The authors report of a case of pseudotumour caused by Candida species without evidence of any un... more The authors report of a case of pseudotumour caused by Candida species without evidence of any underlying disease. No portal of entry of the infection was found. Total removal followed by treatment with flucanazole resulted in a favorable outcome. We discuss the differential diagnosis of a huge calcified intracranial mass lesion without any soft tissue component.
Graves' ophthalmopathy (GO) is one of the frequent manifestations of the disorder which is an inf... more Graves' ophthalmopathy (GO) is one of the frequent manifestations of the disorder which is an inflammatory process due to fibroblast infiltration, fibroblast proliferation and accumulation of glycosaminoglycans. Eye irritation, dryness, excessive tearing, visual blurring, diplopia, pain, visual loss, retroorbital discomfort are the symptoms and they can mimic carotid cavernous fistulas. Carotid cavernous fistulas are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical manifestations of GO can mimic the signs of carotid cavernous fistulas. Carotid cavernous fistulas should be considered in the differential diagnosis of the GO patients especially who are not responding to the standard treatment and when there is a unilateral or asymmetric eye involvement. Here we report the second case report with concurrent occurrence of GO and carotid cavernous fistula in the literature.
A 37‐year‐old male, previously diagnosed with GAPO syndrome, was admitted to our hospital complai... more A 37‐year‐old male, previously diagnosed with GAPO syndrome, was admitted to our hospital complaining of recurrent episodes of transient weakness and numbness in his left arm for 3 months, and severe headache with progressive dysphagia for 15 days. His cranial magnetic resonance (MR) images showed multiple ischemic foci in the bilateral periventricular and supraventricular white matter. Cerebral MR‐angiography showed total occlusion of the right internal carotid artery and moderate stenosis in the left internal carotid. We also detected chronic thrombotic changes in the distal left sigmoid sinus, proximal right sigmoid sinus, and bilateral jugular veins on cerebral MR‐venography. He was diagnosed with dilated cardiomyopathy at age 31 years, which was reported as a novel association; and later he had a myocardial infarction at age 34 years. To the best of our knowledge, this is the first patient with GAPO syndrome and arterial atherosclerosis in cerebral—as well as coronary—arteries ...
Males were more represented than females in our cohort (16 (57.1%) vs 12 (42.9%)). Of these 28 pa... more Males were more represented than females in our cohort (16 (57.1%) vs 12 (42.9%)). Of these 28 patients, 14 (50%) are currently undergoing treatment, 13 (46.4%) have achieved at least 95% and up to complete cure of the VOGM, and one patient (3.6%) passed away. A total of 46 thalamoperforator embolizations were performed during the treatment course of our cohort with an average of 1.64 (SD: 1.13) treatments per patient. A total of 20 patients underwent neuromuscular junction monitoring on at least one occasion to ascertain avoidance of eloquent brain in the embolization procedure. This was typically performed as a selective WADA test with a 2% Xylocaine (Lidocaine) solution and 25mg of Sodium Amytal, but has also included methohexital in later years. In one case, neuromonitoring revealed that the MEP wave disappeared for five minutes after two rounds of 2% Xylocaine and 25mg Sodium Amytol infusion. This led to termination of embolizing the thalamoperforator. Conclusion We have found that ThP and AchA embolization are feasible and effective means for achieving cure of VOGM and tectal/thalamic AVM. We report favorable, post-procedural outcomes in the majority of our patients; however, as with any embolization within the thalamic region of the brain, we maintain that caution should always be used due to the risk of stroke which we observed in one of our patients. If there is any doubt as to the safety of a given embolization, provocative testing with neuromonitoring is performed. In the case of the patient who experienced a post-procedural stroke, neuromonitoring was performed and still MEP/SEP waves were maintained after injection of amytal and lidocaine. To improve the safety of ThP and AchA embolization, we perform intraoperative neurophysiological monitoring of MEP and SEP with sodium amytal and lidocaine. We intend to expand this practice beyond VOGM and tectal/thalamic AVM into other eloquent AVMs as we have seen great success in our own clinic and in the literature. Disclosures M.
