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Intracranial dural arteriovenous fi stulas with retrograde leptomeningeal or cortical drainage are considered aggressive. Conventional treatment in these cases is possible surgically or with endovascular arterial injections of Onyx or cyanoacrylate, but there are still some cases where distal navigation is not possible due to tortuosity of the arterial feeders. We present fi ve cases of direct transforaminal Onyx embolization where endovascular distal navigation could not be achieved. [ABSTRACT FROM AUTHOR]

Cerebral arteriovenous malformations (AVMs) are uncommon. Treatment options include embolization, radiosurgery and surgery, separately or combined, the final goal being complete occlusion of the malformation. We describe the case of a symptomatic small subependymal AVM with a single deep drainage vein previously treated unsuccessfully by radiosurgery and transarterial embolization. The AVM was successfully embolized transvenously using Onyx, achieving complete occlusion in a single treatment session. [ABSTRACT FROM AUTHOR]

The present article aims to describe the current role of interventional neuroradiology in the diagnosis and treatment of head and neck paragangliomas, based on our experience and a literature review. The cellular polymorphism of head and neck paragangliomas confers these tumors with their characteristics hypervascularization (angioarchitecture) with characteristic arteriographic signs and hemorrhage that justify presurgical embolization. The main indications of digital angiography in head and neck paragangliomas are to confirm diagnosis and identify functional involvement of the large cervical vessels, as well as their possible vascular replacement. Extensive carotid or jugular involvement may require excision of these vessels. Functional tests that allow the patency of the circle of Willis and/or that of the contralateral sigmoid sinus to be identified are required to predict post-treatment neurological complications. Although the treatment of choice of head and neck paragangliomas is complete excision, hypervascularization may complicate surgical resection. Presurgical embolization is used to facilitate treatment by reducing blood loss, shortening operating time and lowering postoperative neurological morbidity. Palliative embolization is indicated in patients with inoperable tumors. Currently, three interventional techniques can be used in the treatment of head and neck paragangliomas: endovascular embolization, direct percutaneous puncture, and placement of vascular stents. Although infrequent, the most severe complications are those related to embolism of the embolizing material. These complications are less frequent in highly specialized centers.

Study Design: Prospective, double-cohort study., Objective: To evaluate conservative and percutaneous vertebroplasty (PV) management of osteoporotic vertebral fractures., Summary of Background Data: PV is an elective alternative to conservative management for the treatment of a painful osteoporotic vertebral fracture., Methods: We performed a prospective study consisting of 101 consecutive patients who underwent PV and 27 patients who refused PV treatment and were managed conservatively. We used a data evaluation and outcomes system that was developed to evaluate the outcomes of surgical intervention., Results: Patients that elected for PV as a treatment of their fractures had significantly more pain and functional impairment before the procedure than the patients of the conservative group (P < 0.001). The pain, functional, and general health scores of the PV group were improved from the preoperative mean values (P < 0.001) in all postoperative periods. Compared with the conservative treatment group, there was a significant difference at month 3. However, no statistical differences on function were observed between these groups at 6 months and 1 year posttreatment., Conclusions: PV demonstrated a rapid and significant relief of pain and improved the quality of life. PV election for treatment of painful osteoporotic vertebral fracture after 6 weeks of conservative treatment was based on pain and functional impairment.