Early Outcomes of the Pipeline Vantage Flow Diverter : A Multicentre Study

PURPOSE

The recently introduced Pipeline Vantage Embolization Device with Shield Technology is the fourth generation of Pipeline flow diverter devices. Due to the relatively high rate of intraprocedural technical complications, modifications were subsequently made to the device after a limited release of the device in 2020. This study aimed to evaluate the safety and efficacy of the modified version of this device.

METHODS

This was a multicentre retrospective series. The primary efficacy endpoint was aneurysm occlusion in the absence of retreatment. The primary safety endpoint was any neurological morbidity or death. Ruptured and unruptured aneurysms were included in the study.

RESULTS

A total of 52 procedures were performed for 60 target aneurysms. Treatment was performed on 5 patients with ruptured aneurysms. The technical success rate was 98%. The mean clinical follow-up time was 5.5 months. In patients presenting with unruptured aneurysms there were no deaths, 3 (6.4%) major complications and 7 (13%) minor complications. In the five patients presenting with subarachnoid haemorrhage there were 2 (40%) major complications with 1 (20%) of these resulting in death, and 1 (20%) minor complication. Of the patients 29 (56%) had undergone 6‑monthly postprocedural angiographic imaging with a mean time of 6.6 months demonstrating that 83% of patients had achieved adequate occlusion (RROC1/2) of the aneurysm.

CONCLUSIONS

In this non-industry-sponsored study, the occlusion rates and safety outcomes were similar to those seen in previously published studies with flow diverter devices and earlier generation Pipeline devices. Modifications to the device appear to have improved ease of deployment.

Multimodal imaging of the aging brain: Baseline findings of the LoCARPoN study

We quantified and investigated multimodal brain MRI measures in the LoCARPoN Study due to lack of normative data among Indians. A total of 401 participants (aged 50-88 years) without stroke or dementia completed MRI investigation. We assessed 31 brain measures in total using four brain MRI modalities, including macrostructural (global & lobar volumes, white matter hyperintensities [WMHs]), microstructural (global and tract-specific white matter fractional anisotropy [WM-FA] and mean diffusivity [MD]) and perfusion measures (global and lobar cerebral blood flow [CBF]). The absolute brain volumes of males were significantly larger than those of females, but such differences were relatively small (<1.2% of intracranial volume). With increasing age, lower macrostructural brain volumes, lower WM-FA, greater WMHs, higher WM-MD were found (P = 0.00018, Bonferroni threshold). Perfusion measures did not show significant differences with increasing age. Hippocampal volume showed the greatest association with age, with a reduction of approximately 0.48%/year. This preliminary study augments and provides insight into multimodal brain measures during the nascent stages of aging among the Indian population (South Asian ethnicity). Our findings establish the groundwork for future hypothetical testing studies.

Preterm neonate delivered to COVID-19 positive mother on ECMO support

Despite ongoing research and recent discoveries, there remains a paucity of data regarding COVID-19 and its implications for pregnant women, particularly its effects on the developing fetus. To date, there are a limited number of articles available regarding the utility of Extra Corporeal Membrane Oxygenation (ECMO) for cardio-respiratory support of pregnant women during the perinatal period. Additionally, there are only a few case reports detailing the delivery management of a baby born to a mother on ECMO support. Here, we report a case of a premature, low birth weight neonate delivered by a 32-year-old woman while on ECMO due to severe acute respiratory distress syndrome resulting from COVID-19 infection.

Cost of treatment and consequences for chronic hepatitis B and C virus infection at a tertiary care hospital in Delhi

Patient living with chronic viral hepatitis in India faces the high cost of treatment and impoverishment. The present study is aimed to assess the cost of treatment and economic consequences among chronically infected viral hepatitis patients at a tertiary care hospital in Delhi. The descriptive cross-sectional study was undertaken during October 2016-January 2017. Three hundred and eighty-nine participants were interviewed through a schedule for variables and assessing both direct and indirect costs. Costs of hospital expenditure were extracted from records available with patients or databases of the hospital. The average outpatient expenditure and the inpatient costs were calculated. Direct nonmedical costs were also included. The analysis revealed the total cost of treatment ranged from Rs. 16,600/-to Rs. 1,709,000/-with a median of Rs. 193,500 per year. The cost of treatment increased with the severity of the disease. The cost of treatment led to impoverishment in 52.8% of families and imposed a substantial economic burden and consequences on the patients.

COVID-19: Indian Society of Neuroradiology (ISNR) Consensus Statement and Recommendations for Safe Practice of Neuroimaging and Neurointerventions

The ongoing COVID-19 pandemic has forced every radiology set-up to evolve and formulate guidelines for day-to-day functioning. The sub-speciality of neuroradiology, both diagnostic and neuro-intervention, forms a very important part of any radiology or 'neuro-care' set-up. The present document is a consensus statement of the Indian Society of Neuroradiology, prepared after reviewing the available data and working experience. It scientifically tries to answer many questions faced by neuroradiologists everyday in practice. It encompasses simple things such as which patients need to be imaged, what precautions are essential, the work-flows, cleaning of radiology equipment, how to carry out neuro-interventions in COVID-suspect patients, and what procedures/tests to avoid, or their alternatives, to minimise the spread of COVID infection both to the patients and health care personnel. As radiology set-ups can be large, every sub-speciality may have certain precautions which will not be covered in general guidelines, and this document tries to answer those for neuroradiologists. Carefully evolved Standards of Operating Procedure (SOPs) and guidelines are the need of the hour to guide in providing uninterrupted and adequate services to the needy without compromising the safety of the specialised work force and facilities involved.