BACKGROUND AND PURPOSE: We evaluated the use of MR cisternography after intrathecal administratio... more BACKGROUND AND PURPOSE: We evaluated the use of MR cisternography after intrathecal administration of gadopentetate dimeglumine to detect the presence and localization of CSF leaks in 19 patients diagnosed with spontaneous intracranial hypotension syndrome according to the criteria of International Headache Society. MATERIALS AND METHODS: Lumbar puncture with an injection of 0.5 mL of gadopentetate dimeglumine into the subarachnoid space in the lumbar area was performed. MR images of the cervical, thoracic, and lumbar regions in axial, coronal, and sagittal planes with fat-saturated T1-weighted images were acquired. RESULTS: We observed objective CSF leakage in 17 (89%) of 19 patients. In 14 of these 17 patients, the site of dural tear was demonstrated accurately. In 3 of these 17 patients, the contrast leakage was diffuse, and site of the leak could not be located accurately. No leakage was observed in 2 patients. No complications were detected in any of the patients during the first 24 hours after the procedure or during the 6-to 12-month follow-up. CONCLUSION: The current results demonstrate the relative safety, accuracy, and feasibility of intrathecal gadolinium-enhanced MR cisternography to evaluate dural leaks.
BackgroundFlow diversion is a common endovascular treatment for cerebral aneurysms, but studies c... more BackgroundFlow diversion is a common endovascular treatment for cerebral aneurysms, but studies comparing different types of flow diverters are scarce.ObjectiveTo perform a propensity score matched cohort study comparing the Pipeline Embolization Device (PED) and Flow Redirection Intraluminal Device (FRED) for posterior circulation aneurysms.MethodsConsecutive aneurysms of the posterior circulation treated at 25 neurovascular centers with either PED or FRED were collected. Propensity score matching was used to control for age, duration of follow-up imaging, adjunctive coiling, and aneurysm location, size, and morphology; previously ruptured aneurysms were excluded. The two devices were compared for the following outcomes: procedural complications, aneurysm occlusion, and functional outcome.ResultsA total of 375 aneurysms of the posterior circulation were treated in 369 patients. The PED was used in 285 (77.2%) and FRED in 84 (22.8%) procedures. Aneurysms treated with the PED were mo...
Arterial fenestrations are associated with saccular aneurysms that are often difficult to treat w... more Arterial fenestrations are associated with saccular aneurysms that are often difficult to treat with open surgical techniques. We evaluated our experience with endovascular treatment of such aneurysms. Ten consecutive patients with 11 basilar artery aneurysms associated with fenestrations were treated with coils by means of the endovascular route between November 1994 and February 2000. All patients underwent endovascular embolization by the femoral approach, under general anesthesia. Twelve embolization procedures were perfomed in the 10 patients. Nine proximal and two distal basilar artery fenestration aneurysms were treated successfully. The embolization was complete in 10 of the 11 aneurysms. It was incomplete in one case, and complete occlusion could not be achieved at the second attempt. There was one regrowth at 1-year follow-up, which was successfully treated again. Four of the aneurysms were treated initially with balloon remodeling, whereas one aneurysm with regrowth and o...
Bu makalede, posterior serebral arter P1-P2 segmentine oturmuş geniş boyunlu anevrizmada endovask... more Bu makalede, posterior serebral arter P1-P2 segmentine oturmuş geniş boyunlu anevrizmada endovasküler tedavinin uzun dönem sonuçları bildirilmiştir. Tedavide anevrizma embolizasyonu yapmadan boyun kısmına yerleştirilen stent ile hemodinamik ...
Cavernous hemangioma (CH) is a benign vascular malformation. Intracranial CH is generally localiz... more Cavernous hemangioma (CH) is a benign vascular malformation. Intracranial CH is generally localized as an intracranial-intraaxial and responsible for 5-13% of all intracranial vascular malformations. Intracranialextraaxial CHs are rare rather than intracranial-intraaxial CHs. Clinical findings, imaging characteristics, and surgical approach of extraaxial CHs are rather different than intraaxial CHs. Diagnosing cavernous sinus CH preoperatively is very important, but its radiological differential diagnosis is quite difficult. In this study, we present magnetic resonance imaging findings of a 48-year-old male who was considered preoperatively to have meningioma but was diagnosed with cavernous sinus CH during surgery by pathological examination.
