Our retrospective study confirms that morbidity and mortality rates in treatment with FDD of unruptured wide-neck or untreatable cerebral aneurysms do not differ from those reported in the largest series.

Recent clinical trials demonstrated that mechanical thrombectomy (MT) using second-generation endovascular devices has beneficial effects in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, it remains controversial if intravenous thrombolysis (IVT) prior to MT is superior compared to direct mechanical thrombectomy (DMT). The aims of this study were to compare short and long-term outcomes between IVT + MT and DMT patients. We prospectively recruited AIS patients with LVO in the anterior or posterior circulation eligible for MT with and without prior IVT. Modified Rankin Scale (mRS) and mortality were assessed at baseline, at discharge, 90-days and 1-year after stroke. Favorable outcome was defined as a mRS score ≤2. Of the 66 patients included, 33 (50%) were in IVT + MT group and 33 (50%) were in DMT group. Except for a higher prevalence of patients using anticoagulants at admission in DMT group, baseline characteristics did not differ in the two groups. Procedural characteristics were similar in IVT + MT and DMT group. Rate of favorable outcome was significantly higher in IVT + MT patients than DMT ones both 90-days (51.5 vs. 18.2%; p = 0.004) and 1-year (51.5 vs. 15.2%; p = 0.002) after stroke. DMT patients were six times more likely to die during the 1-year follow-up compared to IVT + MT patients. This study suggests that bridging therapy may improve short and long-term outcomes in patients eligible for endovascular treatment. Further studies with larger patient numbers and randomized design are needed to confirm our findings.

The temporary balloon occlusion technique is useful and improves the safety of the unavoidable exposure of the parent artery in the surgical treatment of giant paraclinoid and vertebrobasilar aneurysms.

RIASSUNTO -Scopo di questo lavoro è valutare l'efficacia dell'ossigeno-ozono terapia intra-foraminale nel trattamento del dolore lombare. Dal Gennaio 1997 al Dicembre 1999, sono stati trattati 407 pazienti con infiltrazione intra-foraminale. Le patologie di più frequente riscontro sono rappresentate dall'ernia del disco, eventualmente aggravata da artrosi delle faccette articolari o da stenosi del canale vertebrale, e dalla fibrosi post-chirurgica; dal punto di vista clinico i pazienti presentavano lombalgia pura o irradiazione radicolare del dolore arto inferiore. L'analisi del risultato è stata effettuata con controllo telefonico e/o clinico, a tre o quattro settimane dal trattamento e con il questionario di McGill sec. R. Melzack per la valutazione del dolore. I risultati migliori (superiori all'80%) sono stati ottenuti nei pazienti affetti da lombalgia, da ernie di piccole dimensioni e da fibrosi post-chirurgica. I dati ottenuti ci consentono di considerare l'ossigeno-ozono terapia intra-foraminale come un'arma potente per sconfiggere il dolore lombare, in modo relativamente semplice, efficace e sicuro. Intraforaminal Oxygen-Ozone TherapySUMMARY -Our aim was to evaluate the efficiency of the oxygen-ozone intraforaminal injection in the treatment of the lumbar pain. From January '97 to December '99 we evaluated 407 patients, all treated with intraforaminal injection of a O 2 -O 3 gas mixture at 30 µg/ml concentration. Patients were affected with small hernia, intrarticular arthrosis, post-surgical fibrosis and canal stenosis. Outcome was analysed with the McGill pain degree scale and with an interview on the clinical condition 3-4 weeks after the injection. The results were very good (over 80%) especially in the small hernia and in post-surgical fibrosis. The mean of re-injection was 14. 40%. Data analysis lead us to use this technique as a routine low back pain treatment. O 2 -O 3 intra-foraminal injection is a very good tool, with low risk and high benefits. IntroduzioneScopo di questo lavoro è valutare l'efficacia dell'ossigeno-ozono terapia intra-foraminale, dei suoi effetti sul dolore in diverse patologie: conflitto disco-radicolare, sindrome faccette articolari intervertebrali, flogosi radicolare, dolore da interessamento del ganglio spinale o neurodocite; viene inoltre fatto un confronto con altre metodiche terapeutiche percutanee al fine di confrontare l'efficacia dell'ozono terapia intra-foraminale.Il conflitto disco-radicolare si genera inseguito ad una rottura dell'equilibrio tra disco e radice nervosa; la causa ovvero il disco può essere rimosso con diverse terapie: Chirurgia, Trattamenti Percutanei (Chemonucleolisi, Nucleoaspirazione Discale), oltre che rimuovere la causa si può curare, esclusivamente, il "sintomo dolore" con svariate terapie: medica o fisioterapica, TENS, agopuntura, terapia fisica, iniezione di corticosteroidi nel forame radicolare, ossigeno-ozono terapia intra-foraminale. Presso l'U.O. di Neuroradiologia e-

