and facial nerves while 3D DRIVE is superior to 3D bFFE in the visualization of the semicircular canals. HRCT and MRI provide accurate anatomical delineation of complex inner ear structures and 3D improves pre-implant evaluation.