Macrocephaly-capillary malformation (M-CM) is characterized by prenatal overgrowth, variable soma... more Macrocephaly-capillary malformation (M-CM) is characterized by prenatal overgrowth, variable somatic and cerebral asymmetry, primary megalencephaly, characteristic facial features, an abnormal neurocognitive profile and cutaneous vascular malformations. It was previously known under the name macrocephaly-cutis marmorata telangiectatica congenital (M-CMTC). However a recent review of the previously reported cases has suggested that the vascular anomalies are not true CMTC but rather capillary malformations. The diagnosis is primary clinical and different criteria have been proposed for this purpose. However, M-CM is frequently associated with structural brain abnormalities that should be properly investigated and monitored because of their possible progressive development. We report the neuroradiological and morphological features observed in a girl with M-CM and we compared them with proposed diagnostic criteria found in the literature.
We present our initial experience with a newly developed endovascular stent graft technique in th... more We present our initial experience with a newly developed endovascular stent graft technique in the treatment of two patients with giant aneurysms. In both of these patients, surgery and conventional endovascular techniques were likely to fail. The technique resulted in the successful management of the aneurysms in both cases. Our technique is described, and related experiences in the literature are discussed.
Computer Methods in Biomechanics and Biomedical Engineering, 2013
This study is aimed at setting a method of experimental parameter estimation for large-deforming ... more This study is aimed at setting a method of experimental parameter estimation for large-deforming nonlinear viscoelastic continuous fibre-reinforced composite material model. Specifically, arterial tissue was investigated during experimental research and parameter estimation studies, due to medical, scientific and socio-economic importance of soft tissue research. Using analytical formulations for specimens under combined inflation/extension/torsion on thick-walled cylindrical tubes, in vitro experiments were carried out with fresh sheep arterial segments, and parameter estimation procedures were carried out on experimental data. Model restrictions were pointed out using outcomes from parameter estimation. Needs for further studies that can be developed are discussed.
BACKGROUND AND PURPOSE: Flow diversion for the posterior circulation remains a promising treatmen... more BACKGROUND AND PURPOSE: Flow diversion for the posterior circulation remains a promising treatment option for selected posterior circulation aneurysms. The Flow-Redirection Intraluminal Device (FRED) system has not been previously assessed in a large cohort of patients with posterior circulation aneurysms. The purpose of the present study was to assess safety and efficacy of FRED in this location. MATERIALS AND METHODS: Consecutive patients with posterior circulation aneurysms treated at 8 centers participating in the European FRED study (EuFRED) between April 2012 and January 2019 were retrospectively reviewed. Complication and radiographic and functional outcomes were evaluated.
primary branch while the compliant balloon can seal the aneurysm neck and temporarily occlude the... more primary branch while the compliant balloon can seal the aneurysm neck and temporarily occlude the secondary branch. Conclusion This device can improve the placement of devices, such as coils and a new generation of liquid embolics, into an aneurysm sac without blocking the parent vessel in the shortterm, nor leaving metal in the parent vessel long-term. A new stent-balloon device would allow neurointerventionalists a lessrestricted time window to deploy embolic devices and obtain a more complete aneurysm sac fill while concurrently limiting any protrusion or migration of the embolic devices downstream.
To explore the value of quantitative texture analysis of conventional magnetic resonance imaging ... more To explore the value of quantitative texture analysis of conventional magnetic resonance imaging (MRI) sequences using artificial neural networks (ANN) for the differentiation of high-grade gliomas (HGG) and low-grade gliomas (LGG). MATERIALS AND METHODS: A total of 181 patients, 97 with HGG (53.5%) and 84 with LGG (46.5%) with brain MRI having T2-weighted (W) fluid attenuation inversion recovery (FLAIR), and contrast-enhanced T1W images were enrolled in the present study. Histogram parameters and high-order texture features were extracted using manually placed regions of interest (ROIs) on T2W-FLAIR and contrast-enhanced T1W images covering the whole volume of the tumours. The reproducibility of the features was assessed by interobserver reliability analyses. The cohort was divided into training (n¼121) and test partitions (n¼60). The training set was used for attribute selection and model development, and the test set was used to evaluate the diagnostic performance of the pre-trained ANNs in discriminating HGG and LGG. RESULTS: In the test cohort, the ANN models using texture data of T2W-FLAIR and contrastenhanced T1W images achieved an area under the receiver operating characteristic curve (AUC) of 0.87 and 0.86, respectively. The combined ANN model with selected texture features achieved the highest diagnostic accuracy equating 88.3% with an AUC of 0.92. CONCLUSIONS: Quantitative texture analysis of T2W-FLAIR and contrast-enhanced T1W enhanced by ANN can accurately discriminate HGG from LGG and might be of clinical value in tailoring the management strategies in patients with gliomas.