Parkinson’s disease (PD) is a progressive neurodegenerative disorder, characterized by motor and non-motor symptoms due to the degeneration of the pars compacta of the substantia nigra (SNc) with dopaminergic denervation of the striatum. Although the diagnosis of PD is principally based on a clinical assessment, great efforts have been expended over the past two decades to evaluate reliable biomarkers for PD. Among these biomarkers, magnetic resonance imaging (MRI)-based biomarkers may play a key role. Conventional MRI sequences are considered by many in the field to have low sensitivity, while advanced pulse sequences and ultra-high-field MRI techniques have brought many advantages, particularly regarding the study of brainstem and subcortical structures. Nowadays, nigrosome imaging, neuromelanine-sensitive sequences, iron-sensitive sequences, and advanced diffusion weighted imaging techniques afford new insights to the non-invasive study of the SNc. The use of these imaging methods, alone or in combination, may also help to discriminate PD patients from control patients, in addition to discriminating atypical parkinsonian syndromes (PS). A total of 92 articles were identified from an extensive review of the literature on PubMed in order to ascertain the-state-of-the-art of MRI techniques, as applied to the study of SNc in PD patients, as well as their potential future applications as imaging biomarkers of disease. Whilst none of these MRI-imaging biomarkers could be successfully validated for routine clinical practice, in achieving high levels of accuracy and reproducibility in the diagnosis of PD, a multimodal MRI-PD protocol may assist neuroradiologists and clinicians in the early and differential diagnosis of a wide spectrum of neurodegenerative disorders.

Brain abscesses (BAs) are focal infections of the central nervous system (CNS) that start as a localised area of weakening of the brain parenchyma (cerebritis) and develops into a collection of pus surrounded by a capsule. Pyogenic (bacterial) BAs represent the majority of all BAs; in some cases, the diagnostic and therapeutic management can be challenging. Imaging has a primary role in differentiating BAs from other lesions. Conventional magnetic resonance imaging (cMRI) is essential for the identification of the lesion, its localisation and its morphological features. However, cMRI does not allow to reliably Cerebral abscesses imaging: A practical approach

No abstract

The evaluation of the isocitrate dehydrogenase (IDH) mutation status in the glioma decision-making process has diagnostic, prognostic and therapeutic implications. The aim of this study was to evaluate whether conventional magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) can noninvasively predict the most common IDH mutational status (R132H) in GIII-astrocytomas and the overall survival (OS). Hence, twenty-two patients (9-F, 13-M) with a histological diagnosis of GIII-astrocytoma and evaluation of IDH-mutation status (12-wild type, 10-mutant) were retrospectively evaluated. Imaging studies were reviewed for the morphological feature and mean ADC values (ADCm). Statistics included a Fisher’s exact test, Student’s t-test, Spearman’s Test and receiver operating characteristic analysis. A p ≤ 0.05 value was considered statistically significant for all the tests. A younger age and a frontal location were more likely related to mutational status. IDH-wild type (Wt) exhibited a slight enhancement (p = 0.039). The ADCm values in IDH-mutant (Mut) patients were higher than those of IDH-Wt patients (p < 0.0004). The value of ADC ≥ 0.99 × 10−3 mm2/s emerged as a “cut-off” to differentiate the mutation state. In the overall group, a positive relationship between the ADCm values and OS was detected (p = 0.003; r = 0.62). Adding quantitative measures of ADC values to conventional MR imaging could be used routinely as a noninvasive marker of specific molecular patterns.