Table of Contents
Editorials
Perspectives
Editorial
Review Articles
Methodologic Perspectives
Practice Perspectives
- Attitudes about Medical Malpractice: An American Society of Neuroradiology Survey
An email survey yielded over 900 responses from neuroradiologists with regard to their experiences and attitudes about the medicolegal environment. Nearly one-half of neuroradiologists had been sued once, while over 10% had been sued more than 3 times with payouts in the range of US $50,000–$150,000 and up to $1.2 million for lawsuits affecting interventional neuroradiologists. Over 80% of neuroradiologists opined that the system was weighted toward plaintiffs and nearly 20% expressed being extremely concerned about being sued.
Patient Safety
Health Care Reform Vignette
Brain
- DWI Reversal Is Associated with Small Infarct Volume in Patients with TIA and Minor Stroke
The implications of the reversal of DWI abnormalities in patients with TIA and minor strokes were assessed. Patients were imaged within 24 hours of symptoms and followed for 3 months and baseline and final infarct volumes were calculated using DWI and FLAIR, respectively. Over 55% of patients had DWI lesions and 37% had perfusion deficits. DWI reversal occurred in 6% of patients with lesion volume being considerably smaller than in those that did not reverse. Perfusion abnormalities were less common in reversible lesions as well. The authors concluded that DWI lesion reversal is uncommon and more likely with smaller lesions.
- The Impact of Arterial Collateralization on Outcome after Intra-Arterial Therapy for Acute Ischemic Stroke
The presence of poor leptomeningeal collaterals as assessed by CTA was correlated with patient outcome after receiving intra-arterial treatment for stroke. Functional outcomes in 87 patients with MCA and/or ICA occlusions were retrospectively assessed at 3 months. The authors found that poor arterial collateralization was associated with poor outcome after adjustment for recanalization success. They recommend that future studies include collateral scores as one of the predictors of functional outcome.
Interventional
- Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes
These authors analyzed data on 131 non-selected MCA aneurysms treated during a 6-year period. One month after treatment, permanent morbidity and mortality was 3.3% without significant differences according to technique used. The rate of recanalization was nearly 16%, also without differences according to technique, and re-treatment was needed in 7.6% of cases. A greater rate of complications occurred with balloon remodeling and only large aneurysm size predicted recanalization. The authors concluded that endovascular treatment of MCA aneurysms is safe, effective, and durable.
- Endovascular Treatment of 300 Consecutive Middle Cerebral Artery Aneurysms: Clinical and Radiologic Outcomes
Controversy about the best treatment method for MCA aneurysms persists and these authors report the results of endovascular treatment of these lesions in a large series in which 295 such aneurysms were treated during a 17-year period and the results retrospectively analyzed. Complete occlusion was achieved in 94% and treatment failed in 4.3%. Procedure-related morbidity and mortality occurred in nearly 8%. Death occurred in 13.6% of patients and 4.3% needed to be re-treated. Thus, endovascular treatment of MCA aneurysms is acceptable as a primary treatment.
Extracranial Vascular
Head & Neck
- Spontaneous Lateral Sphenoid Cephaloceles: Anatomic Factors Contributing to Pathogenesis and Proposed Classification
Imaging findings in 26 patients with spontaneous lateral sphenoid cephaloceles were studied. The authors were able to classify these lesions into those involving the lateral recess of the sphenoid sinus that typically manifested as CSF leaks and headaches, and a second type that involved the lateral sphenoidal wing without extension into the sinus and presented with a variety of findings including seizures, headaches, meningitis, or neuropathy, or were incidental. All patients showed sphenoid arachnoid pits and 61% had an empty or partially empty sella.