BACKGROUND AND PURPOSE: Serpentine aneurysms are partially thrombosed aneurysms with an eccentric... more BACKGROUND AND PURPOSE: Serpentine aneurysms are partially thrombosed aneurysms with an eccentrically located tortuous intraaneurysmal vascular channel. The large size, distinctive neck anatomy, and supply of the brain parenchyma by the outflow tract pose technical challenges in treatment. The aim of this study was to discuss the endovascular treatment results and illustrate the dynamic nature of serpentine aneurysms. Spontaneous transformation of saccular and fusiform aneurysms into serpentine morphology, along with a case of serpentine-into-fusiform aneurysm transformation during follow-up, is presented. MATERIALS AND METHODS: A retrospective analysis from 3 institutions revealed 15 patients with serpentine aneurysms who underwent diagnostic evaluation and endovascular treatment. Nine of the 15 patients underwent endovascular occlusion of the parent vessel with detachable balloon or coils. Six of the 15 patients underwent aneurysm and parent artery occlusion with coiling. RESULTS: In 11 patients, improvement or resolution of symptoms was achieved by an endovascular approach without any treatmentrelated morbidity. Morbidity related to treatment in the immediate postoperative period was seen in 3 patients, with resolution of the deficits at long-term follow-up in 2 patients and persistence of a mild deficit in 1 patient. Endovascular treatment failed to achieve resolution of symptoms in a case with a basilar tip aneurysm treated by aneurysm coiling. CONCLUSIONS: Serpentine aneurysms are dynamic structures with spontaneous transformation possible from a saccular or fusiform shape into a serpentine configuration. An endovascular approach by parent vessel occlusion or intra-aneurysmal occlusion is a successful treatment technique for serpentine aneurysms.
The authors report of a case of pseudotumour caused by Candida species without evidence of any un... more The authors report of a case of pseudotumour caused by Candida species without evidence of any underlying disease. No portal of entry of the infection was found. Total removal followed by treatment with flucanazole resulted in a favorable outcome. We discuss the differential diagnosis of a huge calcified intracranial mass lesion without any soft tissue component.
Graves' ophthalmopathy (GO) is one of the frequent manifestations of the disorder which is an inf... more Graves' ophthalmopathy (GO) is one of the frequent manifestations of the disorder which is an inflammatory process due to fibroblast infiltration, fibroblast proliferation and accumulation of glycosaminoglycans. Eye irritation, dryness, excessive tearing, visual blurring, diplopia, pain, visual loss, retroorbital discomfort are the symptoms and they can mimic carotid cavernous fistulas. Carotid cavernous fistulas are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical manifestations of GO can mimic the signs of carotid cavernous fistulas. Carotid cavernous fistulas should be considered in the differential diagnosis of the GO patients especially who are not responding to the standard treatment and when there is a unilateral or asymmetric eye involvement. Here we report the second case report with concurrent occurrence of GO and carotid cavernous fistula in the literature.
A 37‐year‐old male, previously diagnosed with GAPO syndrome, was admitted to our hospital complai... more A 37‐year‐old male, previously diagnosed with GAPO syndrome, was admitted to our hospital complaining of recurrent episodes of transient weakness and numbness in his left arm for 3 months, and severe headache with progressive dysphagia for 15 days. His cranial magnetic resonance (MR) images showed multiple ischemic foci in the bilateral periventricular and supraventricular white matter. Cerebral MR‐angiography showed total occlusion of the right internal carotid artery and moderate stenosis in the left internal carotid. We also detected chronic thrombotic changes in the distal left sigmoid sinus, proximal right sigmoid sinus, and bilateral jugular veins on cerebral MR‐venography. He was diagnosed with dilated cardiomyopathy at age 31 years, which was reported as a novel association; and later he had a myocardial infarction at age 34 years. To the best of our knowledge, this is the first patient with GAPO syndrome and arterial atherosclerosis in cerebral—as well as coronary—arteries ...
