Atlas of Neurosurgical Techniques: Spine and Peripheral Nerves, 2nd Edition

Fessler RG, Sekhar LN. Atlas of Neurosurgical Techniques: Spine and Peripheral Nerves. 2nd ed. Thieme; 2016; 994 pp; 1300 ill; $399.99

Cover of Fessler and Sekhar

Despite interpreting a considerable number of post-operative spine images daily, a radiologist may not understand the exact steps taken in these surgical procedures. The second edition of Atlas of Neurosurgical Techniques: Spine and Peripheral Nerves, edited by Drs. Fessler and Sekhar, allows one to gain an appreciation of the maneuvers taken in all of the key surgeries of the spine and peripheral nerves. With over 150 contributing authors and nearly the same number of chapters, one can—with the help of descriptions, copious diagrams, operative photographs, and even some videos (available online via a registration process)—understand the basics of all operations and clinical situations we constantly encounter in image interpretation.

There are six sections: occipital–cervical junction (21 chapters), cervical spine (20 chapters), cervicothoracic junction (5 chapters), thoracic spine (36 chapters), lumbar spine (42 chapters), and peripheral nerves (21 chapters), all of which cover 950 pages.

Some chapters are short and simply descriptive, while others, such as the chapter on vascular malformations, are written in greater depth. As would be expected, there are many images (e.g., plain radiographs, CTs, and MRs), but there has been no specific radiologist input. Nonetheless, our interest in this book lies in how procedures are done, not in the interpretation of the images.

This is not a book that a neuroradiologist would purchase; however, neurosurgery libraries would probably carry this atlas (in addition to Fessler’s Atlas of Neurosurgical Techniques: Brain). Therefore, both would hopefully be available in the event that one wanted information concerning a particular surgical procedure.…

ASNR 2017 Abstract Submission Site Is Now Open

2017 meeting logo

The abstract submission site for the ASNR 55th Annual Meeting at the Long Beach Convention Center to be held on April 22-27, 2017 is now open at:


Note:  The Submission Site has changed; we recommend prior review before submitting.

Reminders… All authors must disclose. For submitted abstracts to be finalized, all primary and co-authors must complete online disclosure process to be considered for presentation for ASNR 2017. Author changes will not be allowed after the submission deadline Friday, December 9, 2016. All correspondence (including the notification) will be sent via email to the primary/presenting author.

Any notification emails from the abstract system will be labeled from We suggest you add this email to your safe sender list.

The 2016 Annual Meeting was a success with over 1,700 attendees and a record number of 1,400 submitted abstracts; let’s keep that momentum and make our 2017 meeting another memorable year.

For more details about the ASNR 2017 Annual Meeting on Diagnosis and Delivery and The Foundation of the ASNR Symposium 2017: Discovery and Didactics, please visit:…

Journal Scan – This Month in Other Journals, October 2016

Mossa-Basha M, de Havenon A, Becker KJ, et al. Added Value of Vessel Wall Magnetic Resonance Imaging in the Differentiation of Moyamoya Vasculopathies in a Non-Asian Cohort. Stroke. 2016;47(7):1782–1788. doi:10.1161/STROKEAHA.116.013320.

Moyamoya vasculopathy is divided into moyamoya disease (MMD) and moyamoya syndrome (MMS). This is a steno-occlusive process of the carotid termini, proximal middle cerebral artery, and anterior cerebral artery with development of compensatory collaterals. If patients have a well-recognized associated condition, then it is called moyamoya syndrome, whereas those patients with no known associated risk factors are said to have moyamoya disease. By definition, the pathognomic arteriographic findings are bilateral in moyamoya disease (although severity can vary between sides). Patients with unilateral findings have moyamoya syndrome, even if they have no other associated risk factors. MMS may arise secondary to many underlying disease processes, including sickle cell anemia, NF1, radiation therapy, congenital syndromes, intracranial atherosclerotic disease (A-MMS), and vasculitis (V-MMS). Making a correct and specific diagnosis will alter management, since MMD is treated by surgical revascularization, whereas the SAMMPRIS trial showed that aggressive medical management is the first-line therapy for a patient with high-grade (70%–99%) atherosclerotic stenosis. In this study, 10 atherosclerotic disease related MMS patients, 3 vasculitis disease related MMS patients, and 8 moyamoya disease patients with 38 affected carotid segments were evaluated with vessel wall MR. The most common vessel wall MRI findings for moyamoya disease were nonenhancing, nonremodeling lesions without T2 heterogeneity; for A-MMS eccentric, remodeling, and T2 heterogeneous lesions with mild/moderate and homogeneous / heterogeneous enhancement; and for V-MMS concentric lesions with homogeneous, moderate enhancement. There was an 11% inter-reader agreement for diagnosis on luminal imaging when compared with 82% for luminal imaging + vessel wall MRI. They conclude that vessel wall MRI improves diagnostic accuracy and diagnostic confidence in the differentiation of MMD …

How NOT to Write a Medical Paper: A Practical Guide

Heinemann MK. How NOT to Write a Medical Paper: A Practical Guide. Thieme; 2016; 104 pp; $10.99

