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BackgroundData on the frequency and outcome of mechanical thrombectomy (MT) for large vessel occlusion (LVO) in patients with COVID-19 is limited. Addressing this subject, we report our multicenter experience.MethodsA retrospective cohort study was performed of consecutive acute stroke patients with COVID-19 infection treated with MT at 26 tertiary care centers between January 2020 and November 2021. Baseline demographics, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at discharge and 90 days were noted.ResultsWe identified 111 out of 11 365 (1%) patients with acute or subsided COVID-19 infection who underwent MT due to LVO. Cardioembolic events were the most common etiology for LVO (38.7%). Median baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score were 16 (IQR 11.5–20) and 9 (IQR 7–10), respectively. Successful reperfusion (mTICI ≥2b) was achieved in 97/111 (87.4%) patients and 46/111 (41.4%) patients were reperfused completely. The procedure-related complication rate was 12.6% (14/111). Functional independence was achieved in 20/108 (18.5%) patients at discharge and 14/66 (21.2%) at 90 days follow-up. The in-hospital mortality rate was 30.6% (33/108). In the subgroup analysis, patients with severe acute COVID-19 infection requiring intubation had a mortality rate twice as high as patients with mild or moderate acute COVID-19 infection. Acute respiratory failure requiring ventilation and time interval from symptom onset to groin puncture were independent predictors for an unfavorable outcome in a logistic regression analysis.ConclusionOur study showed a poor clinical outcome and high mortality, especially in patients with severe acute COVID-19 infection undergoing MT due to LVO.

To compare the intra- and interobserver variability of diameter and semiautomated volume measurements of brain metastases on contrast-enhanced magnetic resonance imaging (CE-MRI) data.

Lumbar spinal stenosis (LSS) comprises narrowing of the spinal canal with subsequent neural compression, and is frequently associated with symptoms of neurogenic claudication. To establish a diagnosis of LSS, clinical history, physical examination results and radiological changes all need to be considered. Patients who exhibit mild to moderate symptoms of LSS should undergo multimodal conservative treatment, such as patient education, pain medication, delordosing physiotherapy and epidural injections. In patients with severe symptoms, surgery is indicated if conservative treatment proves ineffective after 3–6 months. Clinically relevant motor deficits or symptoms of cauda equina syndrome remain absolute indications for surgery. The first randomized, prospective studies have provided class I–II evidence that supports a more rapid and profound decline of LSS symptoms after decompressive surgery than with conservative therapy. In the absence of a valid paraclinical diagnostic marker, however, more evidence-based data are needed to identify those patients for whom the benefit of surgery would outweigh the risk of developing complications. In this Review, we briefly survey the underlying pathophysiology and clinical appearance of LSS, and explore the available diagnostic and therapeutic options, with particular emphasis on neuroradiological findings and outcome predictors.

Zusammenfassung Die CT-gestützte Perfusionsbildgebung (Perfusions-CT, PCT) hat in den letzten Jahren durch die Einführung der Mehrschichtspiraltechnik, die Verwendung von Untersuchungsprotokollen mit niedrigeren Injektionsraten und nicht zuletzt die Verfügbarkeit verbesserter Auswertungsprogramme wesentliche neue Impulse erhalten. Auf dem derzeitigen Stand der Technik ist die PCT mit nur geringem zusätzlichem Aufwand in der Routinediagnostik einsetzbar. Semiautomatische Auswertungsverfahren liefern innerhalb von Minuten quantitative Parameterbilder zur Beurteilung des zerebralen Perfusionsstatus. Damit ist die PCT zu einem wichtigen Bestandteil der Schlaganfallbildgebung geworden und liefert als solche über das mit der nativen CT bildmorphologisch erfassbare Ausmaß der Pathologie hinausreichende pathophysiologische Informationen. Durch die Kombination von nativer CT mit den verschiedenen Perfusionsparametern ist auch mit der CT eine relativ zuverlässige Unterscheidung zwischen irreversibel geschädigtem Infarktareal und der Infarktpenumbra möglich. Dadurch kann die PCT eine Wendung von rigiden therapeutischen Zeitfenstern hin zu einer prospektiv an den individuellen Perfusionsstatus adaptierten Behandlung unterstützen. Weitere Indikationsbereiche, wie die Differenzierung zerebraler Läsionen hinsichtlich ihrer Dignität, ihrer histopathologischen Graduierung, der intraläsionalen Verteilung vitaler und regressiver Tumoranteile für bioptische und therapeutische Zwecke sowie des Therapiemonitorings und der Rezidivkontrolle, sind derzeit Gegenstand der Forschung. Eine Perfusionsbildgebung in der Schlaganfalldiagnostik ist auch mit der MRT möglich. Für den Einsatz der PCT sprechen allerdings die bessere örtliche und zeitliche Verfügbarkeit der CT und der geringere Zeitaufwand der Untersuchung. Gerade für medizinische Einrichtungen ohne rund um die Uhr verfügbare MRT kann die PCT eine wertvolle Bereicherung des diagnostischen Spektrums darstellen.

