Neuroimaging clinics of North America
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Sinus thrombosis in children is increasingly recognized; however, the diagnosis is still frequently missed. Children may have an increased incidence of this disorder compared with adults, and neonates are at greatly increased risk compared with older children. Childhood CSVT carries significant long-term sequelae that include death or neurologic deficits in nearly 50% of cases. ⋯ Among the most significant current and future developments in childhood CSVT is the evolution of accurate, noninvasive and economical neuroimaging techniques. The latter techniques have the potential to increase the detection rate of childhood CSVT, improve our understanding of the pathophysiology and define important subgroups of patients who best respond to treatment. An international interest in childhood CSVT is developing and, in the next decade, will enable the necessary multi-national clinical trials to provide evidence-based treatments and decrease the adverse outcomes.
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Neuroimaging Clin. N. Am. · Feb 2003
ReviewHydrovenous disorders in pediatric intracranial arteriovenous fistula.
High-flow AVFs are a challenging problem in the pediatric age group. Venous occlusive changes develop as part of the dynamic response to these fistulas. The development of adequate venous collateral flow circumvents the destructive sequelae of longstanding venous hypertension. ⋯ Venous hypertension interferes with CSF resorption, resulting in increased brain water. Ventriculomegaly and tonsillar prolapse commonly develop and are reversible if therapeutic intervention is done in a timely fashion. If left untreated, chronic venous ischemic changes develop, which result in delay in important developmental milestones.
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Neuroimaging Clin. N. Am. · Feb 2003
ReviewRadiologic findings and clinical significance of venous compartment of brain arteriovenous shunts.
The venous compartment of brain AVS is closely related to the development of various clinical consequences, including hemorrhage, seizure, and neurologic deficit. Therefore, understanding the venous etiology of the clinical symptoms and the imaging characteristics of partial or complete venous outlet thrombosis is critical for the proper management of patients with brain AVSs.
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Neuroimaging Clin. N. Am. · Nov 2002
ReviewAnti-angiogenic agents for the treatment of brain tumors.
It is accepted that novel therapeutic approaches are needed for the majority of patients with malignant brain tumors. The vascularity of many primary brain tumors and the encouraging preclinical studies suggest that antiangiogenic agents have the potential to become an important component of multimodality treatment of patients with brain tumors. The understanding of the biology of angiogenesis is improving rapidly, offering the hope for more specific vascular targeting of brain tumor neovasculature. Neuroimaging techniques evaluating the angiogenic process and the impact of antiangiogenic agents will be an important tool for the rapid development of these novel therapeutic agents.
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Neuroimaging Clin. N. Am. · Nov 2002
ReviewIntraoperative magnetic resonance imaging and magnetic resonance imaging-guided therapy for brain tumors.
Since their introduction into surgical practice in the mid 1990s, intraoperative MRI systems have evolved into essential, routinely used tools for the surgical treatment of brain tumors in many centers. Clear delineation of the lesion, "under-the-surface" vision, and the possibility of obtaining real-time feedback on the extent of resection and the position of residual tumor tissue (which may change during surgery due to "brain-shift") are the main strengths of this method. High-performance computing has further extended the capabilities of intraoperative MRI systems, opening the way for using multimodal information and 3D anatomical reconstructions, which can be updated in "near real time." MRI sensitivity to thermal changes has also opened the way for innovative, minimally invasive (LASER ablations) as well as noninvasive therapeutic approaches for brain tumors (focused ultrasound). Although we have not used intraoperative MRI in clinical applications sufficiently long to assess long-term outcomes, this method clearly enhances the ability of the neurosurgeon to navigate the surgical field with greater accuracy, to avoid critical anatomic structures with greater efficacy, and to reduce the overall invasiveness of the surgery itself.