Delineation of the central retinal artery using computed tomography: a pilot study.

PURPOSE: The prospective study aimed to examine the central retinal artery (CRA) using computed tomography (CT). MATERIALS AND METHODS: Seventy adult outpatients comprising 32 men and 38 women, at a mean age of 60.6 ± 13.3 years, were enrolled in the study. The patients underwent contrast-enhanced CT. The scan timing was set to start 5.0 s after the circle of Willis began to be delineated. RESULTS: The ophthalmic arteries (OphAs) were comfortably delineated in all. In 97% of the patients, the CRA was delineated from the original site on the OphA to a more distal segment coursing on the optic sheath. Unilateral and bilateral CRA delineations were observed in 44% and 53% of cases, respectively. The delineated CRAs demonstrated highly variable morphologies in terms of the course and length on the optic sheath. In addition, the distance between the original site of the CRA and the posterior limit of the bulb was measured. The mean distance was 18.6 ± 5.0 mm on the right and 17.8 ± 4.3 mm on the left, respectively. No significant right-to-left differences in the measurements (p > 0.05) were observed. CONCLUSIONS: If optimal scan timing is adopted, the CRA segments coursing on the optic sheath can be delineated using contrast-enhanced CT. CT may be a useful diagnostic modality for the CRAs and associated pathological conditions.

Are bone erosion and peripheral feeding vessels hallmarks of intracranial solitary fibrous tumor/hemangiopericytoma?

An 86-year-old man sustained progressive motor weakness in the left lower extremity for 1 month. Cranial computed tomography (CT) revealed an isodense mass in the right parietal lobe, with a smooth-contoured focal erosion in the adjacent parietal bone. The extra-axial tumor appeared isointense on T1- and hyperintense on T2-weighted magnetic resonance imaging with intense enhancement. On three-dimensional CT angiography, the ectatic left occipital artery coursed into the right parietal foramina and connected with a dilated meningeal vessel supplying the tumor. The focal erosion formed in the inner parietal bone was located adjacent to the feeding vessel. A total tumor resection was achieved. The microscopic findings of the resected specimen were consistent with a World Health Organization grade III hemangiopericytoma (HPC). Bone erosion and peripheral feeding vessels may be characteristic findings of intracranial solitary fibrous tumor (SFT)/HPC. Careful interpretation of neuroimages could help detect clues for distinguishing an SFT/HPC masquerading as a meningioma from a true meningioma.

Bilateral vertebral artery fenestrations in the craniocervical junction region: the clinical role of 3D computed tomography angiography.

Fenestration of the vertebral artery (FVA) is a rare occurrence that comprises only 2% of fenestrations formed in the intracranial arteries. Herein, we report a unique case of bilateral FVA in the craniocervical junction (CCJ) region using conventional magnetic resonance angiography (MRA) and three-dimensional computed tomography angiography (3D-CTA). Compared to MRA, 3D-CTA was more sensitive in delineating the FVAs located in the region. Furthermore, it effectively depicted the relationships between the VAs and surrounding bony structures. The clinical implications of FVAs can be better understood in relation to the surrounding bony structures. 3D-CTA is mandatory when performing endovascular and open surgical interventions in and around the VA segments in the CCJ region.

Traumatic pseudoaneurysm arising from the anterior superficial temporal artery in an infant.

INTRODUCTION: Pseudoaneurysm arising from the superficial temporal artery (STA) is an uncommon sequela of head and facial trauma. This entity is very rare in the pediatric population. The conventional treatment is surgical excision. CASE REPORT: A 13-month-old boy presented with a progressively enlarging subcutaneous mass in the left forehead that appeared 1 week after indoor minor head trauma. The mass was hard and prominently expansile and was more than 5 cm in the largest dimension. The mass did not have audible bruit and was not diminished by manual compression of the proximal STA. Cranial computed tomography (CT) did not reveal intracranial hemorrhage or skull fracture in association with the head trauma. CT angiography showed a large aneurysm arising from the anterior branch of the left STA. RESULT: En bloc extirpation of the aneurysm was performed. Histological examination of the excised specimen showed findings consistent with pseudoaneurysm. CONCLUSION: In addition to careful observation for a sufficiently long period after the head trauma, neurosurgeons should be aware of the need to start treatment before a traumatic pseudoaneurysm reaches a significant size.