PURPOSE:The best treatment for distal basilar artery aneurysms is controversial. We aimed to review our single-centre experience with coil embolisation of aneurysms at this location and compare it with the surgical and endovascular literature.METHODS:Forty-two aneurysms in a distal basilar location in 42 consecutive patients (15 ruptured and 27 unruptured) were treated endovascularly from 2010 to 2015. Unassisted single and multiple microcatheter coil embolisation alone was used in all cases. We studied our immediate and long-term anatomical results, operative complications, and outcome.RESULTS:The immediate angiographic results showed complete occlusion in 34 (81%), a neck remnant in seven (16.6%) and a residual aneurysm in one patient (2.4%). There were two thromboembolic events (4.7%) without clinical sequelae; therefore, the operative morbidity and mortality were zero.Three patients with ruptured aneurysms (7.1%) died due to complicated vasospasm. Thirty-nine patients (93%) had clinical and MR imaging follow-up (mean 32.3 months ± 18.6, range from 12 to 66 months). There was recanalization in 30.8% with a retreatment rate of 15.3% and no new bleedings. The aneurysm size was the most important predictor of early anatomical outcome and recurrence.CONCLUSION:Unassisted and multiple microcatheter coiling is a safe treatment for distal basilar aneurysms. Early anatomical results and recurrence depend on the aneurysm size. Morbidity and mortality are lower and recurrence rates are higher in comparison with clipping or other adjunctive endovascular techniques.

Background and purpose. - Endovascular treatment is offered for symptomatic intracranial stenosis (ICS) when medical therapy fails. The purpose of this meta-analysis is to evaluate the risks and effectiveness of balloon angioplasty (BA) alone. Materials and methods. - Systematic review and meta-analysis of all available articles on BA for symptomatic ICS was conducted. Data was analyzed separately for > 70% (Group 1) and > 50% (Group 2) stenosis. The results of the Group 1 were compared with those of SAMMPRIS study to the extent possible. Results. - A total of 25 studies comprising 674 patients were included. The cumulative incidence of periprocedural (within 30 days) stroke and death were 16.3% (Group 1), 7.6% (Group 2) and 11.5% (all studies). Incidence rates of ischemic stroke in the qualifying artery territory during follow-up (per 100 patient-years) were 2.0, 2.4 and 2.3, any stroke and death during follow-up were 4.4, 7.4 and 6.9, restenosis rates were 4.9, 11.5 and 8.9 respectively. While comparison of cumulative incidences of periprocedural ischemic stroke between Group 1 (13.0%) and the medical arm from SAMMPRIS study(4.4%) showed a significant difference (P=0.008), there was no significant difference between the Group 1 and the stenting arm from SAMMPRIS study(10.7%) in the same variable. Conclusion. - Balloon angioplasty for stenosis of more than 70% is likely to have similar outcome comparable to the stenting arm in the SAMMPRIS study, however it presents lower rates of late ischemic events and restenosis. These data may help deciding on the endovascular method of choice in case of medical therapy failure. (C) 2019 Elsevier Masson SAS. All rights reserved.

Background The types of cranial dural arteriovenous fistulae (cDAVFs) that constitute good surgical candidates are unclear despite the use of classifications. We aimed to compare the DES classification with other classification schemes in identifying "ideal lesions for surgery." The DES scheme is based on two features: the level of the shunt (BVS, bridging vein shunt; DSS, dural sinus shunt; ISS, isolated sinus shunt; EVS, emissary vein shunt) and the type of leptomeningeal venous reflux (LVR) (direct, exclusive, strained). Methods In this observational cohort study, the angiographies of 20 consecutive patients treated over 1 year were analyzed retrospectively. We defined cDAVFs as ideal for surgery, if cure may be achieved by disconnecting the arterialized draining vein through a single craniotomy. To evaluate the performance of each classification scheme in identifying the "ideal lesion for surgery," we carried out a sensitivity analysis of the Borden, Cognard, and DES schemes. Results Eight lesions were Borden type 3 and 1 type 2, and 11 type 1. According to Cognard, 2 lesions were type IV, 2 type III, 1 type IIa+b, 11 type I, and 4 lesions could not be clearly classified. According to the DES scheme, 8 lesions were DSS, 4 BVS, 3 ISS, and 5 EVS. All 4 lesions classified as BVS in the DES were ideal lesions for surgery (sensitivity, specificity, PPV, NPV 100%). Not all high-grade lesions according to Borden were good surgical candidates. Conclusion The DES scheme, as opposed to other classifications, facilitates the therapeutic decision-making especially for selecting candidates for surgery.

