Long-term clinical and angiographic follow-up results of the dual-layer flow diverter device (FRED) for the treatment of intracranial aneurysms in a multicenter study.

PURPOSE: Our aim was to determine the long-term safety and efficacy of the Flow Re-Direction Endoluminal Device (FRED) in this multicenter study with prospective design. MATERIALS-METHOD: This study included 136 consecutive patients with 155 aneurysms treated between March 2013 and June 2016 in 10 centers. Twenty-two (16.2%) patients presented with rupture of the index aneurysm. Large/giant aneurysms comprised 1/3 of the cohort. Adjuvant coil use during the treatment was 15.5%. The effectiveness measure in the study was the percentage of aneurysms with stable occlusion at follow-up. RESULTS: Vascular imaging follow-up was performed at least once in 131/136 (96.3%) patients with 148/155 (95.5%) aneurysms up to 75 months (mean: 37.3 months; median: 36 months according to latest follow-up), and 102/155(65.8%) aneurysms in 90/136 (66.2%) patients had ≥ 24-month control. According to the latest controls, the overall stable occlusion rate was 91.9% (95% CI, 87.5 to 96.3%). Three out of 148 aneurysms with follow-up were retreated (2%, 95% CI 0.0 to 4.3%). Adverse events were noted in 19/136 (14%, 95% CI, 9 to 21%) patients with a morbidity of 1.5% (95% CI, 0.0 to 3.5%). Mortality was 1/136 (0.7%, 95% CI, 0.02 to 2.2%) and was unrelated to aneurysm treatment. In-stent stenosis (ISS) was detected in 10/131 of the patients with follow-up (7.6%, 95% CI; 3.1 to 12.2%), only one being symptomatic. No adverse events have occurred in any of the patients with follow-up after 24 months, except the one resulting from ISS. CONCLUSION: In the treatment of cerebral aneurysms which were candidates for flow diversion technique, this study showed long-term efficacy of FRED with good safety and occlusion rates.

A rare concurrence: gelastic seizures in a patient with right temporal nongalenic pial arteriovenous fistula.

INTRODUCTION: Gelastic seizures are the type of seizures that are most commonly seen in childhood and should be excluded definitely in the differential diagnosis of hypothalamic hamartomas. This seizure type may be accompanied by refractory seizures, cognitive decline, and early puberty. However, etiology may also include other causes different than hypothalamic hamartomas. The seizure may also arise from temporal and frontal region, in addition to hypothalamus. Different clinical findings may be observed based on origin and areas of spread. CONCLUSIONS: In this article, we report a case of gelastic seizure that has been observed by a different cause other than hypothalamic hamartoma which was reported for the first time in the literature.

Stent-Assisted Coil Embolization of Posttraumatic Dissecting Carotid Aneurysm Causing Ophthalmoplegia.

BACKGROUND: Ophthalmoplegia secondary to a traumatic dissecting aneurysm in the cavernous segment of internal carotid artery (ICA) is a relatively rare entity. Anticoagulant or antiplatelet therapy is the preferred treatment option for carotid dissections. However, endovascular interventions are noninvasive and alternative methods to surgery, especially in cases of aneurysms that do not respond to medical therapy. CASE REPORT: We report of a 19-year-old man presenting with left-sided, total ophthalmoplegia after a traffic accident. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) revealed a dissection beginning at the cervical segment of internal carotid artery (ICA) together with a dissecting aneurysm in the cavernous segment. A stent was placed in the narrowed and dissected segment of ICA, and the dissecting aneurysm of the cavernous segment was successfully managed with a stent-assisted coil embolization. After the endovascular treatment of the aneurysm, a full recovery of cranial nerve function was achieved. CONCLUSIONS: Immediate diagnosis and appropriate therapy of dissecting aneurysms is necessary for good clinical outcomes in cases of ophthalmoplegia.

Comparison of diagnostic accuracy of Doppler USG and contrast-enhanced magnetic resonance angiography and selective renal arteriography in patients with atherosclerotic renal artery stenosis.

