Calvarial tuberculosis is rare presentation and has been reported in only about 0.01% of all patients with mycobacterial infections. Though rare, the incidence of Calvarial tuberculosis seems to be on the rise, especially in developing countries. We present three cases of Calvarial tuberculosis which were successfully managed at our Centre. All the cases occurred de novo in young, otherwise healthy individuals, hailing from good socio-economic backgrounds and without any past history or contact history with tuberculosis patients. We highlight the importance of keeping this diagnosis in mind in appropriate clinical situations as well as recommend the early commencement of optimal management to prevent serious neurologic complications & sequelae.

Arterial spin labelling is an emerging non-invasive magnetic resonance imaging technique for estimating the cerebral perfusion without the requirement for gadolinium-based intravenous contrast agents. Despite the wide range of applications in epilepsy, dementia, brain tumours, vascular malformations and stroke imaging, obtaining clinically useful arterial spin labelling data is technically challenging and prone to numerous artefacts. The objective of this review is to provide a comprehensive pictorial overview of the various artefacts associated with arterial spin labelling, particularly three-dimensional fast spin echo pseudocontinuous arterial spin labelling with spiral readout. These artefacts could be broadly classified as those occurring during the magnetic labelling, arterial transit or image acquisition. Arterial spin labelling artefacts of clinical diagnostic utility are also elaborated. A thorough knowledge of the basis of these artefacts will avoid diagnostic pitfalls while interpreting arterial spin labelling images. Important tips to reduce or overcome these artefacts are also discussed.

Background Neuroform Atlas stent is a relatively new device used for stent-assisted coiling (SAC) of wide-necked intracranial aneurysms. Purpose To elaborate the initial experience in a single center to assess the efficacy and initial results of Neuroform Atlas for SAC of intracranial aneurysms. Methods Between February 2017 and September 2018, eight patients (five females, three males; mean age 56 years) underwent SAC with Neuroform Atlas. Results Five unruptured and three ruptured wide-necked aneurysms were treated with Neuroform Atlas SAC. Immediate complete occlusion modified Roy-Raymond class 1 (MRRC 1) or mild neck residue class 2 (MRRC 2) was achieved in three patients and five other patients had minimal residual interstitial filling of the aneurysm (MRRC 3b). One patient with ruptured intracranial aneurysm succumbed to the illness in the first postoperative day due to massive rebleed. Other seven patients remained clinically asymptomatic in the follow-up period. Patent stent was noted at three to seven months follow-up magnetic resonance angiography (MRA) in five patients. Complete occlusion of the aneurysm was noted in three patients, and minimal residual aneurysm was seen in two patients. Conclusion Neuroform Atlas stent is safe and effective in achieving good angiographic outcome in complex intracranial aneurysms.

Background:Complex angioarchitecture of brain arteriovenous malformations (BAVM) are often difficult to evaluate with standard imaging technique of digital subtraction angiography (DSA). These details are better provided by 3D rotational angiography (3D-RA).Objective:The aim of the study is to compare two-dimensional digital subtraction angiography (2D-DSA) and 3D rotational angiography in the evaluation of BAVM angiographic architecture.Materials and Methods:2D-DSA and 3D-RA of 167 consecutive patients with BAVM were analyzed for arterial feeders, nidal patterns, and detection of flow-related aneurysms, arteriovenous fistulous components, venous drainage, and draining vein stenosis.Results:3D-RA detected a significantly higher number of aneurysms and draining venous stenoses (P< 0.001). The detected number of true intranidal aneurysms was significantly higher with 3D-RA (n= 94) vs 2D-DSA (n= 34) (P< 0.001). 2D-DSA has low sensitivity (43.1%) and specificity (73.4%) for detecting intranidal aneurysms. 3D-RA detected a significantly higher number (12.6%) of BAVM patients with feeding artery aneurysms as compared to 2D-DSA (8.4%),Pvalue of 0.004. 3D-RA accurately depicted the distal course of dominant arterial feeders and fistulous sites in BAVMs. Direct arteriovenous communications were evident in 31.1% with 3D-RA, as compared to 2D-DSA (15%) withPvalue < 0.0001. A significantly higher number of draining vein stenosis was detected with 3D-RA (21.6%) as compared to 2D-DSA (13.2%),Pvalue < 0.001.Conclusion:3D-RA is better than 2D-DSA for detecting BAVM-associated flow-related aneurysms, distal course of the dominant arterial feeders, direct visualization of the fistulous components, deep venous drainage, and draining venous stenosis; findings imperative for making a prudent therapeutic decision.