Pediatric tibial shaft and distal metaphyseal fractures

Objectives: This study aims to investigate the effects of associated factors like age, fracture level, accompanying fibular fractures and wound condition on healing by determining and comparing union scores of pediatric tibial fractures (PTFs). Patients and methods: Forty-five patients with 46 PTFs (32 males. 13 females: mean age 9.5 years: range 2 to 16 years) who were treated by closed reduction and casting or operated between January 2016 and January 2019 were retrospectively evaluated. The union scores were evaluated at the end of fourth. sixth and eighth weeks and compared to each other. Effects of the age, associated fibular fractures. wound condition. fracture level and treatment type to union score were analyzed. Results: Twenty-eight (60.9%) out of 46 PTFs had associated fibular fractures and 18 (39.1%) did not. Motor vehicle accident was the most frequent etiologic factor (47.8%). Thirty-four out of 46 fractures were closed tibial fractures (73.9%) and 12 had open wound (26.1%). There was a negative correlation between age and the union scores (p<0.001 for each week). No significant difference was observed between the union score of diaphyseal and metaphyseal fractures at the fourth. sixth. and eighth weeks. The union scores of each week were higher in the conservative group compared to operative group (p<0.001 for each week). Associated fibular fracture group had lower union scores compared to isolated tibial fracture group at fourth. sixth and eighth weeks. Likewise, the union scores of the open fracture group were lower than the closed fracture group (p<0.05 for each week). Conclusion: Associated fibular fractures, open fractures and aging negatively affect union scores of PTFs. Attention should be paid. particularly in these conditions. during the selection of the operation type and the follow-up period of PTFs

Safety and Efficacy of the FRED Jr Flow Re-Direction Endoluminal Device for Intracranial Aneurysms: Retrospective Multicenter Experience With Emphasis on Midterm Results

Background and Purpose: Flow diversion is increasingly used as an endovascular treatment for intracranial aneurysms. In this retrospective multicenter study, we analyzed the safety and efficacy of the treatment of intracranial, unruptured, or previously treated but recanalized aneurysms using Flow Re-Direction Endoluminal Device (FRED) Jr with emphasis on midterm results. Materials and Methods: Clinical and radiological records of 150 patients harboring 159 aneurysms treated with FRED Jr at six centers between October 2014 and February 2020 were reviewed and consecutively included. Clinical outcome was measured by using the modified Rankin Scale (mRS). Anatomical results were assessed according to the O’Kelly-Marotta (OKM) scale and the Cekirge-Saatci Classification (CSC) scale. Results: The overall complication rate was 24/159 (16%). Thrombotic-ischemic events occurred in 18/159 treatments (11%). These resulted in long-term neurological sequelae in two patients (1%) with worsening from pre-treatment mRS 0–2 and mRS 4 after treatment. Complete or near-complete occlusion of the treated aneurysm according to the OKM scale was reached in 54% (85/158) at 6-month, in 68% (90/133) at 1-year, and in 83% (77/93) at 2-year follow-up, respectively. The rates of narrowing or occlusion of a vessel branch originating from the treated aneurysm according to the CSC scale were 11% (12/108) at 6-month, 20% (17/87) at 1-year, and 23% (13/57) at 2-year follow-up, respectively, with all cases being asymptomatic. Conclusions: In this retrospective multicenter study, FRED Jr was safe and effective in the midterm occlusion of cerebral aneurysms. Most importantly, it was associated with a high rate of good clinical outcome

Fused magnetic resonance angiography and 2D fluoroscopic visualization for endovascular intracranial neuronavigation Technical note

Advanced transluminal neurovascular navigation is an indispensable image-guided method that allows for real-time navigation of endovascular material in critical neurovascular settings. Thus far, it has been primarily based on 2D and 3D angiography, burdening the patient with a relatively high level of iodinated contrast. However, in the patients with renal insufficiency, this method is no longer tolerable due to the contrast load. The authors present a novel image guidance technique based on periprocedural fluoroscopic images fused with a preinterventionally acquired MRI data set. The technique is illustrated in a case in which the fused image combination was used for endovascular treatment of a giant cerebral aneurysm. (http://thejns.org/doi/abs/10.3171/2012.11.JNS111355