The Swiss Federation of Clinical Neuro-Societies (SFCNS) was founded in 2009 and currently unites 14 clinical neuroscience associations. Its primary goals are the promotion of clinical, scientific, and educational interdisciplinary collaboration, as well as to establish a united voice towards other organisations, policy makers, and society.1Bassetti C Merlo A Steinlin M Valavanis A Weder B Swiss Federation of Clinical Neuro-Societies (SFCNS) - Eine starke Allianz der klinischen Neurodisziplinen.Schweiz Ärztezeitung. 2013; 94: 870-872Google Scholar The SFCNS has received a mandate from the Swiss public health authorities to coordinate the implementation of highly specialised medicine in clinical neuroscience. Similar to the German Neurowoche,2von Kummer R Editorial-Neurowoche 2010: a highlight of neuromedicine in Germany.Clin Neuroradiol. 2010; 20: 151-152Crossref PubMed Scopus (1) Google Scholar the SFCNS organises an interdisciplinary congress every 3 years (the next taking place in Lausanne, Switzerland, on Oct 23–25, 2019). This congress and our annual SFCNS Summer School promote education and discussion in clinical neuroscience. Last year, the SFCNS launched the journal Clinical and Translational Neuroscience, as successor of the Swiss Archives of Neurology and Psychiatry, founded by Constantin von Monakow about a century ago.3Bassetti C Valavanis A A 100-year- old newborn, former Swiss Archives of Neurology and Psychiatry (1917–2016).Clin Transl Neurosci. 2017; (published online Sept 20.)doi.org/10.1177/2514183X17725631Crossref Google Scholar In 2016, the SFCNS endorsed the creation of the Young Clinical Neuroscientists Network (YouCliN). The need and advantages of encouraging and engaging junior minds are increasingly recognised.4Sokolov AA Kurmann R Creating a junior minds' community: the Swiss Association of Young Neurologists.Clin Transl Neurosci. 2017; (published online Sept 20.)http://dx.doi.org/10.1177/2514183x17721247Crossref Google Scholar The mission of YouCliN includes to represent the interests of junior clinicians with respect to current issues and future development of Swiss clinical neuroscience and the promotion of interdisciplinary training. These goals are enacted by a steering committee composed of 14 delegates at an intermediate career stage from across the country, reflecting the clinical neuroscience specialties represented within the SFCNS. Other aims are the integration of care providers and researchers from non-medical disciplines, and the rapprochement of neurology and psychiatry.5Insel TR Quirion R Psychiatry as a clinical neuroscience discipline.JAMA. 2005; 294: 2221-2224Crossref PubMed Scopus (205) Google Scholar YouCliN will also elaborate on strategies for equal gender opportunities. To the best of our knowledge, the SFCNS appears to be the only national association of professionals from different clinical neuroscience disciplines in Europe. Development of the SFCNS might have been favoured by the circumscribed Swiss clinical neuroscience landscape, where most colleagues know each other well, despite working in three different linguistic zones, but certainly also by a strong tradition of dialogue and consensus. This small world striving for excellence and its enthusiasm towards innovative biomedical research, regenerative cell therapy, genomics, and neurotechnology provide an ideal environment for synergy and progress in clinical neuroscience. At a global level, interdisciplinary cooperation has already become indispensable in the management of patients with stroke, CNS tumours, dementia, or sleep disorders.6Shakir R Brain health: widening the scope of NCDs.Lancet. 2016; 387: 518-519Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar Functional restoration and neuroprosthetics represent imminent challenges for clinical neuroscience, requiring specific skills in translational research, neuroradiology, and intensive care. State-of-the-art clinical neuroscience will also depend on the implementation of integrative clinical pathways from the emergency room to neurorehabilitation, for patients of different ages. These challenges require united and determined action. We declare no competing interests. CB served as founding and first president of the SFCNS from 2009 to 2013, AV was the second SFCNS president from 2013 to 2017, KS is the third and current SFCNS president and AAS serves as founding YouCliN chair. We thank Renaud Du Pasquier and Philippe Ryvlin for valuable discussion. AAS reports fellowships from the Baasch-Medicus Foundation and the Leenaards Foundation.

