E ndoscopic third ventriculostomy (ETV) is a minimally invasive, safe, and relatively new CSF diversion method; it is mostly used in aqueductal stenosis, but may also be indicated in the treatment of other causes of hydrocephalus.1 With this procedure the inferior wall of the third ventricle is fenestrated, and CSF in the ventricular system is diverted into the prepontine cisternthereby bypassing the obstruction-and CSF circulation is reestablished. 4,7 It is a more physiological treatment option compared with shunt procedures, and therefore it is being done with increasing frequency. 4,7,10 Clinical, laboratory, and conventional imaging findings may be useful to determine whether the ETV stoma is patent, although advanced radiological methods are mostly required. 2,6 Ventriculography is a gold-standard technique for determination of ETV patency. 4 On the other hand, abbreviatioNs ETV = endoscopic third ventriculostomy; PC = phase-contrast cine; T1W, T2W = T1-, T2-weighted; 3D-SPACE = 3D sampling perfection with application-optimized contrasts using different flip-angle evolutions. obJect The goal of this study was to determine the value of the 3D sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) technique in the evaluation of endoscopic third ventriculostomy (ETV) patency. methods Twenty-six patients with ETV were examined using 3-T MRI units. Sagittal-plane 3D-SPACE with variant flip-angle mode, 3D T1-weighted (T1W), and 3D heavily T2-weighted (T2W) images were obtained with isotropic voxel sizes. Also, sagittal-axial plane phase-contrast cine (PC)-MR images were obtained. The following findings were evaluated: diameters of stoma and third ventricle, flow-void sign on 3D-SPACE and PC-MR images, integrity of the third ventricle on heavily T2W images, and quantitative PC-MRI parameters of the stoma. Obtained sequences were evaluated singly, in combination with one another, and all together. results The mean area, flow, and velocity values measured at the level of stoma in patients with patent stoma were significantly higher than those measured in patients with closed stoma (p < 0.05). There was significant correlation among PC-MRI, 3D-SPACE, and 3D heavily T2W techniques regarding assessment of ETV patency (p < 0.001). The 3D-SPACE technique provided the lowest rate of ambiguous results. coNclusioNs The 3D-SPACE technique seems to be the most efficient one for determination of ETV patency. The authors suggest the use of 3D-SPACE as a stand-alone first-line sequence in addition to routine brain MRI protocols in assessing patients with ETV, thereby decreasing scan time and reserving the use of a combination of additional sequences such as PC-MRI and 3D heavily T2W images in suspicious or complex cases.
AIm: Piriformis syndrome is a rare neuromuscular disorder that occurs when the piriformis muscle compresses or irritates the sciatic nerve. The treatment of piriformis syndrome includes injections into the piriformis muscle around the sciatic nerve. These invasive approaches have been used with various techniques to increase the safety of the procedure. Computed tomography (CT)-guided injection of the piriformis muscle and the clinical outcome of the patients are discussed. mAterIAl and methOds: The authors presented 10 consecutive patients that underwent CT-guided piriformis injection between March and December 2007. Three patients had a history of a severe fall on the buttocks, one had gluteal abscess formation following deep intramuscular injection, and another one had a habit of prolonged sitting on the carpet. Etiology was not identified in the other patients. Main complaints of the patients were pain and numbness in the legs. Hypesthesia was the major neurological finding. Magnetic resonance imaging (MRI) and electromyography (EMG) were performed in all patients. results: Nine patients had full and sustained recovery of their symptoms after piriformis injection. Only the patient who had gluteal abscess formation following deep intramuscular injection showed moderate improvement. Another patient was operated on in the 6th month after piriformis injection due to an extruded disc herniation.COnClusIOn: CT-guided piriformis injection is a safe and effective method in the treatment of piriformis syndrome. KeywOrds:Computed tomography, Piriformis syndrome, Sciatica, Treatment ÖZ AmAÇ: Piriformis sendromu, piriformis kasının siyatik sinire bası ya da irritasyonu sonucu, kalçada ve siyatik sinir trasesi boyunca yayılan ağrıya neden olan nadir bir nöromusküler sendromdur. Tedavisinde piriformis kasına ve siyatik sinir çevresine enjeksiyonlar yapılmaktadır. Bu invazif girişimler çoğunlukla işlemin güvenliğini arttıracak farklı teknikler kullanılarak yapılmaktadır. Bu makalede, bilgisayarlı tomografi (BT) eşliğinde piriformis enjeksiyonu yapılan hastalar ve prognozları tartışılmıştır. yÖntem ve GereÇler: Yazarlar Mart-Kasım 2007 tarihleri arasında BT eşliğinde piriformis enjeksiyonu yapılmış on hastayı sunmaktadır. Üç hastada yüksekten kalça üzerine düşme, bir hastada intramüsküler enjeksiyonu takiben abse gelişimi, bir hastada da sert yerde uzun sureli oturma alışkanlığı öyküleri mevcuttur. Diğer hastalarda etiyoloji belirlenememiştir. Başlıca yakınma bacaklarda ağrı ve uyuşmadır. Hipoestezi ana nörolojik bulgudur, Tüm hastalara lomber manyetik rezonans (MR) ve elektromyonörografi (EMG) yapılmıştır.BulGulAr: Dokuz hastada piriformis enjeksiyonu sonrası uzun süreli belirgin iyileşme görülmüştür. İntramüsküler enjeksiyonu takiben abse gelişimi öyküsü olan hasta orta derecede fayda görmüştür. Bir başka hasta da piriformis enjeksiyonundan 6 ay sonra lomber disk hernisi nedeniyle opere edilmiştir.sOnuÇ: BT-eşliğinde piriformis enjeksiyonu bu sendromun tedavisinde etkili ve güvenilir bir yöntemdir.
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