Differentiation of vestibular schwannomas from meningiomas of the internal auditory canal using perilymphatic signal evaluation on T2-weighted gradient-echo fast imaging employing steady state acquisition at 3T.

BACKGROUND: Our aim was to confirm the usefulness of the perilymphatic signal changes on T2-weighted (T2W) gradient-echo sequence to differentiate vestibular schwannomas from internal auditory canal (IAC) meningiomas, through a compartmental analysis of inner ear fluids signal intensity. METHODS: A total of 203 patients with all criteria for typical vestibular schwannoma on T1-weighted contrast-enhanced sequences were retrospectively enrolled (190 schwannomas and 13 meningiomas). All patients underwent a T2W gradient-echo steady state free precession (SSFP) acquisition at 3T. Two radiologists analysed the signal intensity of the perilymph (cistern and cochlea) and endolymph (saccule and utricle) using a region of interest-based method for obtaining ratios between the analysed structures and the cerebrospinal fluid (CSF). RESULTS: Obstructive vestibular schwannomas showed a markedly decreased perilymphatic signal in both cistern and cochlea; the cistern/CSF ratio (Ci/CSF) was 0.62. The decrease was more moderate in IAC meningiomas (Ci/CSF = 0.81). For Ci/CSF > 0.70, the tumour was more likely a meningioma, with a 92% sensitivity and 83% specificity. No endolymphatic signal changes were observed. CONCLUSION: The pronounced decrease in perilymphatic signal on a T2W SSFP sequence in obstructive vestibular schwannoma provides a new tool to differentiate schwannomas from IAC meningiomas, which may be useful to overcome the insufficiencies of morphological analysis.

The learning curve effect on embolization of cerebral dural arteriovenous fistula single-center experience in 48 consecutive patients.

BACKGROUND: Cerebral dural arteriovenous fistulas (DAVFs) are rare intracranial vascular lesions but can cause significant morbidity and mortality. OBJECTIVES: To analyze the effect of the center's experience on DAVF embolization efficacy and safety. METHODS: From May 2008 to October 2014, 57 embolization procedures were attempted on 48 patients (37 men and 11 women; median age: 63.9 years) for DAVF in a single center. DAVF presented with cortical venous reflux in 44/48 cases (91.7%) and hemorrhagic manifestation in 21/48 cases (43.75%). Angiographic occlusion quality, whether complete or incomplete (efficacy), and neurological complications (safety) were recorded. The patient population was divided into four consecutive quartiles during the inclusion period to assess the progress profile. Efficacy and safety outcomes were compared with Fisher's test. RESULTS: A logistic regression was performed to explore a learning curve phenomenon, showing a significant association between the chronological rank in the cohort and embolization efficacy (P=0.007). Significant differences were found between first and last quarter (P=0.036). The endovascular technique involved an arterial injection of Onyx® in 36/48 cases (75%), administered via the middle meningeal artery in 25/36 cases (69.5%). The complete occlusion rate improved significantly from 33.3% for the first quartile of the population, to 75.0% for the 2nd and 3rd quartiles and 83.3% for the last quartile. Neurological complications were found in 7/48 patients (14.6%), the rate decreased by 41.7% to 16.7%, without statistically difference. CONCLUSION: The efficacy and safety of DAVF embolization improved with the experience gained at the center, suggesting the existence of a learning curve.

Effects of a wheelchair ergometer training programme on spinal cord-injured persons.

STUDY DESIGN: Before and after investigation of the effects of a wheelchair ergometer Training programme. OBJECTIVE: To investigate the effects of an original interval-training programme on work capacity and cardiorespiratory variables with spinal cord-injured persons (SCIP's) on a wheelchair-specific ergometer. SETTING: BESANCON, FRANCE. METHODS: Seven SCIP's (male) performed 45 min of wheelchair ergometry three times per week, for 6 weeks. Training effects on maximal dynamic performance and endurance capacity were studied by comparison of performance and cardiorespiratory responses observed during both a maximal progressive test (10 W/2 min) and the same training session performed before and after training. RESULTS: Training induced significant improvements in maximal tolerated power (+19.6%), in peak oxygen consumption (VO2,+16%), and in oxygen pulse (O2p,+18.7%). At ventilatory threshold, significant improvements were also observed in power output (+63%), VO2VT(+ 34.1), ventilation VEVT(+ 37.1%), and V2pVT(+ 19.9% ). Heart rate and ventilation were significantly lower (-11 and -14.6%, respectively) after training at the same work rate, while VO2 was unchanged. Between the first and the last training session, the total physical work was improved by 24.7%, whereas heart rate was unchanged. CONCLUSION: An interval-training programme individualised to each paraplegic subject using a wheelchair ergometer can significantly improve the fitness level and endurance capacity.

[Dislocated hips in cerebral palsy (author's transl)]. / Les défauts de centrage de la tête fémorale chez l'infirme moteur d'origine cérébrale.

The authors have observed 119 excentrated hips in 81 spastic children. Most of the cases were noted in non walking children under the age of ten. However some excentrated hips were seen in older patients eventually able to walk. The importance of a three dimensional approach of the problem is pointed out. The results of the surgical procedures are analysed. It appeared that it was important to restore a muscle balance before any pelvic or femoral osteotomy. Triple pelvic osteotomy was indicated of obtaining a better orientation of the acetabulum in younger children. Its complications were infrequent. Chiari's osteotomy was indicated in older children. The authors point out the importance of an early diagnosis in cases of lack of muscles balance which can be corrected by minor surgical procedures on soft tissues.