BACKGROUND: There are many systemic complications of conventional selective renal arteriography (SRA), such as contrast-mediated nephropathy. Contrast-enhanced magnetic resonance angiography (CE-MRA) and renal artery Doppler ultrasonography (DUSG) have been used increasingly for renal artery stenosis (RAS). The aim of this study was to evaluate the accuracy of CE-MRA and DUSG as used for diagnosis of RAS. MATERIAL AND METHODS: We divided 130 consecutive patients investigated for resistant hypertension into 2 groups based on age: group 1 was patients <60 years old and group 2 was patients >60 year. DUSG, CE-MRA, and SRA were performed in group 1 and group 2 patients. RESULTS: Seventy-two patients (24 males [M], 48 females [F]) in group 1, and 58 patients (26 M, 32 F) in group 2 were included in the study. In the evaluation of clinically significant renal artery stenosis with DUSG, in group 1 the overall sensitivity was 83.33% and overall specificity was 81.82%, and in group 2 they were 69.23% and 0%, respectively, when compared with SRA. In the evaluation of clinically significant renal artery stenosis with CE-MRA, the overall sensitivity and specificity were 92.31% and 36.36%, respectively, in group 1 and 100.00% and 73.33%, respectively in group 2, when compared with SRA. CONCLUSIONS: CE-MRA is an accurate, non-invasive method for the diagnosis of RAS in patients above 60 years of age and DUSG may be the choice of diagnostic method for RAS in patients under 60 years of age.

Flow Diversion Therapy of Remnant and Recurrent Intracranial Aneurysms Treated Surgically.

AIM: To evaluate the safety and efficacy of flow diverter stents (FDSs) for treating remnant or recurrent intracranial aneurysms that were treated surgically. MATERIAL AND METHODS: The patients who were treated with FDSs due to remnant or recurrent intracranial aneurysms after microsurgery were included in the study. The patients' demographics, treatment histories, aneurysm features, complications associated with flow diversion, and neurological and angiographic follow-up findings were evaluated. RESULTS: Twenty patients (eight males) with 20 aneurysms were included in the study. Of 20 aneurysms, 18 (90%) were in the anterior, and two (10%) were in the posterior circulation. The initial treatment methods were clipping in 17 (85%) and wrapping in three (15%) aneurysms. The endovascular procedure was successful in all patients. In three patients (15%), periprocedural and postprocedural complications were encountered. No hemorrhagic complications were detected on cone-beam computed tomography. One patient with a basilary aneurysm died because of brain stem ischemia. The total morbimortality was 5%. The mean length of follow-up was 13.7 ± 7.3 months in 18 patients. The first angiographic follow-up (3-6 months) revealed the complete occlusion in 7 of 11 aneurysms (63.6%). By contrast, 16 aneurysms (94.1%) were occluded at the last angiographic follow-up, one aneurysm (5.9%) was still filling. CONCLUSION: An FDS seems effective, safe, and extremely attractive in treating remnant and recurrent intracranial aneurysms treated surgically.

Development of high-output heart failure after correction of central venous occlusion: a case report.

Temporary or permanent central venous catheter (CVC) insertion has been performed frequently for hemodialysis treatment. One of the most important long-term complications of CVC is the central venous occlusion (CVO). Treatment of CVO consists of percutaneous angioplasty (PTA), PTA and stent implantation, or surgical procedure for resistant occlusions. Clinical outcome and long-term results of the revascularization procedures are well documented. However, there is no clear information about acute medical complications of the procedures. High-output heart failure (HOHF) is associated with several diseases including chronic anemia, psoriasis, systemic arteriovenous fistula, sepsis, hypercapnia, multiple myeloma, and hyperthyroidism. Herein, we report a case of chronic kidney disease with CVO that developed acute HOHF immediately after the revascularization procedure (PTA and stenting).

Ectopic kidney with varied vasculature: demonstrated by CT angiography.

An ectopic kidney was found incidentally in a 20-year-old male patient during the abdominopelvic CT angiography. It was situated on the right side at the abdominopelvic junction, partly in the abdomen at the level of the intervertebral disc between L3 and L4 superiorly and partly in the greater pelvis at the level of the promontorium and close to the inferior border of the sacroiliac joints. It was supplied by two arteries which were nearly in the same caliber, and each of which branched from the common iliac arteries both close to the aortic bifurcation. There were two renal veins. The larger one which was emerging from the lateral part of the ectopic kidney was draining into the inferior vena cava. The smaller one which was the only hilar vessel of the ectopic kidney was draining into the left common iliac vein. The orthotopic left kidney was also supplied by two arteries from the abdominal aorta. Ectopic kidneys pose a problem for any planned surgical intervention given their anomalous blood supply. Ectopic position and varied vasculature can predispose to iatrogenic trauma during interventional radiological and laparoscopic procedures, and emergency operations.

