Diego A. Herrera

Endovascular Treatment of Traumatic Injuries of the Vertebral Artery

BACKGROUND AND PURPOSE: There are a few reports regarding the treatment of traumatic vertebral arteriovenous fistulas and pseudoaneurysms. Our aim was to describe the clinical and angiographic results of endovascular therapy for traumatic injuries of the vertebral artery. MATERIALS AND METHODS: The clinical and angiographic features of 18 traumatic injuries of the vertebral artery during an 8-year period were reviewed. There were 14 male (78%) and 4 female patients (22%). The average age was 28 years (range, 11–49 years). Of the 18 lesions of the vertebral artery, 17 (95%) were the result of penetrating trauma (gunshot or stab wound injury) and 1 (5%) was iatrogenic (jugular vein catheter). In 16 (89%) instances, the injury resulted in an arteriovenous fistula, and in the other 2 (11%), in a pseudoaneurysm. All patients were treated with an endovascular approach by using different techniques (balloon occlusion, coil embolization, and/or stent deployment). RESULTS: Endovascular therapy resulted in immediate lesion total occlusion in 16 (89%) patients. Delayed total occlusion was demonstrated angiographically during follow-up in the 2 remaining patients. Clinical improvement was documented in all patients, and there were no clinically symptomatic complications. CONCLUSION: In this small series, endovascular techniques were a safe and effective method of treatment and were not associated with significant morbidity or mortality.

Imaging Findings of Rhinocerebral Mucormycosis

BACKGROUND AND OBJECTIVES The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis of rhinocerebral mucormycosis. METHODS We retrospectively evaluated the imaging and clinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. RESULTS All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistently observed in all five patients (100%). Our series demonstrated a mortality rate of 60%. CONCLUSION Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery and antifungals.

Endovascular Treatment of Penetrating Traumatic Injuries of the Extracranial Carotid Artery

PURPOSE To describe the clinical and angiographic results of endovascular therapy for traumatic injuries of the extracranial carotid artery. MATERIALS AND METHODS The clinical and angiographic features of 36 traumatic injuries of the carotid artery during a 12-year period were reviewed. There were 35 male patients (97.2%) and 1 female patient (2.8%) with an average age of 28.8 years (range 13-60 years). Of the 36 lesions of the carotid artery, 29 (80.6%) were the result of gunshot injury, and 7 (19.4%) were secondary to stab wounds. In 24 (66.7%) instances, the injury resulted in a pseudoaneurysm; in 7 (19.4%), in an arteriovenous fistula (AVF); in 4 (11.1%), in a dissection; and in 1 (2.8%), in inactive bleeding. All patients were treated with an endovascular approach using different techniques (balloon occlusion, embolization, or stent deployment). RESULTS Endovascular therapy resulted in documented lesion occlusion in 34 (94.4%) patients. Two patients declined any follow-up postprocedural imaging; however, they have remained asymptomatic. Clinical improvement was documented in 35 (97.2%) patients, and there was one procedure-related complication with fatal consequences. CONCLUSIONS In this series, endovascular techniques were an effective method of treatment. It was possible to use different endovascular reconstructive techniques or parent artery occlusion depending on the degree of vessel damage, with resolution of clinical symptoms and avoidance of surgery in most cases.

Intracranial Aneurysms in Children: The Role of Stenting and Flow‐Diversion

To report a single‐center experience in the endovascular management of cerebral aneurysms in children with stenting and flow‐diversion techniques.

Ultrasonographic Evaluation of a Vascularized Tracheal Transplantation

Tracheal stenosis is a frequent problem that in most cases is a complication of prolonged intubation. When the stenosis impairs more than half of the length of the trachea, it is not technically feasible to make a resection with a terminoterminal anastomosis. 1 In this clinical context, tracheal transplantation is a therapeutic alternative. We report the case of a patient in whom a vascular-ized tracheal transplantation was performed successfully and emphasize the importance of an imaging evaluation, particularly with ultrasonography.

Traumatic carotid-cavernous fistula with pontomesencephalic and cervical cord venous drainage presenting as tetraparesis.

A 27‐year‐old male presented with progressive ascending myelopathy leading to tetraparesis. Magnetic resonance imaging of the cervical spine showed dilated perimedullary veins and spinal cord edema. Catheter angiography demonstrated a direct carotid‐cavernous fistula (CCF) with prominent pontomesencephalic and perimedullary venous drainage. Successful coil embolization of the fistula was performed with improvement of the patients symptoms. To our knowledge, no case of a direct CCF with perimedullary drainage has been previously reported.

Characteristic brain MRI findings in ataxia-neuropathy spectrum related to POLG mutation:

Patients with mutations in the polymerase gamma gene (POLG) may present with progressive ataxia and in such situations neuroimaging findings may suggest the diagnosis. Herein we report a patient with a POLG gene W748S homozygous mutation and characteristic lesions in the thalamus, cerebellum and inferior olivary nucleus seen on magnetic resonance imaging.

Delayed Complication after Embolotherapy of a Vertebral Arteriovenous Fistula: Spinal Cord Ischemia

Previous reports suggest a generally successful experience with embolotherapy of vertebral arteriovenous fistulas of the neck. However, potential complications do exist, as shown by this report documenting spinal cord ischemia secondary to compromise of a dominant spinal artery arising from the proximal aspect of the right vertebral artery.

Extraforaminal Meningioma with Extrapleural Space Extension

3Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112-4800. horacic involvement by meningioma is uncommon. Most reported cases are secondary to metastatic disease. Brachial plexus invasion by extraforaminal meningioma has been reported in the literature. This case illustrates another form of thoracic involvement by meningioma: extension to the chest wall. To our knowledge, the imaging findings of extrapleural space involvement by meningioma have not been described previously in the radiologic literature. We therefore present the MRI findings and pathologic correlation in the case of a patient with this unusual presentation of meningioma.

Unicentric Castleman's disease in the posterior cervical space mimicking a schwannoma.

INTRODUCTION Castlemans disease (CD) is a benign and rare lymphoid tissue disease of undetermined origin. It affects the neck infrequently; therefore its preoperative diagnosis is difficult and can be confused with other hypervascular lesions. CASE REPORT We present a case of unicentric hyaline-vascular CD in the posterior cervical space (PCS) evaluated by MRI and initially presumed to be a cervical schwannoma. DISCUSSION As shown with our case, unicentric CD should be included in the differential diagnosis for masses in the PCS, especially when a hypervascular lesion like a schwannoma is suspected. The finding of central low intensity areas in a fissured and radial pattern in T2 sequences can help to consider CD when dealing with PCS masses as shown by previous cases and our reported experience.