Teaching NeuroImages: A rare cause of trigeminal neuralgia Dysplastic venous aneurysm of dural arteriovenous fistula

A 56-year-old man presented with episodic intense facial pain. Trigeminal neuralgia was the presumed diagnosis. MRI revealed vascular compression of the root entry zone (REZ) of the trigeminal nerve (TN) (figure 1, A and B). A dural arteriovenous fistula was detected at the left side of the cerebellar tentorium on digital subtraction angiography (figure 2). A dysplastic venous aneurysm of the draining vein was determined to be the compressive vascular lesion seen on MRI. Trigeminal neuralgia is a common neuropathic disorder characterized by episodes of intense facial pain, most often because of a vascular compression of the REZ of the TN.(1,2</SUP

Endovascular Treatment of Aneurysms Associated with Fenestrated A1 Segment of Anterior Cerebral Artery: Report of Two Cases

Fenestration in A1 segment of anterior cerebral artery is a rare entity. Treatment of aneurysms derived from a fenestrated artery may be more challenging because the fenestrations provide specific difficulties. A thorough radiologic work-up driven by high clinical suspicion is needed. Endovascular treatment, although it has been tried only once,7 appears to be the treatment of choice. We successfully treated 2 cases using endovascular techniques and can conclude that endovascular treatment is a safe and effective treatment of aneurysms associated with this rare variation in the A1 segment of ACA

Dissecting aneurysms of posterior communicating artery itself: anatomical, diagnostic, clinical, and therapeutical considerations

Posterior communicating artery (PCoA) itself is an unusual location for intracranial aneurysms in that isolated dissections or dissecting aneurysms are extremely rare. In the way of correct diagnosis of dissecting aneurysms of PCoA itself, a proper understanding of (1) the anatomy of the PCoA and its perforator branches, (2) some particular diagnostic features, and (3) related clinical aspects is of significant importance. Although there are no established treatment strategies for this particular type of aneurysms, the endovascular approach might be considered as a plausible one. In this paper, our scope was to report five cases with dissecting aneurysm of the PCoA itself and to discuss this rare vascular pathology from anatomical, diagnostic, clinical, and therapeutical perspectives

Combined endovascular and surgical treatment of fusiform aneurysms of the basilar artery: technical note

To present the combined treatment of fusiform basilar artery aneurysms consisting of a surgical posterior fossa decompressive craniectomy and ventriculoperitoneal (VP) shunt operation at the same sitting, before the endovascular procedure with telescopic stenting of the aneurysmatic vessel segment in four cases

Detection of wall and neck calcification of unruptured intracranial aneurysms with flat-detector computed tomography

Object Microsurgical clipping is a widely used surgical technique in intracranial aneurysm treatment. It can be difficult in large sized aneurysms, and those with wide necks, thick walls and calcification located in the vicinity of the neck. This study reviewed calcification of the intracranial aneurysm wall and its relation to patient age, gender, location and size of the aneurysm. A possible cut-off value after which the aneurysm calcification rate increases was also investigated to classify patients' risk factors for microclipping

Cavernous hemangioma of the cavernous sinus misdiagnosed as a meningioma: a case report and MR imaging findings

Cavernous hemangioma (CH) is a benign vascular malformation. Intracranial CH is generally localized as an intracranial-intraaxial and responsible for 5-13% of all intracranial vascular malformations. Intracranial-extraaxial CHs are rare rather than intracranial-intraaxial CHs. Clinical findings, imaging characteristics, and surgical approach of extraaxial CHs are rather different than intraaxial CHs. Diagnosing cavernous sinus CH preoperatively is very important, but its radiological differential diagnosis is quite difficult. In this study, we present magnetic resonance imaging findings of a 48-year-old male who was considered preoperatively to have meningioma but was diagnosed with cavernous sinus CH during surgery by pathological examination. (C) 2013 Elsevier Inc. All rights reserved