Temporal bone hemangioendothelioma as a rare vascular tumor in childhood: case report and review of the literature.

BACKGROUND: Hemangiondothelioma is a rare vascular tumor that can occur in the bone. Temporal bone involvement has been reported extremely rare in the literature. CASE: Radiological examination of a one-year-old girl who was admitted due to facial paralysis revealed vascular tumor of the temporal bone and Galen vein aneurysm. Pathological examination showed retiform hemangioendothelioma. She was treated with propranolol, prednisolone, vincristine, and endovascular embolization followed by oral sirolimus. With sirolimus treatment, a partial response was obtained first, then the tumor remained stable and sirolimus treatment was discontinued. No progression was observed in the disease after discontinuation of treatment. CONCLUSION: In this article, a case of hemangioendothelioma originating from the temporal bone is discussed in the light of other case reports in the literature.

Deterioration of bone quality by long-term magnetic field with extremely low frequency in rats.

The aim of our study was to investigate the effects of long-term (45 days) magnetic field (50 Hz, 1 mT; MF) on femur biomechanical parameters of rats. Bone mineral density (BMD) and histological investigation were also evaluated. For this purpose, twenty-four 8-week-old, Wistar-Albino female and male rats were assigned randomly to female control (FC) and MF-exposed rats (F-MF); male control (MC) and MF-exposed rats (M-MF). BMD was measured by dual-energy X-ray absorptiometry. Cross-sectional area of the femoral shaft was evaluated by computerized tomography. Biomechanical measurements were performed at the mid-diaphysis of the left femur with tensile test. Maximum load, displacement, stiffness, energy absorption capacity (structural properties); ultimate stress, ultimate strain, elastic modulus and toughness (material properties) were calculated. Diaphysial cortical bone thickness was measured by using histological method from the right femur. In respect to the cortical thickness of the rats' femurs, there was statistically significant interaction between the gender and group (P<0.05), while the BMD and cortical area were not (P>0.05). The BMD, cortical thickness and area values of the femurs of MF-exposed rats (F-MF, M-MF) were significantly decreased in comparison to that of the controls (FC, MC) (P<0.05). There were no statistically significant differences between the control and the MF-exposed rats in respect to the femur length (P>0.05). There were no statistically significant interaction between the gender and group with regard to the maximum load, displacement, stiffness, ultimate stress, ultimate strain, elastic modulus and toughness endpoints, while the energy absorption capacity was significant (P<0.05). Maximum load, displacement and stiffness values of MF-exposed rats were significantly decreased compared to that of the controls (P<0.05). Femurs of M-MF rats had less absorbed energy than that in controls (P<0.05). Ultimate stress and elastic modulus parameters were significantly decreased in MF-exposed rats in comparison to that of the controls (P<0.05). Ultimate strain was higher in MF-exposed rats than that in controls (P>0.05). The mean of toughness was decreased in MF-exposed rats compared to that of the controls (P>0.05). In conclusion, the bone quality of rats is decreased by magnetic field exposure.

Biomechanical evaluation in osteoporosis: ovariectomized rat model.

The aim of our study was to investigate the effects of ovariectomy on rat femur biomechanical parameters. Bone mineral density (BMD) and histological investigation were also evaluated. Fourteen female Sprague-Dawley rats (seven ovariectomized, seven control) were used. BMD was measured by dual-energy X-ray absorbsiometry. Bone biomechanical parameters were measured in femoral midshaft with tensile test using a biomaterial testing machine and maximum load, stiffness, energy absorption capacity (structural properties), ultimate stress, ultimate strain, and elastic modulus (material properties) were calculated. Diaphyseal cortical bone thickness was measured by using histological method. The ovariectomized (OVX) rat femur's BMD was 14% lower than control rats (p=0.006). Mean maximum load was 55% less than the control group's (p=0.0001). Stiffness was 72% less in OVX rats (p=0.05). Femurs of rats with OVX had 32% less absorbed energy than controls (p=0.09). From the stress-strain curve ultimate stress, ultimate strain and elastic modulus was calculated. Elastic modulus was 53% less than controls (p=0.05). Ultimate stress decreased 21% in OVX rats (p=0.097). Ultimate strain was 25% less than controls in OVX rats. Cortical thickness was significantly decreased in OVX rats than in controls (p<0.05). In conclusion, femur biomechanical parameters are decreased in osteoporosis.

