Endovascular Treatment of Wide Neck Aneurysms.

BACKGROUND: An aneurysm is an abnormal focal dilatation of an artery. Most of the unruptured aneurysms are asymptomatic and discovered incidentally or some of them symptomatic with mass effect or nerve palsy, but rupture of aneurysm results in a potentially life-threatening subarachnoid haemorrhage. Aneurysms with wide necks are defined by neck diameters greater than 4 mm or dome-to-neck ratios less than 2 and are the most difficult to treat with the endovascular method. AIM: This study aimed to analyse the endovascular treatment of intracranial aneurysms with a wide neck. METHODS: The study population included 37 patients with 46 aneurysms referred to the University Clinic of Radiology in Skopje, the Republic of Macedonia for endovascular treatment during the period January 2013 to May 2018. This study included 24 females and 13 males, ranging in age from 25 to 74 years. RESULTS: From total 46 treated aneurysms 13 were ruptured and 33 unruptured. Six patients were with multiple aneurysms. In these study complex aneurysms were treated with combined technique, 5 with balloon-assisted coiling, 25 with stent-assisted coiling, 6 stents, 2 with flow diverter assisted coiling, 6 FD and 2 with partial coil filling without assistance device. CONCLUSION: Aneurysms with wide neck remain a challenge for endovascular treatment. But the development of new techniques and materials in the treatment of aneurysms makes endovascular treatment of intracranial aneurysms safe and feasible.

Posterior cerebral artery--variation in the origin and clinical significance.

With the introduction of new techniques in diagnostic and interventional radiology and progress in micro-neurosurgery, accurate knowledge of the brain blood vessels is essential in daily clinical work. The aim of this study was to describe the different types of PCA origin, their diameter, and to emphasize their clinical significance. In this study we examined radiographs of 53 patients who had CT angiography undertaken for a variety of clinical reasons, performed as a part of their medical treatment at the University Radiology Clinic in Skopje, R. Macedonia. This study included 24 females and 29 males, ranging in age from 32 to 73 years; mean age 55.3±11.5 years. The results showed that the diameter of the posterior cerebral artery was 1.74±0.317 mm on the right side and 1.98±0.408 mm on the left side. The adult configuration was present in 37 (69.81%); foetal configuration was present in 12 (22.64%) and transitional configuration was present in 4 (7.54%) of the patients. We found two patients with bilateral foetal type and ten with unilateral foetal type (six on the right side and four on the left side). Despite the limitations of the study, we found that the foetal variant was presented in 22.64% of patients. Thorough knowledge of the anatomy of the intracranial vessels is important to clinicians as well as basic scientists who deal with problems related to intracranial vasculature on a daily basis.

Computed tomography or magnetic resonance imaging - our experiences in determining preoperative TNM staging of bladder cancer.

UNLABELLED: Bladder cancer is the ninth most common cancer diagnosis worldwide. Early detection of bladder cancer is important, since up to 47% of bladder cancer-related deaths might be avoided. AIM: To show our experience in determining the staging of bladder cancer with multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), making comparison of stage accuracy with contrast enhanced MDCT, conventional MR imaging and dynamic contrast-enhanced MR imaging on the one hand and pathoistological diagnoses after transurethral resection of the non-muscle invasive bladder cancers or radical cystectomy for patients with muscle-invasive bladder cancers. MATERIALS AND METHODS: Ninety patients with histologically proved bladder cancer were prospectively examined with MDCT, conventional and dynamic MR imaging before tumour resection. RESULTS: Staging was correct in 55.6% with CT, 56.7% with conventional MRI and in 86.7% with dynamic MRI, which was highly significant compared with CT and conventional MRI. Overestimation for superficial tumors was high with CT (31.25%) and conventional MR imaging (25%), but was significantly reduced with dynamic MR imaging (8.3%). The percentages of underestimation in surgically proved invasive tumours (pT2- pT4) were lowest with dynamic MR imaging. CONCLUSION: CT and MR imaging are less accurate in the evaluation of the depth of mural invasion and for both techniques overstaging is the most frequent error. Dynamic contrast-enhanced MRI with 87% of accuracy, 8.3% overestimation for superficial tumours and lowest underestimation for invasive tumours, make this imaging considerably more accurate.