A comparison between controlateral and ipsilateral insonation rate is shown in Table 1. There was a statistical significant difference between contralateral and ipsilateral insonation in favor of the ipsilateral insonation, both for the global insonation rates and for segmental insonation rates. The challenge of this work was to find the way for improving the insonation of the TS by TCCS and the first step was the casual observation of the larger extent of the TS evaluable by an ipsilateral view. The direct comparison of TCCS images

with the MRI reconstructed planes by the Virtual Navigator software helped to define and standardize the anatomical landmarks of this proposed approach. The insonation of the TS by an ipsilateral approach causes a higher success rate than the contralateral approach, mainly for severely CP-868596 price hypoplasic TS. The use of previously non-standardized approach for insonating cerebral vessels, particularly APO866 ic50 veins and sinuses, could be made easier by real time fusion imaging technologies, as Virtual Navigator. The proposed ipsilateral approach to the TS allows the arbitrary segmentation of its entire course, and it is not possible through the contralateral approach because of the lesser field of view. The standardization of this approach has been performed through

the precise identification of the bone and parenchymal landmarks, comparing real time TCCS with MR angiography and brain MR imaging. The ipsilateral approach could be even more successful than the contralateral one for the insonation of the TS, and the combination of both strategies could further increase the likelihood of successful insonation of the TS. “
“Patency of the superior sagittal sinus (SSS) is a key factor in surgery of parasagittal

meningiomas (PSM) and, therefore, its determination is the standard of preoperative work-up [1]. Up to 50% of PSM invade the SSS lumen [2]. It is generally accepted that totally invaded SSS should be resected en bloc, but if the invasion is partial the SSS should be reserved even in cases with residual flow in it [3]. There are three methods of evaluation of the SSS – digital subtraction angiography (DSA), C-X-C chemokine receptor type 7 (CXCR-7) computed tomography (CT) and magnetic resonance venography (MR venography). DSA is the “gold standard” of cerebral angiography and cerebral venography in particular. It gives the most precise information about SSS patency, but it is invasive and costly, therefore its usage gradually declines. CT is believed to be slightly more accurate than MR venography in verification of SSS patency [4]. CT is less invasive than DSA yet requires irradiation and iodine contrast medium. MR venography is presently the method of choice for evaluation of SSS patency in patients with PSM due to its noninvasiveness [5].