Paraganglioma of the skull base: a case report.

Paragangliomas are rare benign neuroendocrine tumors derived from the extra-adrenal paraganglia of the autonomic nervous system. Here, we described a new case of a 75-year-old woman with paraganglioma arising in the middle and posterior cranial fossa with extended destruction of the skull base and clivus. She was admitted to our department with the complaint of severe respiratory distress due to vocal cord paralysis. We discussed its clinical, radiological, histopathological features and treatment modalities in the light of the current literature.

[Determining the biomechanical quality of normal and osteoporotic bones in rat femora through biomechanical test and finite element analysis]. / Normal ve osteoporotik siçan femurunda kemigin biyomekanik kalitesinin biyomekanik testle ve sonlu elemanlar analizi ile belirlenmesi.

OBJECTIVES: This study aimed to determine the biomechanical quality of cortical bone in normal and osteoporotic rat femora with the use of biomechanical analysis and finite element analysis. METHODS: Fourteen young adult female Sprague-Dawley rats weighing 225-250 g were randomized into two groups equal in number. One group underwent bilateral ovariectomy under ketamine anesthesia. Fourteen weeks after ovariectomy, bone mineral density was measured by dual energy X-ray absorptiometry in two groups and the rats were sacrificed under high-dose ketamine anesthesia for removal of all the femora. The right femora were subjected to biomechanical tension tests. In the left femora, cortical bone sections were visualized by computed tomography and finite element analysis was performed on computer-generated three dimensional images using the ANYSIS 9.0 software. Deformation, stress, and strain values obtained by the two analyses were compared. RESULTS: Compared to the control group, bone mineral density decreased by 29%, and decreases in deformation, stress, and strain values were 39%, 51%, and 64%, respectively, in the ovariectomized rats (p<0.05). No significant differences were found between the results of biomechanical measurements and finite element analysis (p>0.05). CONCLUSION: Our data suggest that finite element analysis can be used in vivo to determine biomechanical quality of bone in osteoporotic patients.

Bilateral thalamic lesions: A pictorial review.

Bithalamic lesions are uncommon, however, both focal and systemic disorders may present bilateral abnormalities in the thalamus in different acute and chronic clinical situations. Neuroimaging, in particular magnetic resonance imaging, plays an essential role in diagnostic approach. Imaging features such as signal alterations, diffusion restriction or contrast enhancement are helpful in characterization of these abnormalities. The location of the lesions may provide key information because some pathologies typically involve a certain part of the thalamus. In addition to thalamic findings, neuroimaging findings in other parts of the brain associated with the clinical and laboratory information should be taken into account to make a correct diagnosis.

Ruptured superior gluteal artery pseudoaneurysm with hemorrhagic shock: Case report.

Pseudoaneurysm of the superior gluteal artery (SGA) is very rare and the most common causes are blunt or penetrating pelvic traumas. Although pseudoaneurysm can be asymptomatic at the time of initial trauma, it can be symptomatic weeks, months, even years after initial trauma. We present a case of a ruptured superior gluteal artery pseudoaneurysm with hemorrhagic shock twenty days after a bomb injury in the Syria civil war. In addition, we review the anatomy of the SGA, clinical presentation and pitfalls of pseudoaneurysm, and imaging and treatment options.

Inspiratory and expiratory HRCT findings in Behçet's disease and correlation with pulmonary function tests.

