Background: Arteriovenous malformation (bAVM) presents maldevelopment of the brain’s vessels with a direct connection between cerebral arteries and veins. By current data, patients from Spetzler Ponce A (SP) are found to benefit from the treatment. Considering the outcome, most of SP C and some of the SP B are the most debatable. Objective: Arteriovenous malformation presents maldevelopment of the brain’s vessels with a consequent direct connection between cerebral arteries and veins. The annual risk of hemorrhage in adults is reported for 2-3 %. They usually present with unilateral headaches seizures and intracranial hemorrhage. By current data, patients from Spetzler Ponce A (SP) are found to benefit from the treatment. Considering the outcome, most of SP C and some of the SP B are the most debatable. Methods: The study included a cohort of bAVM patients referred to Fujita Health University Bantane Hotokukai Hospital, Nagoya, Aichi, Japan where the main author (AA) has completed an international cerebrovascular fellowship under the mentorship of Professor Yoko Kato. Japanese Stroke Guidelines (JSG) were used for the treatment decision. Patients were graded according to the Spetzler Ponce (SP) system. Considering American Heart Association criteria (AHA), embolization was used as a part of multimodal treatment. Intraoperative microscopic video tools included Indocyanine green ICG, FLOW 800 and dual image video angiography DIVA. Clinical outcomes were measured using Modified Ranking Score (mRs). Results: A total of eleven patients with brain bAVM were studied with a median age of 32 years [IQR = 22-52]. There were ten patients presented with supratentorial and a single patient with infratentorial AVM. Patients were graded according to the Spetzler Ponce (SP) system. There were eight patients in SP A (72,7%), one in group B (9 %) while the rest of them were in C (18 %). Two patients had associated aneurysms that required treatment. The median size of the AVM nidus was 3,50 cm [IQR= 2-5]. Deep venous drainage was found in six patients while three were located in eloquent zones. Clinical outcomes were considered good by mRs <2 in eight patients, seven from the surgically treated group (72,7 % respectively). Surgery median length time was 427, 5 minutes; [IQR =320 - 463] with complete AVM resection in all patients and no mortality recorded in this cohort with the median follow up of 39,5 months [IQR = 19-59]. Conclusion: Ideal management of bAVM is still controversial. Those complex vascular lesions require multimodal treatment in a majority of cases in highly specialized centers. In SP A patients, surgery provides the best results with a positive outcome and a small number of complications. With the improvement of endovascular feeder occlusion SP B patients become prone to a more positive outcome. Nowadays, intraoperative microscopic tools such as FLOW 800, ICG and DIVA are irreplaceab...

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Background: MRI techniques of the lumbar spine have not provided data on the effect of gravity on the spine and on the relationship of anatomic structures during its action. Because conventional MRI examinations of the spine are usually performed in the supine position these are often exacerbated by standing upright and are not evident in the supine position the loading conditions differ from those known to cause symptoms in patients with lumbar instability. Axial loading imaging may improve diagnostics in the clinical management of LBP and lead to appropriate treatment decisions. Objective: The aim of this study is to determine the significance of alMRI in detecting the morphologic changes of the lumbar spine caused by axial loading and to compare it with conventional MRI images of the lumbar spine without loading. Methods: The study was conducted as a prospective, descriptive clinical trial. Imaging was performed with a MRI 1.5 T in the head-first supine position. Imaging was performed in two acts: without load and under load. Loading for alMRI was performed with the DynaWell L-Spine device. The onset of loading was 10 minutes before the start of alMRI. The loading continued throughout the imaging procedure. The height of the IV, AP and LL diameters of IV, IV disk surface area, DSCA and width of the IV foraminas before and under load was measured. Results: After evaluating the changes in the height and size of the lumbar disks, the size of the DSCA, and the narrowing of the intervertebral foramina significant differences were found between the images before and after axial loading. Conclusion alMRI provides information on morphological changes of all segments of the lumbar spine. This data represents significant information that can lead to more accurate and effective treatment of LBP.

Uvod: Do sad korištene tehnike magnetno rezonantnog oslikavanja lumbalne kičme nisu davale podatke o djelovanju sile gravitacije na kičmu, te o odnosu anatomskih struktura prilikom djelovanja iste. Budući da se konvencionalni MRI pregledi kičme obično izvodi u ležećem položaju, u funkcionalnom mirovanju, stanje opterećenja se razlikuje od stanja za koje se zna da izaziva simptome kod pacijenata pogođenih nestabilnošću lumbalne kičme, to se često pogoršava uspravnim stajanjem i nevidljivo je u ležećem položaj. alMRI može poboljšati kvalitet dijagnosticiranja patologije lumbalne kičme i dovesti do lakšeg odlučivanja o daljem tretmanu. Cilj ovog istraživanja je utvrditi značaj alMRI u otkrivanju morfoloških promjena lumbalnog dijela kičme uzrokovanih aksijalnim opterećenjem i uporediti ga sa konvencionalnim MRI snimcima lumbalne kičme bez opterećenja. Metode: Studija je provedena kao prospektivno, deskriptivno kliničko ispitivanje. Snimanje je izvedeno na MR aparatu 1,5 T u ležećem položaju. Snimanje je izvedeno u dva čina: bez opterećenja i pod opterećenjem. Opterećenje za alMRI obavljeno je DynaWell L-Spine uređajem. Početak opterećenja bio je 10 minuta prije početka snimanja alMRI, a opterećenje se nastavilo tokom čitave procedure snimanja. Izmjerena je visina inetrevtebralnih (IV) prostora, AP i LL prečnik IV diska, površina IV diska, površina duralne vreće i širina IV foramena prije opterećenja i pod opterećenjem. Rezultati: Nakon evaluacije promjena visine i veličine lumbalnih diskova, površine duralne vreće i širine intervertebralnih prostora utvrđene su značajne razlike između slika prije i pod aksijalnim opterećenjem. Zaključak: alMRI daje informacije o morfološkim promjenama svih segmenata lumbalnog dijela kičme. Ovi podaci predstavljaju značajnu informaciju koja može dovesti do preciznijeg i efikasnijeg liječenja LBP.