Schon diese etablierte Interdisziplinarität der jährlichen Fortbildungsveranstaltungen zeigt auf, wie nahe sich die Disziplinen innerhalb der klinischen Neurowissen­ schaften stehen und wie stark sie sowohl in der Praxis als auch in der Theorie aufeinander angewiesen sind. Doch obwohl ein harmonisches Zusammenspiel zwi­ schen der Neuroradiologie und den anderen klinischen Neurowissenschaften für die erfolgreiche Behandlung vieler neurologischer Krankheiten unverzichtbar ist, wird der Neuroradiologie nicht jene Verantwortung zuteil, die heute eigentlich erforderlich wäre. Denn im Gegensatz zur Neurologie und Neurochirurgie verfügt die Neuroradiologie über keinen eigenen Facharzttitel. Das Ungleichgewicht, welches dadurch innerhalb dieser drei Kerndisziplinen der klinischen Neurowissenschaf­ ten entsteht, gefährdet zunehmend die Behandlungs­ qualität.

Preoperative embolization of radiographically suspected meningiomas is often performed to facilitate subsequent tumor resection. Its effects on the post-operative course have not been studied in detail and randomized trials are lacking. To gain insight into the role of tumor embolization, we conducted a retrospective study in all patients undergoing resection of an intracranial meningioma at the University Hospital Zurich 2000-2013 with a post-operative follow-up of at least 3 months (N=741). Patients were reviewed for the inclusion of pre-operative embolization in the management strategy. Annotations included demographics, radiographic, surgical, histological and hematological parameters, cardiovascular risk factors, pre- and postoperative neurological function and genome-wide methylation-based classification. Binary regression and Cox proportional hazards models were applied to determine factors associated with outcome. Pre-operative embolization was performed in 337 patients (42%). The decision for embolization was associated with larger tumor size and presence of peritumoral edema. On multivariate analyses controlling for established prognostic factors, pre-operative embolization was associated with inferior post-operative neurological outcome (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.30-2.63), whereas gross total resection was associated with better neurological outcome (OR 0.59, 95% CI 0.39-0.87). Cardiovascular events after surgery comprised mostly deep vein thrombosis (N=39) and pulmonary embolisms (N=64). There were also associations with embolization (OR 2.38, 95% CI 1.37-4.00) and female gender (OR 2.18, 95% CI 1.17-4.08). Recurrence-free survival (RFS) of embolized patients was less favorable among patients with WHO grade II or grade III meningiomas (median RFS: 4.3 versus 7.0 years, multivariate hazard ratio [HR] 1.92, 95% CI 0.97-3.79, p=0.062) or in patients with intermediate or malignant gene methylation subtype meningiomas (median RFS: 2.0 versus 8.2 years, multivariate HR 8.66, 95% CI 3.00-25.05, p<0.001). Pre-operative meningioma embolization may cause adverse surgical outcomes. Randomized trials to determine benefit-risk ratios are warranted to clarify the role of pre-operative embolization for meningioma surgery.