PURPOSE: The purpose of our study was to describe the pulmonary parenchymal changes of Behçet's disease using high-resolution computed tomography and to correlate them with pulmonary function tests. MATERIALS AND METHODS: Thirty-four patients with Behçet's disease (18 men, 16 women), 3 of whom were symptomatic, were included as the study group. Four of 34 patients were smokers. Twenty asymptomatic volunteers (12 men, 8 women), 4 of whom were smokers, constituted the control group. The pulmonary function tests and high-resolution computed tomography were performed for both groups. RESULTS: Inspiratory high-resolution computed tomography findings were abnormal in nine patients (26.5%) of the study group. In eight patients, there were multiple abnormalities, whereas one patient had only one abnormality. Pleural thickening and irregularities, major fissure thickening, emphysematous changes, bronchiectasis, parenchymal bands, and irregular densities, and parenchymal nodules were the encountered abnormalities. Inspiratory high-resolution computed tomography scans were normal in the control group. On expiratory scans, there was statistically significant difference between study group and control group when air trapping, especially grades 3 and 4, was compared (P<0.01). Pulmonary function tests of both the study and the control groups were in normal ranges, and there was no statistically significant difference between the two groups according to pulmonary function tests (P>0.05). DISCUSSION AND CONCLUSION: High-resolution computed tomography is sensitive in the demonstration of pulmonary changes in patients with Behçet's disease. End-expiratory high-resolution computed tomography examination is very useful and necessary to show the presence of air trapping, thus the presence of small airway disease, even if the patient is asymptomatic or has normal pulmonary function tests.

A case of missing mitral valve leaflet: radiological detection.

Intravascular foreign bodies may be introduced into the circulation as a complication of minimally invasive or interventional techniques, or during cardiac valve surgery. Prosthetic heart valve leaflets have been rarely described as intravascular foreign bodies. Herein we report a case of prosthetic heart valve leaflet embolization to the aortic bifurcation with computed tomography and ultrasonography findings, and the importance of radiographic imaging in the localization of missing leaflet fragment is pointed out.

Disseminated pneumocephalus secondary to an unusual facial trauma.

Pneumocephalus can be secondary to a postintrathecal procedure, sinus fracture, basilar skull fracture, congenital skull defect, neoplasm, gas producing organism, barotrauma, neurosurgery, paranasal sinus surgery, mask or nasal continuous positive-airway pressure. Unusual facial traumas can also be rare causes of pneumocephalus. Here, we present such a case in whom an air compressor tip injury to both eyes led to the disseminated pneumocephalus. We report this rare case with the computed tomography findings and try to explain the possible mechanism of the pnemocephalus.

HRCT evaluation of the accessory fissures of the lung.

INTRODUCTION: The purpose of this study was to classify the accessory fissures of the lung and to assess their frequency by using high-resolution CT. METHODS AND PATIENTS: HRCT scans of 115 patients were prospectively reviewed. 1 mm thin sections were obtained at 10 mm intervals with a scan time of 1.9 s. The fissure and its relationship to the segmental bronchovascular structures were then evaluated on transverse sections. RESULTS: Forty-four accessory fissures were detected in 35 of 115 patients. The most common accessory fissure was the inferior accessory fissure (12%). The second most common accessory fissure was the left minor fissure (8%). The right superior accessory fissure (5%), the accessory fissure between the medial and lateral segments of the right middle lobe (5%), and the accessory fissure between the superior and inferior segments of the lingula (5%) were seen in equal frequencies. Also, intersegmental accessory fissures, namely the fissure between the anterobasal and laterobasal of both the right (1%) and the left (2%) lower lobes were detected. We found only one subsegmental accessory fissure. DISCUSSION AND CONCLUSION: The inferior accessory fissure and the left minor fissure were the most common accessory fissures in our study.

Primary diffuse tracheobrochial amyloidosis: case report.

Respiratory amyloidosis is a rare disease that occurs in three forms: tracheobronchial, nodular parenchymal and diffuse parenchymal involment. Tracheobronchial amyloidosis is characterized by focal or diffuse deposition of amyloid in the submucosa of the trachea and proximal bronchi. Herein, we report a case of diffuse tracheobronchial amyloidosis with plain radiography and thorax computed tomography findings.

Inferomedially projecting pneumatised secondary middle turbinate.

Secondary middle turbinate (SMT), a rare variation of the nasal cavity, is a bony projection covered by soft tissue that arises from the lateral nasal wall. It is almost always bilateral and usually projects superomedially without any ostiomeatal unit obstruction. Herein, we report a case of bilateral inferomedially projecting secondary middle turbinates, one of which is pneumatised and hypertrophied, resembling a large ethmoid bulla extending into the middle meatus. The recognition of this variation is important since it may predispose to inflammatory sinus disease, by narrowing the ostiomeatal unit.