Endovascular treatment and prognosis of intracranial aneurysms are based on size and volume, which demand more accurate neuroimaging techniques. Aneurysm volume calculation is important to choose endovascular treatment modalities and packing density calculation. Of all these methods, it remains unknown which one is the most accurate to calculate aneurysm volume. The objective of this study is to compare the accuracy of three angiography-based versus three tomographic-based methods which calculate aneurysm volume. A retrospective study which included patients with ruptured and unruptured cerebral aneurysms diagnosed by angiogram and computed tomography angiography (CTA) was done. The accuracy of each method was assessed with an ellipsoid glass model of known volume, which helped us to adjust variation in volumetric measurements done with AngioSuite© and AngioCalc© softwares (based on angiographic and tomographic images), 3D-rotational angiography and 3D-CTA (tridimensional computed tomography angiography), based on measurements of diameters such as maximal width and maximal height. Descriptive statistics, ANOVA for repetitive samples and t test were used. We included 89 patients (126 saccular intracraneal aneurysms). AngioSuite© software (angiography-based) showed more accuracy compared to other methods in our control model. The geometric system (AngioCalc) based on CTA images was statistically different from all other methods studied. AngioCalc (CTA-based) demonstrated a significant difference compared with other methods hence, it may overestimate volume measurements. AngioSuite

No abstract

Background:Whether cerebral arteriovenous malformations (AVMs) should be treated remains an ongoing debate. Nevertheless, there is a need for predictive factors that assist in labelling lesions as low or high risk for future rupture. Our aim was to design a new classification that would consider hemodynamic and anatomic factors in the rapid assessment of rupture risk in patients with AVMs.Methods:This was a retrospective study that included 639 patients with ruptured and unruptured AVMs. We proposed a new classification score (1–4 points) for AVM rupture risk using three factors: feeding artery mean velocity (Vm), nidus size, and type of venous drainage. We employed descriptive statistics and logistic regression analysis.Results:A total of 639 patients with cerebral AVMs, 388 (60%) had unruptured AVMs and 251 (40%) had ruptured AVMs. Logistic regression analysis revealed a significant effect of Vm, nidus size, and venous drainage type in accounting for the variability of rupture odds (P = 0.0001, R2 = 0.437) for patients with AVMs. Based in the odds ratios, grades 1 and 2 of the proposed classification were corresponded to low risk of hemorrhage, while grades 3 and 4 were associated with hemorrhage: 1 point OR = (0.107 95% CI; 0.061–0.188), 2 point OR = (0.227 95% CI; 0.153–0.338), 3 point OR = (3.292 95% CI; 2.325–4.661), and 4 point OR = (23.304 95% CI; 11.077–49.027).Conclusion:This classification is useful and easy to use, and it may allow for the individualisation of each cerebral AVM and the assessment of rupture risk based on a model of categorisation.

Benign melanocytic neoplasms of the central nervous system must be treated aggressively in the early phases with strict follow-up to avoid progression to advanced phases that do not respond to any treatment method. Unfortunately, the prognosis for malignant melanocytic lesions is very poor irrespective of the method of treatment given.

Los estesioneuroblastomas conforman el 3% de tumores endonasales. La importancia en nuestra área radica en su alta tendencia a invadir la base del cráneo y estructuras adyacentes; el impacto negativo que tiene sobre la vida de los pacientes obliga a manejarlos inmediatamente posterior al diagnóstico. Objetivos: establecer conducta quirúrgica en el manejo de esta patología; evaluar el tratamiento, factores pronósticos y compararlos con la literatura. Material y métodos: estudio retrospectivo, descriptivo y longitudinal de 5 pacientes con diagnóstico de estesioneuroblastomas Kadish C manejados en este servicio, realizando análisis de factores pronósticos de importancia de la técnica quirúrgica, seguimiento y resultados. Resultados: se trataron 2 mujeres (40%) y 3 hombres (60%); según la clasificación de Kadish, los 5 fueron tipo C. El resultado histológico según la clasificación de Hyams fue de 3 casos grado I, un caso grado II y un caso grado IV. Se realizó abordaje bifrontal con desguante facial en 5 casos, lográndose un 100% de resección tumoral en el 80% con comprobación de la exéresis mediante endoscopia endonasal. De ellos, 5 recibieron manejo con radioterapia; el 80% sin enfermedad. Conclusiones: el abordaje bifrontal con desguante facial en estadios Kadish C apoyados por endoscopía endonasal en todos los casos creemos es la mejor elección de tratamiento quirúrgico. La radioterapia es coadyuvante en todos los casos y la quimioterapia en casos seleccionados. El único factor pronóstico bien documentado en nuestra serie es el grado histológico de Hyams.