OBJECTIVE:Embolization of cranial dural sinus arteriovenous fistulae with transvenous occlusion of the involved sinuses is an established strategy when the collateral brain drainage allows it. We aimed to investigate the frequency and types of complications after endovascular occlusion of the sigmoid sinus.METHODS:From our database, we detected 52 endovascularly treated consecutive cases of cranial dural arteriovenous shunts involving the sigmoid sinus. The cases treated through the transvenous approach alone or combined with the transarterial one were analyzed retrospectively. Previously reported series and cases were reviewed and critically analyzed.RESULTS:In 15 cases, a transvenous approach was used and in 4 combined a transvenous approach with a transarterial approach. Two patients (13.3%) both treated with the transvenous approach alone presented postoperatively with vertigo and hearing loss. In the first case, the sinus occlusion involved the whole sigmoid sinus, whereas in the second case the occlusion was restricted to a parallel channel posteriorly to the proximal segment of the sigmoid sinus. Magnetic resonance imaging and ear, nose, and throat investigations failed to elucidate the cause and pathomechanism of these symptoms. No other complications occurred.CONCLUSIONS:Although the transvenous occlusion of the sigmoid sinus generally is a safe therapeutic option for the treatment of dural arteriovenous fistulae, inner ear dysfunction is still a possible complication. The combined analysis of the reported and our cases did not allow a plausible explanation of this complication and its pathomechanism remains obscure.

The involvement of the central nervous system in sarcoidosis can manifest with a variety of neurological symptoms, most of them nonspecific. We identified 13 patients with neurosarcoidosis diagnosed at our clinic. Six of 13 patients presented with clinically isolated neurosarcoidosis (CINS) without signs or symptoms of systemic disease. CINS patients were not different with respect to age, as well as imaging and spinal fluid findings, or disease course. However, we found spinal cord involvement in neurosarcoidosis patients much more common than previously described (in 8 out of 13 patients). Spinal cord affection was associated with older age at diagnosis and a less favorable response to therapy. Based on our findings, we propose a diagnostic path for neurosarcoidosis, including spinal magnetic resonance imaging (MRI) as a mandatory and early step during diagnostic workup. i 2014 S. Karger AG, Basel

This review focuses specifically on the developments in brain imaging, as opposed to the spine, and specifically conventional, clinical, cross-sectional imaging, looking primarily at advances in magnetic resonance imaging (MRI) and computed tomography (CT). These fields are viewed from a perspective of landmark publications in the last 50 years and subsequently more in depth using sentinel publications from the last 5 years. It is also written from a personal perspective, with the authors having witnessed the evolution of both fields from their initial clinical introduction to their current state. Both CT and MRI have made tremendous advances during this time, regarding not only sensitivity and spatial resolution, but also in terms of the speed of image acquisition. Advances in CT in recent years have focused in part on reduced radiation dose, an important topic for the years to come. Magnetic resonance imaging has seen the development of a plethora of scan techniques, with marked superiority to CT in terms of tissue contrast due to the many parameters that can be assessed, and their intrinsic sensitivity. Future advances in MRI for clinical practice will likely focus both on new acquisition techniques that offer advances in speed and resolution, for example, simultaneous multislice imaging and data sparsity, and on standardization and further automation of image acquisition and analysis. Functional imaging techniques including specifically perfusion and functional magnetic resonance imaging will be further integrated into the workflow to provide pathophysiologic information that influence differential diagnosis, assist treatment decision and planning, and identify and follow treatment-related changes.

PURPOSE:The descriptions of collateral circulation in moyamoya have so far been a mixture of topography-based and vessels' source-based analyses. We aimed to investigate the anatomy and systematize the vascular anastomotic networks in pediatric moyamoya disease.METHODS:From a series of 25 consecutive complete angiographic studies of newly diagnosed children with moyamoya, 14 children had moyamoya disease and 11 were diagnosed with moyamoya syndrome, i.e., moyamoya angiopathy with some additional concomitant systemic disease. We retrospectively analyzed the arterial branches supplying the moyamoya anastomotic networks, their origin, course, location, and connections with the recipient vessels.RESULTS:We describe four types of anastomotic networks in children with moyamoya disease, two superficial-meningeal and two deep-parenchymal. As superficial-meningeal, we defined the leptomeningeal and the durocortical networks. Apart from the previously described leptomeningeal network observed in the convexial watershed zones, we report on the basal temporo-orbitofrontal leptomeningeal network. The second superficial-meningeal network is the durocortical network, which can be basal or calvarian in location. We define as deep-parenchymal networks the nonpreviously described subependymal network and the inner striatal and inner thalamic networks. The subependymal network is fed by the intraventricular branches of the choroidal system and diencephalic perforators, which at the level of the periventricular subependymal zone, anastomose with medullary-cortical arteries as well as with striatal arteries. The inner striatal and thalamic networks are constituted by intrastriatal connections among striatal arteries and intrathalamic connections among thalamic arteries when the disease compromises the origin of one or more sources of their supply.CONCLUSION:The previously inexplicitly described "moyamoya abnormal network" in pediatric moyamoya disease can be described as a composition of four anastomotic networks with distinct angioarchitecture. A better understanding of the collateralization in moyamoya may help in defining a new staging system of the disease with clinical relevance.