Males were more represented than females in our cohort (16 (57.1%) vs 12 (42.9%)). Of these 28 pa... more Males were more represented than females in our cohort (16 (57.1%) vs 12 (42.9%)). Of these 28 patients, 14 (50%) are currently undergoing treatment, 13 (46.4%) have achieved at least 95% and up to complete cure of the VOGM, and one patient (3.6%) passed away. A total of 46 thalamoperforator embolizations were performed during the treatment course of our cohort with an average of 1.64 (SD: 1.13) treatments per patient. A total of 20 patients underwent neuromuscular junction monitoring on at least one occasion to ascertain avoidance of eloquent brain in the embolization procedure. This was typically performed as a selective WADA test with a 2% Xylocaine (Lidocaine) solution and 25mg of Sodium Amytal, but has also included methohexital in later years. In one case, neuromonitoring revealed that the MEP wave disappeared for five minutes after two rounds of 2% Xylocaine and 25mg Sodium Amytol infusion. This led to termination of embolizing the thalamoperforator. Conclusion We have found that ThP and AchA embolization are feasible and effective means for achieving cure of VOGM and tectal/thalamic AVM. We report favorable, post-procedural outcomes in the majority of our patients; however, as with any embolization within the thalamic region of the brain, we maintain that caution should always be used due to the risk of stroke which we observed in one of our patients. If there is any doubt as to the safety of a given embolization, provocative testing with neuromonitoring is performed. In the case of the patient who experienced a post-procedural stroke, neuromonitoring was performed and still MEP/SEP waves were maintained after injection of amytal and lidocaine. To improve the safety of ThP and AchA embolization, we perform intraoperative neurophysiological monitoring of MEP and SEP with sodium amytal and lidocaine. We intend to expand this practice beyond VOGM and tectal/thalamic AVM into other eloquent AVMs as we have seen great success in our own clinic and in the literature. Disclosures M.
BACKGROUND AND PURPOSE: We evaluated the use of MR cisternography after intrathecal administratio... more BACKGROUND AND PURPOSE: We evaluated the use of MR cisternography after intrathecal administration of gadopentetate dimeglumine to detect the presence and localization of CSF leaks in 19 patients diagnosed with spontaneous intracranial hypotension syndrome according to the criteria of International Headache Society. MATERIALS AND METHODS: Lumbar puncture with an injection of 0.5 mL of gadopentetate dimeglumine into the subarachnoid space in the lumbar area was performed. MR images of the cervical, thoracic, and lumbar regions in axial, coronal, and sagittal planes with fat-saturated T1-weighted images were acquired. RESULTS: We observed objective CSF leakage in 17 (89%) of 19 patients. In 14 of these 17 patients, the site of dural tear was demonstrated accurately. In 3 of these 17 patients, the contrast leakage was diffuse, and site of the leak could not be located accurately. No leakage was observed in 2 patients. No complications were detected in any of the patients during the first 24 hours after the procedure or during the 6-to 12-month follow-up. CONCLUSION: The current results demonstrate the relative safety, accuracy, and feasibility of intrathecal gadolinium-enhanced MR cisternography to evaluate dural leaks.
BackgroundFlow diversion is a common endovascular treatment for cerebral aneurysms, but studies c... more BackgroundFlow diversion is a common endovascular treatment for cerebral aneurysms, but studies comparing different types of flow diverters are scarce.ObjectiveTo perform a propensity score matched cohort study comparing the Pipeline Embolization Device (PED) and Flow Redirection Intraluminal Device (FRED) for posterior circulation aneurysms.MethodsConsecutive aneurysms of the posterior circulation treated at 25 neurovascular centers with either PED or FRED were collected. Propensity score matching was used to control for age, duration of follow-up imaging, adjunctive coiling, and aneurysm location, size, and morphology; previously ruptured aneurysms were excluded. The two devices were compared for the following outcomes: procedural complications, aneurysm occlusion, and functional outcome.ResultsA total of 375 aneurysms of the posterior circulation were treated in 369 patients. The PED was used in 285 (77.2%) and FRED in 84 (22.8%) procedures. Aneurysms treated with the PED were mo...