Cover of Heinemann

Here’s a switch—how not to do something. This short (104 page, small, softcover publication) is authored by Dr. Heinemann, the Editor-in-Chief of the journal The Thoracic and Cardiovascular Surgeon. The various types of medical papers are mentioned, including full-length scientific papers, case reports, meta-analyses, review papers, “how I do it” papers, and letters. The material quotes what are termed (and probably invented) “bad examples” as they pertain to authors. In other words, these examples illustrate how each section of the paper should and should not be written. “Bad” examples of editors’ comments and reviewers’ comments are part of the publication. To this reviewer, the biggest impediment to writing a paper is simply breaking the inertia of inaction. In other words, it is often tough to start getting something on paper. A wise neurologist once told me to start by writing the legends for the images first, because if you can’t get those descriptions down solid, then the rest will be difficult.

In any event, this booklet would be good to circulate around the housestaff (residents and fellows). Short hints may save a lot of time. …

Correlation of MRI Brain Injury Findings with Neonatal Clinical Factors in Infants with Congenital Diaphragmatic Hernia

Fellows’ Journal Club

The authors evaluated MRIs performed before hospital discharge in 53 infants with congenital diaphragmatic hernia that were scored forbrain injury by 2 pediatric neuroradiologists. Potential associations with perinatal and clinical variables from the neonatal intensive care unit stay were probed. The most common findings were enlarged extra-axial spaces (36%), intraventricular hemorrhage (23%), ventriculomegaly (19%), white matter injury (17%), and cerebellar hemorrhage (17%). Brain injury score was associated with extracorporeal membrane oxygenation, lack of oral feeding at discharge, use of inotropes, and gastrostomy tube placement before hospital discharge.


Figure 2 from paper
A, Coronal T2-weighted image demonstrates ventriculomegaly, scored as grade 2 on our scale; B, Coronal T2-weighted image demonstrates enlarged extra-axial spaces, scored as grade 2 on our scale. C, SWI shows evidence of grade 2 intraventricluar hemorrhage (arrows). D, SWI shows evidence of parenchymal hemorrhage, grade 1 on our scale (arrow). E, SWI shows foci of cerebellar hemorrhage, grade 2 on our scale (arrows). F, Axial T1 weighted images demonstrate foci of bilateral white matter injury, grade 2 on our scale (arrows).


Infants with congenital diaphragmatic hernia are reported to have evidence of brain MR imaging abnormalities. Our study aimed to identify perinatal clinical factors in infants with congenital diaphragmatic hernia that are associated with evidence of brain injury on MR imaging performed before hospital discharge.


MRIs performed before hospital discharge in infants with congenital diaphragmatic hernia were scored for brain injury by 2 pediatric neuroradiologists. Perinatal variables and clinical variables from the neonatal intensive care unit stay were analyzed for potential associations with brain MR imaging findings.


Fifty-three infants with congenital diaphragmatic hernia (31 boys) were included. At least 1 abnormality was seen on MR imaging in 32 infants (60%). The most common MR imaging findings were enlarged extra-axial spaces (36%),

Risk Factors for Ischemic Complications following Pipeline Embolization Device Treatment of Intracranial Aneurysms: Results from the IntrePED Study

Editor’s Choice

This is a retrospective subanalysis of the IntrePED study, which has beenpreviously published (AJNR Am J Neuroradiol 2015;36:108–15).Seven hundred ninety-three patients with 906 treated aneurysms were enrolled. Thirty-six (4.5%) patients had postoperative acute ischemic stroke, 21 of which occurred within 1 week of the procedure. There was no difference in the rate of acute stroke between the anterior and posterior circulations. Stroke rate was 3% in patients with 1 PED, and 7% in those with 2 PEDs. With multivariate analysis, the only variable independently associated with postoperative stroke was treatment of fusiform aneurysms. Among the patients with stroke, 10 (27.0%) died and 26 (73.0%) had major neurologic morbidity. The authors conclude that acute ischemic stroke following treatment of intracranial aneurysms with the PED is an uncommon but devastating complication, with 100% of patients having major morbidity or mortality.

WEB Treatment of Ruptured Intracranial Aneurysms

Fellows’ Journal Club

This observational cohort study evaluated 32 patients with 32 acutely ruptured aneurysms endovascularly treated with the Woven EndoBridge (WEB) device. The mean aneurysm size was 4.9 mm, with 14 less than or equal to 4 mm, and most had a wide neck. All aneurysms were adequately occluded, and there were no procedural ruptures or complications related to the WEB device. No adjunctive stents or balloons were needed. Seven patients with poor clinical grade died during hospital admission due to the sequelae of their subarachnoid hemorrhage. The authors conclude that WEB treatment of small ruptured aneurysms was safe and effective without the need for anticoagulation, adjunctive stents, or balloons.


Figure 3 from paper
A 57-year-old woman with a ruptured anterior communicating artery aneurysm. A, 3D angiogram shows a small anterior communicating artery aneurysm. Note the spasm in the left A1. B, Measurement of the height (3.9 mm) and neck width (2.3 mm). C, Angiogram directly after placement of a 4-mm WEB-SLS. Note some opacification inside the WEB. D, Angiogram at 3 months demonstrates complete occlusion of the aneurysm.