Cranial dural arteriovenous fistulae have been classified into high- and low-risk lesions mainly based on the pattern of venous drainage. Those with leptomeningeal venous drainage carry a higher risk of an aggressive clinical presentation. Recently, it has been proposed that the clinical presentation should be considered as an additional independent factor determining the clinical course of these lesions. However, dural shunts with leptomeningeal venous drainage include a very wide spectrum of inhomogeneous lesions. In the current study, we correlated the clinical presentation of 107 consecutive patients harboring cranial dural arteriovenous shunts with leptomeningeal venous drainage, with their distinct anatomic and angiographic features categorized into eight groups based on the "DES" (Directness and Exclusivity of leptomeningeal venous drainage and features of venous Strain) concept. We found that among these groups, there are significant angioarchitectural differences, which are reflected by considerable differences in clinical presentation. Leptomeningeal venous drainage of dural sinus shunts that is neither direct nor exclusive and without venous strain manifested only benign symptoms (aggressive presentation 0 %). On the other end of the spectrum, the bridging vein shunts with direct and exclusive leptomeningeal venous drainage and venous strain are expected to present aggressive symptoms almost always and most likely with bleeding (aggressive presentation 91.5 %). Important aspects of the above correlations are discussed. Therefore, the consideration of leptomeningeal venous drainage alone, for prediction of the clinical presentation of these shunts appears insufficient. Angiographic analysis based on the above concept, offers the possibility to distinguish the higher- from the lower-risk types of leptomeningeal venous drainage. In this context, consideration of the clinical presentation as an additional independent factor for the prediction of their clinical course seems superfluous and possibly misleading. Topography is connected to the clinical presentation of the dural shunts inasmuch as the former determines the venous anatomy and the angioarchitectural features of the lesions.

Current technological advances in CT, specifically those with a major impact on clinical imaging, are discussed. The intent was to provide for both medical physicists and practicing radiologists a summary of the clinical impact of each advance, offering guidance in terms of utility and day-to-day clinical implementation, with specific attention to radiation dose reduction.

A population-based analysis of patterns of care and outcome in glioma patients diagnosed 1980-1994 in the Canton of Zurich, Switzerland, has confirmed the overall poor prognosis of glioblastoma. To explore changes in outcome over the last decades, the registry data were re-evaluated for patients diagnosed in the time frame 2005-2009. Patients diagnosed with glioblastoma in the Canton of Zurich from 2005-2009 were identified by the Cancer Registry Zurich. Clinical and epidemiological data, as well as molecular markers were assessed, and analyzed using the Kaplan-Meier method and the Cox proportional hazards model. In the current database, there were 264 patients with glioblastoma, including 256 primary glioblastomas with an annual incidence of 3.98 compared to 3.55 in the former patient group. Median age at diagnosis was 60.0 years recently as opposed to 61.3 years previously. Overall survival (OS) for all glioblastoma patients was 41.7% at 1 year, 22.7% at 2 years and 13.1% at 3 years in the present study while previously the OS was significantly lower, namely 17.7% at 1 year, 3.3% at 2 years and 1.2% at 3 years, respectively. Median OS for primary glioblastomas was 11.0 months for the period ending 2009 versus 4.7 months for the patient population of 1980-1994. In the present study, by treatment, the median OS for best supportive care, radiotherapy alone, temozolomide alone or radiotherapy plus temozolomide was 2.0, 6.0, 6.0 or 17.0 months, respectively. Multivariate analysis revealed age, KPS, extent of resection, adjuvant treatment regimens, year of diagnosis, IDH-1 mutation status and MGMT promoter methylation status significantly associated with survival. The OS of patients in the Canton of Zurich with newly diagnosed glioblastoma has markedly improved from the period of 1980-1994 to 2005-2009.

