Woo Jin Choe

MR angiographic evaluation is limited in intracranial aneurysms embolized with Nexus coils

IntroductionNexus coils are a type of bioactive coil used to embolize intracranial aneurysms. The purpose of this study was to test the feasibility of the noninvasive follow-up of aneurysms treated with Nexus coils by means of magnetic resonance angiography (MRA).MethodsThree-dimensional (3D) time-of-flight (TOF) MRA images of patients treated with Nexus coils (the Nexus coil group) or bare platinum coils (the control group) were compared for the severity and frequency of artifacts. The reviewers were unaware of the coil types used. In the Nexus coil group, 17 MRA examinations were performed in 14 patients harboring 15 aneurysms treated with Nexus coils using 3-T (n = 11) and 1.5-T (n = 6) MR units. The findings of these examinations were compared to those of 28 MRA studies conducted on 24 control patients (bare platinum coils). Conventional angiograms, maximum intensity projections, and source data of 3D-TOF MRA were reviewed in terms of residual flow within aneurysms and parent arterial patencies. The qualities of the MRA images were rated from grade 0 (no significant signal loss) to grade 2 (complete segmental signal loss of the parent artery). The normalized ratio, defined as the diameter of signal loss on MRA axial source images (in mm) divided by that of coil mass on plain radiographs (in mm), was calculated to compare the sizes of coil-related artifacts in the two groups.ResultsThe quality of the MRA image for the Nexus coil group was significantly poorer than that for the control group (p < 0.0001) due to signal loss caused by the presence of artifacts in the former. In particular, the interpretation of aneurysmal status was impossible in all cases of coiled aneurysms due to segmental signal loss. The sizes of the MRA artifacts were also significantly larger in the Nexus coil group (normalized ratio 1.61 ± 0.22 vs. 1.15 ± 0.20; p < 0.0001).ConclusionFollow-up evaluations by 3D-TOF MRA of aneurysms treated with Nexus coils are severely limited.

Traumatic Entrapment of the Vertebrobasilar Junction Due to a Longitudinal Clival Fracture: A Case Report

Vertebrobasilar junction entrapment due to a clivus fracture is a rare clinical observation. The present case report describes a 54-yr-old man who sustained a major craniofacial injury. The patient displayed a stuporous mental state (Glasgow Coma Scale [GCS]=8) and left hemiparesis (Grade 3). The initial computed tomography (CT) scan revealed a right subdural hemorrhage in the frontotemporal region, with a midline shift and longitudinal clival fracture. A decompressive craniectomy with removal of the hematoma was performed. Two days after surgery, a follow-up CT scan showed cerebellar and brain stem infarction, and a CT angiogram revealed occlusion of the left vertebral artery and entrapment of vertebrobasilar junction by the clival fracture. A decompressive suboccipital craniectomy was performed and the patient gradually recovered. This appears to be a rare case of traumatic vertebrobasilar junction entrapment due to a longitudinal clival fracture, including a cerebellar infarction caused by a left vertebral artery occlusion. A literature review is provided.

Eosinophilic Myelitis in the Cervical Cord Mimicking Intramedullary Cord Tumor

Eosinophilic myelitis (EM) or atopic myelitis is a rare disease characterized by a myelitic condition in the spinal cord combined with allergic process. This disease has specific features of elevated serum IgE level, active reaction to mite specific antigen and stepwise progression of mostly the sensory symptoms. Toxocariasis can be related with a form of EM. This report describes two cases of cervical eosinophilic myelitis initially considered as intramedullary tumors. When a differential diagnosis of the intramedullary spinal cord lesion is in doubt, evaluation for eosinophilic myelitis and toxocariasis would be beneficial.

Glomus Tumor in the Femoral Nerve

The glomus tumor of the peripheral nerve is one of the mesenchymal tumors originating in the epineurium, and is extremely rare. A 56-year-old man presented complaining of lancinating pain on the left thigh, which was provoked by pressure or exercise. Subsequent image study revealed a mass in the femoral nerve. Total surgical excision with the aid of intraoperative ultrasonography was performed and the pain was successfully controlled. The authors report an unusual case of a patient diagnosed with glomus tumor in peripheral nerve, with a review of the clinical features, imaging, and pathological findings.

Cervical epidural lymphangioma presenting as a hemorrhagic cyst: a case report.

