Preoperative use of the Onyx liquid embolic system in cerebral AVM treatment allows profound occlusion by targeted embolization and provides a basis for safe neurosurgical resection.

Background and Purpose-Recanalization in dural sinus thrombosis (DST) has been observed previously; however, systematic prospective data are lacking. The influence of recanalization on DST outcome has not yet been thoroughly evaluated. Methods-Thirty-seven consecutive patients with DST were prospectively examined. Neurological deficits were graded with the National Institutes of Health Stroke Scale (NIHSS) on hospital admission and discharge. Functional outcome was assessed with the modified Rankin Scale (mRS) on hospital discharge and after 12 months. All patients were treated with intravenous heparin in the acute stage of illness, followed by oral anticoagulation for 12 months. Imaging follow-up with MR angiography and, in a few cases, with CT or conventional angiography was performed on hospital discharge and after 6 and 12 months. Results-Twelve-month functional outcome was excellent in 89% of patients with an mRS of 0 or 1. A recanalization rate of 60% was already observed on hospital discharge (22Ϯ6 days); thereafter, recanalization rates increased insignificantly. Early recanalization was not related to NIHSS score on hospital discharge or an mRS of 0 on discharge or after 12 months. Conclusions-We found a high frequency of early recanalization but without influence on clinical outcome parameters.Frequent imaging follow-ups in DST are not useful because they provide no information on patient outcome.

BackgroundCerebral venous thrombosis (CVT) is a disease with a wide spectrum of symptoms and severity. In this study we analysed the predictive value of clinical signs and symptoms and the contribution of D-dimer measurements for diagnosis.MethodsWe evaluated consecutive patients admitted with suspected CVT receiving non-invasive imaging. Symptoms and symptom combination as well as D-dimer levels were evaluated regarding their diagnostic value.Results239 patients were included in this study, 170 (71%) were females. In 39 patients (16%) a CVT was found. For identifying a CVT patients underwent either a venous CT-angiography or MR-angiography or both. No combination of symptoms either alone or together with the D-dimer measurements had a sensitivity and positive predictive value as well as negative predictive value and specificity high enough to serve as red flag. D-dimer testing produced rates of 9% false positive and of 24% false negative results. For D-dimer values a Receiver Operating Characteristic curve (ROC) and the area under the curve (AUC = 0.921; CI: 0.864 - 0.977) were calculated. An increase of sensitivity above 0.9 results in a relevant decrease in specificity; a sensitivity of 0.9 matches a specificity value of 0.9. This corresponds to a D-dimer cut-off level of 0.16 μg/ml.ConclusionImaging as performed by venous CT-angiography or MR-angiography has a 1 to 2 in 10 chance to detect CVT when typical symptoms are present. D-dimer measurements are of limited clinical value because of false positive and negative results.

BACKGROUND AND PURPOSE:Flow diverters for the treatment of posterior circulation aneurysms remain controversial. We aimed to identify factors contributing to outcome measures in patients treated with the Surpass flow diverter for aneurysms in this location.

Background and Purpose: The aim of this study was to evaluate our first results using a new device for mechanical thrombectomy in patients with acute basilar artery occlusion. Methods: Between May 2009 and September 2010 a new device for aspiration thrombectomy (The Penumbra System™; Penumbra Inc., Alameda, Calif., USA) was used in 12 patients with acute basilar artery occlusion. We performed a retrospective review of these patients’ medical records. Results: One patient received endovascular treatment without intravenous (IV) thrombolysis because of infarction on the initial CT scan. Eleven of 12 patients received IV thrombolysis with rtPA followed by endovascular thrombectomy according to a bridging concept. After thrombolysis, the basilar artery was patent in 1 patient (9%), partially recanalized in 3 (27%) and still occluded in 7 (64%). The endovascular device could not access in 2 patients (17%). Among the remaining 10 patients, the patency rate after thrombectomy was 100%. The overall patency rate after treatment was 9 of 12 (75%) at the time of discharge. National Institute of Health Stroke Scale improved from a median of 27 to a median of 18 after treatment. Four patients died (33%). The survivors had a mean modified Rankin Scale before discharge of 2.3 (range 0–4). Conclusions: A bridging therapy with the combination of IV thrombolysis with recombinant tissue plasminogen activator and continuous aspiration thrombectomy seems to be a promising therapy strategy for acute basilar artery occlusion. Furthermore, our results confirm the advantage of the additional use of this new thrombectomy device, working with thrombus aspiration, with a satisfactory patency rate and a good clinical outcome.

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We report a case of symptomatic epidural lipomatosis in a 36-year-old man following a heart lung transplant and 3.5 years of steroid medication. A review of the pertinent literature emphasises the importance of including this diagnosis in the differential diagnosis of patients receiving steroid medication or markedly obese patients with back pain or symptoms suggesting spinal cord or cauda equina compression.

solution consisting of the embolic component and the tantalum powder. The microcatheter is flushed with saline and subsequently after the dead space volume is filled with 0.23 to 0.26 ml of pure DMSO depending on witch catheter is deployed (Ultraflow TM or Marathon TM , Micro Therapeutics, Inc., Irvine, CA). It is important to follow these steps very carefully in order to avoid unintentional precipitation of Onyx, which immediately begins when there is contact to water, saline solution or blood. Therefore, the catheter hub requires to be flushed with DMSO also. After the air-bubble-free aspiration of the Onyx in a dedicated syringe, the syringe is connected to the microcatheter producing a clear interface between Onyx and DMSO by positioning the syringe vertically immediately after the connection or, more simply, by using a special Interface-Adapter. Application of Onyx LD in central AVMs The most important factor for successful embolization of cerebral or spinal AVMs is the intranidal positioning of the microcatheter (figure 1). Beside clinical experiences experimental data using a hydraulic pump model or the rete mirabile 14 of the swine also clearly demonstrat-Preparation of Onyx liquid embolic system The ready-to-use vials of Onyx LD (1,5 ml) are placed on a mixer and have to be shaken for at least 20 minutes to obtain a homogenous