Knowledge of the exact site of leakage of cerebrospinal fluid CSF leakage is important for planning surgery. We report our experience with myelocisternography with Gd-DTPA. We decided that intrathecal use of this contrast medium was justified in selected cases when other techniques have failed. After we had given detailed information to four patients with CSF leakage, they underwent five examinations. The images were interpreted by comparing those before and after injection. In all cases the contrast medium arrived at the basal cisterns, giving high contrast against adjacent structures. All patients tolerated the examination without complications or any indication of side effects.

MMCT sensitivity in acute lacunar or infratentorial stroke was poor. But, we found a high specifity and a fairly good sensitivity in territorial infarct detection. In acute stroke patients with normal MMCT findings on admission, a good clinical prognosis can be expected.

In a medium-volume neurovascular center, coiling significantly reduced the procedure time, the stay in the ICU, and the length of hospital stay suggesting favorable resource allocation in endovascular therapy.

For years, intra-arterial brachytherapy has been a recognized method for treating recurrent stenosis after percutaneous transluminal angioplasty and stent placement. However, its use in arteries supplying the brain has not been described to date. We report a case treated with intra-arterial brachytherapy for high-grade recurrent stenoses of the high cervical internal carotid artery and the proximal vertebral artery. At 2-year follow-up, the outcome was successful.

If penumbral tissue can be conclusively identified, endovascular treatment in proximal and intracranial tandem occlusion can be successful, even in treatments initiated 6-9 h after stroke onset. If the intracranial flow after recanalization can be established via the circle of Willis, the underlying proximal ICA occlusion may not require treatment.