Study Design. A case report. Objective. We report a case of epidural lymphangioma in the cervical spine, and it manifested as a hemorrhagic cyst. Summary of Background Data. Intraspinal lymphangioma is an uncommon tumor with only a few cases reported in the literature. Epidural lymphangioma presenting as a hemorrhagic cyst is extremely rare. Methods. The patient chosen was a 43-year-old woman with the chief complaint of neck pain and right upper extremity numbness of 2-month duration. Results. Cervical spine magnetic resonance (MR) imaging revealed an epidural cystic mass extending to the right C6–C7 neural foramen. The mass showed fluid-fluid levels on T2-weighted image and high-signal intensity on diffusion-weighted image. Surgical resection and histologic analysis confirmed the diagnosis of epidural lymphangioma with internal hemorrhage. Conclusion. Epidural lymphangioma is a rare benign tumor. However, it should be included in the differential diagnosis of hemorrhagic cystic mass in the epidural space, which presented with fluid-fluid levels on MR imaging and high-signal intensity on diffusion weighted imaging.

Tiny aneurysms treated with single coil: Morphological comparison between bare platinum coil and matrix coil

OBJECTIVE We analyzed the angiographic results of tiny aneurysms treated with various kinds of single coils including polyglycolic-polylactic acid (PGLA)-coated coils. METHODS Forty aneurysms with diameters measuring less than 4mm were treated with a single bare platinum, Matrix1, or Matrix2 coil. Most of the aneurysms were treated with a 2 mm diameter coil, except for seven treated with a 3 mm coil, four treated with a 2.5 mm coil, and two treated with a 1.5 mm coil. The mean length of the coils was 3.6 cm. RESULTS With mean packing ratios of 21.2%, 19.7%, and 22.8%, we achieved initial complete occlusion rates of 9.5% with the platinum coil, 28.6% with the Matrix1 coil, and 25.0% with the Matrix2 coil. The mean follow-up interval was 23.1 months and the complete occlusion rate improved up to 47.6% for the platinum coil, 57.1% for the Matrix1 coil, and 83.3%for the Matrix2 coil. Compared to the Platinum group, the Matrix2 group showed a greater tendency toward more complete occlusion on the follow-up images. Regardless of coil type, the aneurysms treated with a stent-assisted technique showed better complete occlusion rates (50.0% vs. 90.0%, p=0.03). CONCLUSIONS The tiny aneurysms treated with a single Matrix2 coil tended to have better follow-up angiographic results than the aneurysms treated with a single platinum coil. Furthermore, the use of a stent-assisted technique and increasing the packing density also positively affected the healing of these tiny aneurysms.

Ganglioneuroma of the Sacrum

Presacral ganglioneuromas are extremely rare benign tumors and fewer than 20 cases have been reported in the literature. Ganglioneuromas are difficult to be differentiated preoperatively from tumors such as schwannomas, meningiomas, and neurofibromas with imaging modalities. The retroperitoneal approach for resection of presacral ganglioneuroma was performed for gross total resection of the tumor. Recurrence and malignant transformation of these tumors is rare. Adjuvant chemotherapy or radiation therapy is not indicated because of their benign nature. We report a case of a 47-year-old woman with a presacral ganglioneuroma.

Endovascular Management of Great Vessel Injury Following Lumbar Microdiscectomy

Great vessel injury is a rare but well-known complication of lumbar disc surgery, which may result in acute or fatal outcomes of delayed diagnosis. Thus, early detection and proper management is vital. The authors report a case of retroperitoneal hemorrhage with arteriovenous fistula and pseudoaneurysm after lumbar microdiscectomy. The patient was successfully managed by endovascular intervention using a stent graft. Endovascular repair is a minimally invasive and efficient treatment modality with considerably low morbidity and mortality.

Traumatic Pseudoaneurysm Related to Calcified Nodules of Cerebral Convexity Dura Mater in an American College Football Player

Repeated concussion is common among football players; however, these minor blunt head trauma rarely result in serious complications. We report a case of a young college football player who presented acute subdural hematoma, cerebral edema, and seizure due to pseudoaneurysm rupture. The pseudoaneurysm, located at the cortical branch of the middle cerebral artery, was speculated to be formed by dural calcification and adhesion with the underlying brain, possibly due to repeated concussions. Following successful excision of the pseudoaneurysm and control of brain swelling, the patient recovered without sequelae and was discharged after a short while.

Epithelioid Sarcoma in the Cervical Spine: A Case Report

Epithelioid sarcoma is a rare and highly malignant soft tissue neoplasm that most commonly occurs in the long bones. This uncommon tumor has a poor clinical outcome, and the modality of its treatment has not yet been fully established. The authors report an extremely rare presentation of epithelioid sarcoma in the cervical spine, along with its clinical progression, imaging, and pathology. The patient underwent three surgical procedures and adjuvant radiochemical management. He survived for 25 months with a good general condition and adapted well to his social activity. Systemic metastasis was not found, but the patient died of respiratory failure due to direct tracheal invasion of the tumor.