NeuroRadiology

European Society of Neuroradiology (ESNR)

Response to letter regarding "Combined aspiration thrombectomy and continuous intrasinus thrombolysis for cerebral venous sinus thrombosis: technical note and case series"

Correction to: European multicentre study on technical success and long-term clinical outcome of radiofrequency ablation for the treatment of spinal osteoid osteomas and osteoblastomas The original version of this paper contained an error: the Acknowledgements were dropped during early manuscript editing.

Letter regarding "Artery of Adamkiewicz: a meta-analysis of anatomical characteristics"

Hypothalamic malformations in patients with X-linked deafness and incomplete partition type 3 Abstract Patients with X-linked deafness carry mutations in the POU3F4 gene and have pathognomonic inner ear malformations characterised by symmetrical incomplete partition type 3 (absent modiolus and lamina spiralis but preserved interscalar septum in a normal-sized cochlea) and large internal auditory meatus (IAM) with an increased risk of gusher during stapes surgery. We describe a range of fairly characteristic malformations in the hypothalamus of some patients with this rare condition, ranging from subtle asymmetric appearance and thickening of the tuber cinereum to more marked hypothalamic enlargement. We discuss the role of POU3F4 in the normal development of both the inner ear and hypothalamus and the proposed pathophysiology of incomplete partition type 3.

Improving resolution of head and neck CTA using the small x-ray tube focal spot Abstract CT-resolution depends on tube focal spot size. To investigate the effect of reducing focal spot on vessel wall clarity, 22 patients underwent head and neck CTA acquisition with large and small focal spot size. Hounsfield density profile was assessed for each head and neck vessel separately, and significantly sharper density increase at vessel borders was observed using smaller tube focus by an average of 9.9% to 82° angle degrees (p < .05). In conclusion, spatial resolution of CTA of head and neck vessels can be improved by using the small x-ray tube focal spot.

Haemosiderin cap sign in cervical intramedullary schwannoma mimicking ependymoma: how to differentiate? Abstract A 37-year-old female presented with gradually progressive asymmetric ascending paraesthesia and weakness involving bilateral upper and lower limbs. The MRI spine images revealed expansile intramedullary, solid cystic, peripherally enhancing lesion with a haemosiderin cap along the lower margin. The lesion extended into the left C5 and C6 nerve root exit zones, along with thickening and enhancement of the nerve roots. She underwent excision of the lesion, which revealed intramedullary schwannoma on histopathological examination. Presence of the cap, an extension of the lesion into the nerve root exit zone, with associated thickening and enhancement of the dorsal nerve roots should alert the radiologist to consider the possibility of intramedullary schwannoma rather than ependymoma. Schwannoma showing compact Antoni A area with Schwannian whorls and nuclear palisades (A,B) and loose Antoni B area with haemosiderin pigment (C). The tumour exhibits diffuse positivity for S-100 protein (D) and negativity for GFAP (E). [Stain: A-C: Haematoxylin and Eosin; D,E: Immunoperoxidase. Magnification = Scale Bar, A-E: 100μm]

Reply by Tomaszewski et al. to the letter by Jiang et al. regarding "Artery of Adamkiewicz: a meta-analysis of anatomical characteristics"

Letter regarding "Combined aspiration thrombectomy and continuous intrasinus thrombolysis for cerebral venous sinus thrombosis: technical note and case series"

Artery of Adamkiewicz: a meta-analysis of anatomical characteristics Abstract Purpose The artery of Adamkiewicz (AKA) provides the major blood supply to the anterior thoracolumbar spinal cord and iatrogenic injury or inadequate reconstruction of this vessel during vascular and endovascular surgery can result in postoperative neurological deficit due to spinal cord ischemia. The aim of this study was to provide comprehensive data on the prevalence and anatomical characteristics of the AKA. Methods An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included study type, prevalence of the AKA, gender, number of AKA per patient, laterality, origin based on vertebral level, side of origin, morphometric data, and ethnicity subgroups. Results A total of 60 studies (n = 5437 subjects) were included in the meta-analysis. Our main findings revealed that the AKA was present in 84.6% of the population, and patients most frequently had a single AKA (87.4%) on the left side (76.6%) originating between T8 and L1 (89%). Conclusion As an AKA is present in the majority of the population, caution should be taken during vascular and endovascular surgical procedures to avoid injury or ensure proper reconstruction. All surgeons operating in the thoracolumbar spinal cord should have a thorough understanding of the anatomical characteristics and surgical implications of an AKA.

Alexandros Sfakianakis
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alsfakia@gmail.com