Post-traumatic Sacral Epidermoid Cyst Masquerading as Chordoma on Imaging: A Case Report

Intradural spinal epidermoid cysts are rare, benign lesions either acquired from trauma, surgery, lumbar puncture or arise as congenital lesions, particularly associated with spinal dysraphism. Epidermoid cyst arising from the spine with expansile destruction of vertebrae has not been reported yet in the literature. We report a case of 36-years male presented with history of fall 8 years back with progressive symptoms of lower back pain, weakness of left lower limb and bladder/bowel incontinence. Computed tomography revealed large lytic expansile, midline sacral vertebral lesion with soft tissue component and multiple calcific foci. Magnetic resonance imaging demonstrated large non-enhancing heterogeneous mass showing restricted diffusion on diffusion weighted images. The patient underwent biopsy confirming the diagnosis of an epidermoid cyst. The possibility of an epidermoid tumor should be kept in the differential diagnosis in patients presenting with posttraumatic sacral mass.

Reversible hypoxic brain injury: the penumbra conundrum of Grinker

A female patient, aged 61 years, presented to us with a 3-day history of fever and altered sensorium. She was discharged from another hospital 1 week back where she was admitted for community-acquired pneumonia. She was put on mechanical ventilation for threatened airway and her magnetic resonance brain imaging showed evidence of delayed posthypoxic leucoencephalopathy, also known as Grinker's myelinopathy. She was discharged 1 month later, on room air with a tracheostomy tube in situ. On follow-up after 5 months, she was ambulating with support and carried out activities of daily living independently.

Management of Arterial Pseudoaneurysms of the Neck in a Pediatric Population: An Endovascular Case Series and Review of Literature

BACKGROUND

Arterial pseudoaneurysms of the neck are rarely reported in the pediatric population and no dedicated large series are available. Trauma and infection are the most common causes for these aneurysms, with congenital and collagen vascular disorders being the less common causes. These lesions can be life threatening, especially when they present with bleeding or airway compromise.

METHODS

We searched our radiology information system for all cases of pediatric neck aneurysm presented between June 2015 and May 2018. These cases were analyzed for clinicoepidemiologic variables, clinical presentation, imaging findings, management, and follow-up.

RESULTS

Six children were included in the study (male/female ratio, 5:1), with a mean age of 7.8 years (range, 2.5-15 years). Four presented acutely with either bleeding or rapidly enlarging neck swelling, whereas 2 presented with slowly increasing pulsatile swelling. One had a traumatic cause, 2 had infections, and 1 had infective cervical lymphadenitis complicated by iatrogenic injury whereas no definite causative mechanisms could be accounted for in 2 patients. Two of the children were managed by trapping of the aneurysm and 2 only by proximal parent vessel occlusion. The other 2 children were treated with stent graft deployment across the aneurysm neck to reconstruct the parent vessel. All the patients were doing well during the follow-up period (mean, 14.8 months).

CONCLUSIONS

Endovascular means of treatment for pediatric neck aneurysms is relatively simple and safe. Although parent vessel sacrifice is the gold-standard management, vessel-preserving strategies can be tried in select cases with favorable anatomy.

Evolution of epidermoid cyst into dermoid cyst: Embryological explanation and radiological-pathological correlation

Intracranial dermoid and epidermoid cysts are usually considered to be two different entities in the radiological and surgical literature. Epidermoid cysts are classically off midline in location, isointense to cerebrospinal fluid on T1 and T2-weighted images and have restricted diffusion, whereas dermoid cysts are classically midline in location, have T1-hyperintense regions due to the presence of fat and show facilitated diffusion. We report a case of radiological epidermoid cyst in baseline imaging, which evolved into a radiological dermoid cyst over time, and explain this unique occurrence with a review of the embryology and histopathogenesis of these cysts.

Mucinous cystadenocarcinoma arising in an ectopic kidney simulating a retroperitoneal dermoid cyst: a rare tumour presenting as a diagnostic dilemma

Primary mucinous cystic neoplasms are rare tumours of the kidney, with a very few case reports in the literature. They arise from metaplasia of renal pelvic urothelium. We describe here a 45-year-old male who presented with pain in the abdomen and a lump in the left iliac fossa for two months. Ultrasound and CT scan showed a large, complex, heterogenous mass in the central abdomen and left iliac fossa, suggesting the possibility of dermoid cyst. Excision of the mass showed an enlarged multicystic kidney filled with mucin, destruction of renal parenchyma and a small viable area of grey white tumour. Histopathology revealed a peripherally located mucinous cystadenocarcinoma arising in the background of chronic pyelonephritis and mucinous metaplasia. We report this case for the rarity of the lesion and the associated clinical and radiological diagnostic dilemma.