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The current review provides a literature overview of studies assessing the oncological and fertility outcomes of treatment with neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer >2 cm. Six cohort studies were included showing severe heterogeneity regarding patient selection, chemotherapy regimen, and surgical approach. In total, 111 patients were studied, with overall favorable characteristics. Patients were on average 29 years old, had a tumor of 36 mm, no lymph node metastasis, and response to chemotherapy. In approximately 5-year follow-up, the recurrence rate was 13% (0%-21%) and overall death rate 2.7% (0%-10%). Three patients were alive with recurrent disease (2.7% and 0%-11%). Of the 111 patients, 90 underwent successful fertility-sparing treatment (83%). Roughly one-third conceived and one-fourth had a healthy live-born child. More research is essential to determine proper selection criteria for fertility-sparing treatment of cervical cancer >2 cm and the optimal treatment management.

Background and aims: MRI can detect intracranial vessel wall thickening before any luminal stenosis is present. Apart from representing a vessel wall lesion, wall thickening could also reflect normal (age-related) variations in vessel wall thickness present throughout the intracranial arterial vasculature. The aim of this study was to perform vessel wall thickness measurements of the major intracranial arteries in ex vivo circle of Willis (CoW) specimens using 7T MRI, to obtain more detailed information about wall thickness variations of the intracranial arteries. Methods: Fifteen human CoW specimens were scanned at 7T MRI with an ultrahigh-resolution T1-weighted sequence. Five specimens were used for validation of MRI measurements with histology and evaluation of inter-rater reliability and agreement. The other 10 specimens from patients with (n = 5) and without (n = 5) cerebrovascular disease were used for vessel wall thickness measurements over the entire length of the major arterial segments of the CoW using MRI only. Results: MRI measurements showed excellent agreement with histology. Mean wall thickness varied from 0.45 to 0.66 mm, minimum wall thickness from 0.31 to 0.42 mm, maximum wall thickness from 0.52 to 0.86 mm, and normalized wall index from 0.64 to 0.75. On average, vessel walls were thicker for symptomatic patients compared to asymptomatic patients. Conclusions: High-resolution MRI enables accurate measurement of vessel wall thickness in ex vivo CoW specimens. Vessel wall thickness measurements over the entire length of segments showed considerable variation both within and between arterial segments of patients.

Background and aimsIntracranial atherosclerosis is one of the main causes of ischemic stroke. However, the characteristics of intracranial arteries and atherosclerosis have rarely been studied. Therefore, we systematically investigated atherosclerotic changes in all arteries of the Circle of Willis (CoW).MethodsSixty-seven CoWs obtained at autopsy from randomly chosen hospital patients (mean age, 67.3 ± 12.5 years), of which a total of 1220 segments were collected from 22 sites. Atherosclerotic plaques were classified according to the revised American Heart Association classification and were related to local vessel characteristics, such as the presence of an external and internal elastic lamina and the elastic fibre density of the media.Results181 out of the 1220 segments had advanced plaques (15%), which were mainly observed in large arteries such as the internal carotid, middle cerebral, basilar and vertebral artery. Only 11 out of 1220 segments (1%) showed complicated plaques (p

Intracranial atherosclerosis, one of the leading causes of ischemic stroke, is associated with an increased risk for recurrent stroke and dementia.1,2 Individuals of Asian, Hispanic, and African American ancestry are especially affected. Recent European studies revealed a much higher prevalence of intracranial lesions than commonly presumed, suggesting that intracranial atherosclerotic disease is potentially the most common cause of ischemic stroke worldwide.1,3 Ischemic strokes are clinically categorized into 5 subtypes based on their underlying cause: large-artery atherosclerotic stenosis, small-artery disease (lacunes), cryptogenic, major-risk-source cardiogenic embolism, and unusual (eg, dissections, arteritis). Most nonlacunar ischemic strokes are thought to be thromboembolic, which presumably also accounts for most cryptogenic strokes. Embolic sources include minor-risk or covert cardiac sources, veins via paradoxical embolism, and nonocclusive atherosclerotic plaques in the aortic arch or cervical or cerebral arteries.4 Besides embolic strokes, 2 other mechanisms have been associated with intracranial atherosclerosis-related strokes, namely hypoperfusion through a stenotic artery causing watershed or border-zone stroke and plaque overgrowth of perforator artery ostia, which is associated with penetrating artery disease and lacunar infarcts and has been related to cryptogenic strokes.5–7 Even mild stenosis of intracranial atherosclerotic arteries (