The Woven EndoBridge (WEB) device was recently introduced for intrasaccular treatment of wide-neck aneurysms without the need for adjunctive support. We present our first experience in using the WEB for small ruptured aneurysms.


During 11 months, 32 of 71 (45%) endovascularly treated acutely ruptured aneurysms were treated with the WEB. The patients were 12 men and 20 women, with a mean age of 61 years (range, 34–84 years). The mean aneurysm size was 4.9 mm, and 14 were ≤4 mm. Of 32 aneurysms, 24 (75%) had a wide neck.


All 32 aneurysms were adequately occluded after WEB placement. There were no procedural ruptures and no complications related to the WEB device. No adjunctive stents or balloons

Quantitative Susceptibility Mapping and R2* Measured Changes during White Matter Lesion Development in Multiple Sclerosis: Myelin Breakdown, Myelin Debris Degradation and Removal, and Iron Accumulation

Editor’s Choice

The authors characterized lesion changes on quantitative susceptibility mapping and R2* at various gadolinium enhancement stages (nodular, shell-like, nonenhancing) in 64 patients with 203 lesions. They found that: 1) active MS lesions with nodular enhancement show R2* decrease but no quantitative susceptibility mapping change; 2) late active lesions with peripheral enhancement show R2* decrease and quantitative susceptibility mapping increase in the lesion center; and 3) nonenhancing lesions show both quantitative susceptibility mapping and R2* increase, reflecting iron accumulation.

Imaging of Cerebrovascular Disease: A Practical Guide

Runge VM. Imaging of Cerebrovascular Disease: A Practical Guide. Thieme; 2016; 160 pp; 711 ill; $79.99

Cover of Imaging of Cerebrovascular Disease

In a short, easy-to-read, soft-covered book, “Imaging of Cerebrovascular Disease: A Practical Guide,” Dr. Runge has compiled all the key points in CVD imaging without going into elaborate and unnecessary details. The reader will come away understanding how to acquire and interpret vascular disease imaging, including stroke, vascular malformations, and aneurysms. By providing an initial chapter on MR and CT techniques, Dr. Runge lays a foundation for the 5 chapters that follow. Nice comparisons both technique-wise and with images at 1.5 T and 3.0T scanners are described and illustrated.

Dr. Runge has previously published material on MR physics and on contrast material in MR imaging, so the first chapter is a summary of his experience as it relates to CVD. It is important to start with the reading of this chapter, but one must have a basic knowledge of MR to fully appreciate this material. The material is not intended for someone trying to understand the fundamentals of MR imaging. There is less time spent on CT, in part due to the fact that there are fewer variables to manipulate or consider; nonetheless, the underpinning of CT in CVD is explained.

The chapters on normal anatomy and hemorrhage are short and adequately illustrated.

The chapter on ischemia is one that should be made available to new residents rotating through neuroradiology and all neuroradiology fellows. It will serve to emphasize the appearance and evolution of strokes, using different MR parameters and different strength MR systems. It is noteworthy that when describing and illustrating infarcts, there is a mention of the particular part of the brain involved. Such inclusion in any radiology report makes it more meaningful and helps with the anatomic/clinical correlations. Parameter maps …

The Chronic Ear

Dornhoffer JL, Gluth MB, eds. The Chronic Ear. Thieme; 2016; 368 pp; 472 ill; $179.99

Cover of The Chronic Ear

If you ever thought that imaging of ear diseases (middle ear in particular) is challenging, then wait until you read this book. The Chronic Ear details the breadth of pathophysiology, clinical approach, and surgical management of chronic ear pathology.

The book is divided into eight sections. Section 1, “The Fundamentals of Chronic Ear Disease,” is dedicated to the fundamental principles of anatomy and physiology of ear disease. Section 2 details the clinical evaluation and office management of chronic ear disease, while Section 3 is dedicated to the various surgical techniques. In all these 3 sections, the chapters are didactic, detailed, and easy to follow. The anatomy, histology, and pathophysiology is exhaustive yet written in simple language. The pictures are very illustrative and descriptive, and the image quality is excellent. The radiographic evaluation is included in Section 2. The chapter is only a few pages but covers the most important aspects of radiologic anatomy, preoperative diagnosis, post-operative evaluation/complications, and surveillance. The figures are representative and clearly labeled, and the captions are comprehensive.

Sections 3 through 7 are dedicated to various treatment/surgical options and are presented in a round-table approach. In contradistinction to the first 3 sections, the chapters in these sections are shorter and more practical. Each section starts with a one-paragraph overview/introduction describing the issue at hand. This is followed by small subsections and short chapter discussions of the issue that include real-life cases, technique descriptions, and standardized approaches to patient selection/management. It is obvious that the editors chose a broad-minded approach in presenting the diverse literature.

Section 8 describes “Special Topics and New Horizons in Surgery for Chronic Ear Disease”. This is a very interesting part of this book. It describes new techniques …