Dural arterio-venous fistulas of the middle cranial fossa may occur within the dura of lesser or greater sphenoid wings. Lesser sphenoid wing fistulas rarely recruit cortical venous drainage and mostly drain in the cavernous sinus. On the other hand, greater sphenoid wing dural fistulas, also known as paracavernous fistulas or sphenobasilar and sphenopetrosal sinus fistulas, are much more notorious as they almost always connect with the superficial middle cerebral vein resulting in secondary cortical venous reflux and varix formation. Curative transarterial or transvenous endovascular embolisation of fistulous connection is the primary therapeutic strategy, particularly using onyx via the transarterial approach. In the present case we describe a 62-year-old man who presented with significant subarachnoid haemorrhage, intraparenchymal and intra-ventricular bleed. Digital subtraction angiography showed a middle cranial fossa dural arteriovenous fistula in the region of the sphenobasilar sinus with cortical venous reflux and varix formation. The patient underwent successful transarterial endovascular embolisation with complete elimination of the fistula using onyx 34, onyx 18, squid 12 and a Scepter XC balloon using the pressure cooker technique. We also report the development of facial nerve palsy due to inadvertent reflux of onyx in the petrosal branch of the middle meningeal artery.

Study Design: A cross-sectional study. Background: To document dimensions of the lumbar vertebrae and bony canal in an Indian population and to compare with other studies from the subcontinent as well as from other parts of world.Methods: An observational study was conducted on the basis of a review of thin-cut (3 mm) computed tomographic images of lumbar vertebrae. A total of 302 patients were studied, and various dimensions were analyzed.Results: In general, the vertebral and bony spinal canal dimensions were found to be greater in male patients. Comparison of populations revealed statistically significant differences in the spinal canal between an Indian population and others.Overview of Literature: Lumbar canal stenosis is a condition in which the anteroposterior and lateral dimensions of the bony spinal canal are less than normal for corresponding age and sex. Numerous studies have been conducted to determine morphometry of the lumbar vertebrae and spinal canal, mostly in western populations, using fresh cadaver or osteologic specimens. These studies did not mention the difference between the vertebral parameters in men and women. Moreover, many of these studies have limitations such as a small sample size and lack of demographic data including race, age, and sex. In this study, we have conducted morphometric analysis of the lumbar vertebrae in a relatively large number of Indian patients by using computed tomography scan. The morphometric data thus compiled may provide a baseline of body and canal dimensions that could guide clinical experts in their practice.Conclusions: The dimensions of the lumbar vertebrae and bony canal thus obtained shall provide a baseline normative data for evaluation of patients presenting with low backache and lumbar canal stenosis in an Indian population. Lumbar Spine

Rete MCA anomaly is extremely rare and has been seldomly discussed in literature. Embryologically MCA develops by fusion of multiple twigs which form a single channel. If there is failure to fuse a plexiform network of vessels persists known as rete MCA. This web like network of vessels is at high risk of haemorrhagic stroke and therefore for patients presenting incidentally correct diagnosis is paramount. Here we report a case of rete MCA anomaly in a 35-year-old gentle man who presented with a large haemorrhagic stroke in emergency. DSA showed unilateral involvement of proximal MCA, and otherwise normal intra-cranial vasculature. With this report we aim to correctly diagnose this rare condition and avoid misdiagnosis leading to unnecessary treatments.

A BSTRACT Objective: Tuberculosis continues to be a major infectious disease in developing parts of the world. Primarily central nervous system tuberculosis manifests as meningitis, tuberculoma, or a brain abscess; however, rarely it may manifest as a large neoplastic mass such as lesion known as giant tuberculoma. Especially in central parts of India, the incidence of giant tuberculoma is quite high in pediatric population that too in posterior fossa of brain. Often, they are wrongly reported as neoplastic masses on imaging. The objective of this study was to evaluate different imaging appearances of a giant tuberculoma. Materials and Methods: In this prospective study, all cases of giant tuberculoma presenting to a large tertiary care center in central India for 2 years (duration 2016–2018) were imaged and followed up. A total of nine patients, six females and three males, aged 4–16 years were studied on a 3-Tesla Siemens magnetic resonance imaging (MRI) scanner. Results: In total, nine patients were included with 11 giant tuberculomas. Of 11, eight were infratentorial and three were supratentorial in location. On T2-weighted image sequence, these lesions showed central hypointensity with a peripheral hyperintense rim. Most observed finding on T1-weighted image sequence was central isointensity with peripheral hyperintense rim. Advanced imaging sequences such as magnetic resonance spectroscopy and magnetization transfer were also applied. Conclusion: To the best of our knowledge, this is the largest series of giant tuberculoma in the pediatric population reported so far in any part of the world. We have described the various MRI imaging findings of this lesion in great details. Management of such rare cases and pertinent literature is reviewed briefly.

Purpose Several studies have been conducted to determine morphometry of lumbar vertebrae, mostly in western population and data on other populations is relatively sparse. Most of these studies have been carried out using fresh cadavers or osteological collections and several of them having limitations such as a small sample size and lack of demographic information. We conducted morphometric analysis of the lumbar vertebrae in a relatively large number of Indian patients using computed tomography scan. Vertebral body and pedicle dimensions of lumbar spinal elements were documented in Indian population and compared with other studies from the subcontinent as well as from other parts of the world. The morphometric data thus compiled may help in the development of new spinal implants for transpedicular screw fixations. Methods An observational study was conducted and a total of 302 patients were evaluated. Thin section computed tomographic images of the 12th thoracic vertebra (D12) to 1st sacral vertebra (S1) were acquired and various dimensions of vertebral body and pedicle were recorded and analyzed. Results Generally, the lumbar vertebral and pedicle dimensions were found to be greater in male patients. Comparison of dimensions in different populations revealed statistically significant differences in pedicle dimensions between Indian population and others. Conclusion Morphometric analysis of lumbar vertebrae using computed tomography scan provides measurements of different vertebral dimensions. This will help in development of spinal implants in future to meet the specific needs of the studied population.

We report a case of a 4-year-old boy who presented with moyamoya disease associated with midaortic syndrome. He had been treated for severe persistent hypertension until he suffered multiple episodes of seizure and cerebral ischemic attack. Cerebral angiography showed bilateral terminal internal carotid artery stenosis. Angiographic survey showed severe stenosis of abdominal aorta and bilateral proximal renal arteries. This is a very rare report of moyamoya disease with midaortic syndrome.

Arachnoiditis ossificans (AO) is a rare disorder characterized by calcification of arachnoid membranes first described by Kaufman and Dunsmore in 1971. It is a very rare cause of spinal canal stenosis leading to neurological compromise presenting with progressive lower extremity myelopathy. It has been described to be a sequela of various conditions previous intradural surgery, myelograms, vascular malformations and adhesive arachnoiditis. Associated conditions may include syringomyelia. The imaging findings on MRI may be confusion. Preferred diagnostic method is non contrast computed tomography (CT). Surgical intervention is still controversial and can include decompression. The authors report the case of 48 years female presenting with gradually progressing paraparesis. Magnetic resonance imaging of the spine revealed a spinal cord syrinx but with an extramedullary intradural hypo-intensity. A computed tomography scan clearly demonstrated the abnormality and its extent. We present a unique case of syringomyelia resulting from spinal arachnoiditis ossificans and review the relevant literature. This case reports a unique presentation of arachnoiditis ossificans with syringomyelia in which etiology is not clear. We also highlight the difficulty is diagnosis on MRI and need of non-contrast CT.