Arterial fenestrations are associated with saccular aneurysms that are often difficult to treat w... more Arterial fenestrations are associated with saccular aneurysms that are often difficult to treat with open surgical techniques. We evaluated our experience with endovascular treatment of such aneurysms. Ten consecutive patients with 11 basilar artery aneurysms associated with fenestrations were treated with coils by means of the endovascular route between November 1994 and February 2000. All patients underwent endovascular embolization by the femoral approach, under general anesthesia. Twelve embolization procedures were perfomed in the 10 patients. Nine proximal and two distal basilar artery fenestration aneurysms were treated successfully. The embolization was complete in 10 of the 11 aneurysms. It was incomplete in one case, and complete occlusion could not be achieved at the second attempt. There was one regrowth at 1-year follow-up, which was successfully treated again. Four of the aneurysms were treated initially with balloon remodeling, whereas one aneurysm with regrowth and o...
Bu makalede, posterior serebral arter P1-P2 segmentine oturmuş geniş boyunlu anevrizmada endovask... more Bu makalede, posterior serebral arter P1-P2 segmentine oturmuş geniş boyunlu anevrizmada endovasküler tedavinin uzun dönem sonuçları bildirilmiştir. Tedavide anevrizma embolizasyonu yapmadan boyun kısmına yerleştirilen stent ile hemodinamik ...
Cavernous hemangioma (CH) is a benign vascular malformation. Intracranial CH is generally localiz... more Cavernous hemangioma (CH) is a benign vascular malformation. Intracranial CH is generally localized as an intracranial-intraaxial and responsible for 5-13% of all intracranial vascular malformations. Intracranialextraaxial CHs are rare rather than intracranial-intraaxial CHs. Clinical findings, imaging characteristics, and surgical approach of extraaxial CHs are rather different than intraaxial CHs. Diagnosing cavernous sinus CH preoperatively is very important, but its radiological differential diagnosis is quite difficult. In this study, we present magnetic resonance imaging findings of a 48-year-old male who was considered preoperatively to have meningioma but was diagnosed with cavernous sinus CH during surgery by pathological examination.
Macrocephaly-capillary malformation (M-CM) is characterized by prenatal overgrowth, variable soma... more Macrocephaly-capillary malformation (M-CM) is characterized by prenatal overgrowth, variable somatic and cerebral asymmetry, primary megalencephaly, characteristic facial features, an abnormal neurocognitive profile and cutaneous vascular malformations. It was previously known under the name macrocephaly-cutis marmorata telangiectatica congenital (M-CMTC). However a recent review of the previously reported cases has suggested that the vascular anomalies are not true CMTC but rather capillary malformations. The diagnosis is primary clinical and different criteria have been proposed for this purpose. However, M-CM is frequently associated with structural brain abnormalities that should be properly investigated and monitored because of their possible progressive development. We report the neuroradiological and morphological features observed in a girl with M-CM and we compared them with proposed diagnostic criteria found in the literature.
We present our initial experience with a newly developed endovascular stent graft technique in th... more We present our initial experience with a newly developed endovascular stent graft technique in the treatment of two patients with giant aneurysms. In both of these patients, surgery and conventional endovascular techniques were likely to fail. The technique resulted in the successful management of the aneurysms in both cases. Our technique is described, and related experiences in the literature are discussed.
Computer Methods in Biomechanics and Biomedical Engineering, 2013
This study is aimed at setting a method of experimental parameter estimation for large-deforming ... more This study is aimed at setting a method of experimental parameter estimation for large-deforming nonlinear viscoelastic continuous fibre-reinforced composite material model. Specifically, arterial tissue was investigated during experimental research and parameter estimation studies, due to medical, scientific and socio-economic importance of soft tissue research. Using analytical formulations for specimens under combined inflation/extension/torsion on thick-walled cylindrical tubes, in vitro experiments were carried out with fresh sheep arterial segments, and parameter estimation procedures were carried out on experimental data. Model restrictions were pointed out using outcomes from parameter estimation. Needs for further studies that can be developed are discussed.