To evaluate the impact of multislice computed tomographic (MSCT) imaging, a recently developed computed tomographic technique, on imaging of temporal bone malformations.

This study was designed to assess the value of high-resolution multislice computed tomography (MSCT) data of the petrous bone for the virtual endoscopic visualization of the tympanic cavity.

Zusammenfassung Hintergrund: Die diagnostische Wertigkeit der Schnittbildverfahren CT und MRT im Rahmen der Felsenbeinbildgebung wird wesentlich beeinflusst von der Detailerkennbarkeit der komplexen Mittel- und Innenohrstrukturen. Die weitere Herabsetzung der Schichtdicke war eine logische Folge der Bemühungen um eine optimierte Bildgebung. Optimierte Bildgebung: Bei der MRT hat der Einsatz der Volumendatensätze diesen Fortschritt ermöglicht, bei der CT die Einführung der Mehrschicht-Spiral-CT-Technologie. Basierend auf diesen hoch auflösenden Datensätzen entsteht eine Bild- und Informationsflut, die durch das sequenzielle Betrachten und Abfotografieren der Bilddaten nur unzureichend bewältigt wird und eine Dtennachverarbeitung erforderlich macht. Nachverarbeitungstechniken: Auch die Nachverarbeitungstechniken haben einschneidende Veränderungen erfahren von der Erstellung orthogonaler und multiplanarer Reformationen über die Maximum-Intensitäts-Projektion hin zu 3-D-Verfahren in Surface-Rendering und Volume-Rendering-Technik. Die Einführung der letztgenannten Nachverarbeitungstechnik hat die interaktive extra- und endoluminale Darstellung kleinster anatomischer Hohlräume des Felsenbeins wie der basalen Kochleawindung ermöglicht im Sinne einer virtuell endoskopischen Darstellung. Abstract Background: The diagnostic value of CT and MRI for sectional imaging of the petrous bone crucially relies on the detail resolution of the complex structures of the middle and inner ear. Efforts to optimize imaging have led to a further reduction of slice thickness. Optimized Imaging: These advances have been made possible by the use of volumetric data sets in the case of MRI and by the advent of multislice helical scanners in the case of CT. The high-resolution data sets generated by these techniques have led to a flood of images and information which cannot be adequately coped with by sequential viewing and photographing of the individual images and hence requires data postprocessing. The Postprocessing Techniques have likewise seen considerable changes in the development from orthogonal and multiplanar reformations and maximum intensity projections to 3-D procedures based on surface rendering and volume rendering. The introduction of the latter postprocessing technique has enabled interactive extra- and endoluminal visualization, or virtual endoscopy, of very tiny anatomic cavities of the petrous bone such as the basal cochlea winding.

Objective. To introduce a novel surgical approach to petrous apex lesion (PA) with superior semicircular canal plugging for hearing preservation. Patient. A 63-year-old patient presented with a recurrent cholesteatoma of the left petrous apex. The patient had a long-term history of cholesteatoma and MRI with diffusion-weighted imaging (DWI) detected a suspicious lesion in the left petrous apex on follow-up. Intervention. The cholesteatoma could be completely removed from the petrous apex with partial superior semicircular canal plugging and removal with hearing preservation. Outcomes. Cholesteatomas of the temporal bone are managed by surgery with complete excision of the lesion. Results. The translabyrinthine approach, generally useful in nonhearing ears, could be utilized with the additional technique of superior semicircular canal plugging to preserve hearing in this patient. Conclusions. This case highlights the possibility of a hearing preservation strategy for PA cholesteatomas using a translabyrithine approach.

AbstractThe lacrimo-auriculo-dento-digital (LADD) syndrome is a rare inherited disorder affecting the lacrimal, auricular, salivary, and osseous system. Only very limited data on LADD associated petrous bone lesions are available up to now. We describe a young girl suffering from the LADD syndrome with sensorineural hearing loss and inner ear dysplasia. This case suggests, that inner ear dysplasia might be a more common feature of the LADD syndrome than has been assumed so far.Copyright © 2002 S. Karger AG, Basel

AbstractNeural tissue-derived facial nerve tumours usually present as neurinomas. We describe the extremely rare occurrence of a histologically verified neurofibroma primarily arising in the mastoid segment of the facial canal in a patient not fulfilling diagnostic criteria for neurofibromatosis. The tumour showed evidence of perineural growth into the jugular foramen, as suggested by cross-sectional imaging and intraoperative findings.Copyright © 2002 S. Karger AG, Basel