We reviewed the anatomy and embryology of the bridging and emissary veins aiming to elucidate aspects related to the cranial dural arteriovenous fistulae. Data from relevant articles on the anatomy and embryology of the bridging and emissary veins were identified using one electronic database, supplemented by data from selected reference texts. Persisting fetal pial-arachnoidal veins correspond to the adult bridging veins. Relevant embryologic descriptions are based on the classic scheme of five divisions of the brain (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon). Variation in their exact position and the number of bridging veins is the rule and certain locations, particularly that of the anterior cranial fossa and lower posterior cranial fossa are often neglected in prior descriptions. The distal segment of a bridging vein is part of the dural system and can be primarily involved in cranial dural arteriovenous lesions by constituting the actual site of the shunt. The veins in the lamina cribriformis exhibit a bridging-emissary vein pattern similar to the spinal configuration. The emissary veins connect the dural venous system with the extracranial venous system and are often involved in dural arteriovenous lesions. Cranial dural shunts may develop in three distinct areas of the cranial venous system: the dural sinuses and their interfaces with bridging veins and emissary veins. The exact site of the lesion may dictate the arterial feeders and original venous drainage pattern.

Background: The use of stent retrievers for mechanical thrombectomy in acute ischemic stroke may induce significant vasospasm, which at the early phases of reperfusion may be crucial for rethrombosis of the recanalized vessel. We aimed to study whether the use of intra-arterial papaverine in selected cases of vasospasm was associated with improved cerebral perfusion, arterial reocclusion, or increased hemorrhagic complications. Methods: We retrospectively studied 9 consecutive patients with large artery acute occlusion, treated with stent retriever and intraarterial papaverine. Onset to administration of intravenous recombinant tissueplasminogen activator time, baseline National Institute of Health Stroke Scale, time to reperfusion, number of passes of the stent retriever, modified Rankin Scale score at discharge, postprocedural hemorrhage, onset to reperfusion time, papaverine dose, and thrombolysis in cerebral infarction grade were recorded in all patients. Results: After papaverine administration, the caliber of the infused arteries and their flow was increased in all cases. In none of the treated cases a reocclusion occurred after papaverine infusion. In one of the studied patients (11%), a parenchymal bleeding occurred 36 hours postoperatively. Conclusions: This small study suggests that intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after mechanical thrombectomy in acute ischemic stroke is effective and safe.

The angioarchitecture of the so-called moyamoya vessels in children has not been explicitly analyzed. We aimed to investigate the precise anatomy of the vascular anastomotic networks in patients with childhood moyamoya disease.Six children diagnosed with moyamoya disease for the first time underwent an angiographic investigation with selective and superselective injections. We recorded the arterial branches feeding the moyamoya anastomotic networks, their connections and the recipient vessels.Depending on the level of the steno-occlusive lesion, the feeding vessels included the medial striate arteries, the perforators of the choroidal segment of the carotid, the uncal artery, the medial and lateral branches of the intraventricular segment of the anterior choroidal artery, perforators of the communicating segment, the superior hypophyseal arteries, the prechiasmal branches of the ophthalmic artery, the ethmoidal arteries and the dural branches of the cavernous carotid. Through connections, which are described, the recipient vessels were the lateral striate arteries and the middle cerebral, the medial striate arteries and the anterior cerebral, medullary arteries around the ventricular system, anterior temporal branches of the middle cerebral, orbitofrontal and frontopolar branches of the anterior cerebral, as well as other cortical branches of the anterior and middle cerebral territories.The use of high quality selective and superselective angiography enabled us to clearly demonstrate for the first time aspects of the micro-angiographic anatomy of the moyamoya anastomotic network previously only vaguely or incompletely described.