BACKGROUND AND PURPOSE: Flow diversion for the posterior circulation remains a promising treatmen... more BACKGROUND AND PURPOSE: Flow diversion for the posterior circulation remains a promising treatment option for selected posterior circulation aneurysms. The Flow-Redirection Intraluminal Device (FRED) system has not been previously assessed in a large cohort of patients with posterior circulation aneurysms. The purpose of the present study was to assess safety and efficacy of FRED in this location. MATERIALS AND METHODS: Consecutive patients with posterior circulation aneurysms treated at 8 centers participating in the European FRED study (EuFRED) between April 2012 and January 2019 were retrospectively reviewed. Complication and radiographic and functional outcomes were evaluated.
primary branch while the compliant balloon can seal the aneurysm neck and temporarily occlude the... more primary branch while the compliant balloon can seal the aneurysm neck and temporarily occlude the secondary branch. Conclusion This device can improve the placement of devices, such as coils and a new generation of liquid embolics, into an aneurysm sac without blocking the parent vessel in the shortterm, nor leaving metal in the parent vessel long-term. A new stent-balloon device would allow neurointerventionalists a lessrestricted time window to deploy embolic devices and obtain a more complete aneurysm sac fill while concurrently limiting any protrusion or migration of the embolic devices downstream.
To explore the value of quantitative texture analysis of conventional magnetic resonance imaging ... more To explore the value of quantitative texture analysis of conventional magnetic resonance imaging (MRI) sequences using artificial neural networks (ANN) for the differentiation of high-grade gliomas (HGG) and low-grade gliomas (LGG). MATERIALS AND METHODS: A total of 181 patients, 97 with HGG (53.5%) and 84 with LGG (46.5%) with brain MRI having T2-weighted (W) fluid attenuation inversion recovery (FLAIR), and contrast-enhanced T1W images were enrolled in the present study. Histogram parameters and high-order texture features were extracted using manually placed regions of interest (ROIs) on T2W-FLAIR and contrast-enhanced T1W images covering the whole volume of the tumours. The reproducibility of the features was assessed by interobserver reliability analyses. The cohort was divided into training (n¼121) and test partitions (n¼60). The training set was used for attribute selection and model development, and the test set was used to evaluate the diagnostic performance of the pre-trained ANNs in discriminating HGG and LGG. RESULTS: In the test cohort, the ANN models using texture data of T2W-FLAIR and contrastenhanced T1W images achieved an area under the receiver operating characteristic curve (AUC) of 0.87 and 0.86, respectively. The combined ANN model with selected texture features achieved the highest diagnostic accuracy equating 88.3% with an AUC of 0.92. CONCLUSIONS: Quantitative texture analysis of T2W-FLAIR and contrast-enhanced T1W enhanced by ANN can accurately discriminate HGG from LGG and might be of clinical value in tailoring the management strategies in patients with gliomas.
BACKGROUND AND PURPOSE: Serpentine aneurysms are partially thrombosed aneurysms with an eccentric... more BACKGROUND AND PURPOSE: Serpentine aneurysms are partially thrombosed aneurysms with an eccentrically located tortuous intraaneurysmal vascular channel. The large size, distinctive neck anatomy, and supply of the brain parenchyma by the outflow tract pose technical challenges in treatment. The aim of this study was to discuss the endovascular treatment results and illustrate the dynamic nature of serpentine aneurysms. Spontaneous transformation of saccular and fusiform aneurysms into serpentine morphology, along with a case of serpentine-into-fusiform aneurysm transformation during follow-up, is presented. MATERIALS AND METHODS: A retrospective analysis from 3 institutions revealed 15 patients with serpentine aneurysms who underwent diagnostic evaluation and endovascular treatment. Nine of the 15 patients underwent endovascular occlusion of the parent vessel with detachable balloon or coils. Six of the 15 patients underwent aneurysm and parent artery occlusion with coiling. RESULTS: In 11 patients, improvement or resolution of symptoms was achieved by an endovascular approach without any treatmentrelated morbidity. Morbidity related to treatment in the immediate postoperative period was seen in 3 patients, with resolution of the deficits at long-term follow-up in 2 patients and persistence of a mild deficit in 1 patient. Endovascular treatment failed to achieve resolution of symptoms in a case with a basilar tip aneurysm treated by aneurysm coiling. CONCLUSIONS: Serpentine aneurysms are dynamic structures with spontaneous transformation possible from a saccular or fusiform shape into a serpentine configuration. An endovascular approach by parent vessel occlusion or intra-aneurysmal occlusion is a successful treatment technique for serpentine aneurysms.
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