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Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.

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Despite the fact that endovascular coiling has been proven to be an effective method in the treatment of cerebral aneurysms, certain types of cerebral aneurysms, particularly wide-neck, large, and fusiform aneurysms, are still considered to be challenging for endovascular treatment. 10,11 In treatment of these types of aneurysms, endovascular coiling is associated with a high recurrence rate.4 Self-expandable intracranial stents have been increasingly used to treat these challenging aneurysms with satisfying clinical and anatomical results. 9,13However, the recurrence rate remains significant. 15Recently, flow diverter (FD) devices have been introduced into neurointerventional practice. These devices provide endoluminal aneurysm occlusion by causing flow disruption.5,17 Two well-known and most commonly used FD devices are the Pipeline Embolization Device (PED; Covidien, FDA approved and CE marked) and SILK stent (Balt Extrusion, CE marked). These devices are singlelayer, low-porosity, self-expandable stents, forming highcoverage mesh that covers the aneurysm neck and then simultaneously induces thrombosis of the aneurysm sac while preserving the patency of the adjacent small vessels. Alternatively, the Flow Re- Direction Results. In all patients only 1 device was used without any additional device or material, such as a stent or coil. All procedures were successfully performed. The procedural complication rate was 3% (1 of 33). Thirty patients underwent clinical and radiological follow-up. During the follow-up period, changes in stent morphology, such as "fish mouth" and "foreshortening" phenomena, occurred in 5 patients. The mortality and permanent morbidity rates were 0%. The complete occlusion rates were 32% (6 of 19) at 0-1 month, 67% (8 of 12) at 2-3 months, 80% (4 of 5) at 4-6 months, and 100% (8 of 8) at 7-12 months. The rates for some aneurysms were assessed at more than one time point.Conclusions. The FRED has an ability to serve neurointerventionalists in the treatment of cerebral aneurysms with its different technical advantages. The occlusion rates with FRED are similar to those with other FD devices. However, these short-term results need to be confirmed with mid-and long-term follow-up results of multicenter large series.

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Brucellosis is a multisystem infection with a broad spectrum of clinical presentations. Its nervous system involvement is known as neurobrucellosis. Neurobrucellosis (NB) has neither a typical clinical picture nor specific cerebrospinal fluid (CSF) findings. Its diagnosis is based on the existence of a neurologic picture not explained by any other neurologic disease, evidenced by systemic brucellar infection and the presence of inflammatory alteration in CSF. Imaging findings of NB is divided into four categories: (1) normal, (2) inflammation (recognized by granulomas, abnormal enhancement of the meninges, perivascular space, or lumbar nerve roots), (3) white matter changes, and (4) vascular changes.