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13 July 2021, 1:24 am

Henderson JK, Henderson MA. Arthur Schüller: Founder of Neuroradiology. A Life on Two Continents. Hybrid Publishers; 2021; 218 pp; $18.41

While radiologists (mostly those in the older age group) recognize the name “Schüller” to be associated with the lateral oblique view of the mastoid air cells, the contributions of Arthur Schüller go far beyond a single eponym in radiography. This biography traces the life of Arthur Schüller from his birth in 1874 in Brno in what is now the Czech Republic to his death in Melbourne, Australia in 1972. The triumphs and tragedies that unfolded in this 98-year odyssey are revealing not only from a medical/radiologic/neurosurgical standpoint, but also from a historical perspective, since his life and the life of his family spanned a lengthy period in Europe, part of which was gruesome nearly beyond description.

This biography was written jointly by John Keith Henderson (a now-deceased neurosurgeon from Melbourne) and his son, Michael Henderson (a surgical oncologist). The life of Schüller was chronicled over years by John Henderson, a man who worked with Schüller and greatly admired his work and contributions to the neurologic sciences.

This brief review serves not to summarize the life of Arthur Schüller, his family, and his associates, but instead is intended to pique the curiosity of those who are interested in understanding why Schüller has been considered the founder of neuroradiology. Contained in this book is a history lesson concerning Europe, the Austrian-Hungarian Empire, anti-Semitism, the rise of national socialism in Germany, and the atrocities that accompanied nazism during the early to mid-20th century.

During his years as a student in Vienna and in the time after graduation, Arthur’s intellectual curiosity and talents (music among them) were significant and helped shape approaches to neurologic disorders, and he was the first to describe the …

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6 July 2021, 4:36 pm

1. Meyer L, Stracke CP, Jungi N, et al. Thrombectomy for primary distal posterior cerebral artery occlusion stroke: the TOPMOST study. JAMA Neurol 2021;78:434–44

The objective of this study was to investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation distal, medium vessel occlusion stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. This multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. Of 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median age was 74 years and 51.6% were female individuals. Posterior circulation distal, medium vessel occlusions were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was −2.4 points in the standard medical treatment cohort and −3.9 points in the mechanical thrombectomy cohort, with a mean difference of −1.5 points.  Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher and in the subgroup of patients without IVT.

The fragility of distal smaller-sized vessels has always been a major concern in endovascular stroke treatment because of its increased risk for complications that lead to intracerebral hemorrhage and are associated with poor outcomes, especially in patients who are eligible for IVT. The …

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6 July 2021, 3:42 pm

1. Roa JA, Zanaty M, Osorno-Cruz C, et al. Objective quantification of contrast enhancement of unruptured intracranial aneurysms: a high-resolution vessel wall imaging validation study. J Neurosurg 2020;134(March):1–8

High-resolution vessel wall imaging (HR-VWI) has emerged as a valuable tool in assessing unruptured intracranial aneurysms (UIAs). There is no standardized method to quantify contrast enhancement of the aneurysm wall. Contrast enhancement can be objectively measured as signal intensity (SI) or subjectively adjudicated. In this study, the authors compared the different methods to quantify wall enhancement of UIAs and determined the sensitivity and specificity of each method as a surrogate of aneurysm instability. They also compared SI quantification between scanners from different manufacturers.

The mean and maximal SI values of the aneurysm wall, pituitary stalk, and genu of the corpus callosum were used to compare 3 different measurement methods:

1) aneurysm enhancement ratio AER = (SIwall post − SIwall pre)/SIwall pre;

2) aneurysm-to–pituitary stalk contrast ratio CRstalk = SIwall post/SIstalk post; and

3) aneurysm enhancement index AEI = ([SIwall post/SIbrain post] − [SIwall pre/SIbrain pre])/(SIwall pre/SIbrain pre).

9 UIAs underwent the same HR-VWI protocol using a 3T General Electric (GE) scanner and a 3T Siemens scanner. Three UIAs also underwent a third scanning procedure on a unit with a different magnet strength (7T GE).

CRstalk using maximal SI values was the most reliable objective method to quantify enhancement of UIAs on HR-VWI. The same ratios were obtained between different manufacturers and on scans obtained using magnets of different strengths.

3 figures with MR, 3 tables

2. Alhilali LM, Little AS, Yuen KCJ, et al. Early postoperative MRI and detection of residual adenoma after transsphenoidal pituitary surgery. J Neurosurg 2020;1–10

MRI is the standard of care for evaluation of sellar …

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7 May 2021, 10:52 pm

1. Feigin VL, Vos T, Alahdab F, et al. Burden of neurological disorders across the US from 1990-2017. JAMA Neurol 2021;78:165. Available from: https://jamanetwork.com/journals/jamaneurology/fullarticle/2772579

This study presents the burden estimates of major neurological disorders in the US states by age and sex from 1990 to 2017 from a systematic analysis of the Global Burden of Disease (GBD) 2017 study. Fourteen major neurological disorders were analyzed: stroke, Alzheimer disease and other dementias, Parkinson disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, traumatic brain injury, spinal cord injuries, brain and other nervous system cancers, meningitis, encephalitis, and tetanus.

The 3 most burdensome neurological disorders in the US in terms of absolute number of disability adjusted life-years (DALYs) were stroke (3.58 million DALYs), Alzheimer disease and other dementias (2.55 million DALYs), and migraine (2.40 million DALYs). The burden of almost all neurological disorders (in terms of absolute number of incidents, prevalent, and fatal cases, as well as DALYs) increased from 1990 to 2017, largely because of the aging of the population.

The study showed reductions in the age-adjusted rates of most burden metrics of stroke, AD and other dementias, TBI, spinal cord injuries, meningitis, and encephalitis.

Southeastern states and Arkansas had a relatively higher burden for stroke, while northern states had a relatively higher burden of multiple sclerosis and eastern states had higher rates of Parkinson disease, idiopathic epilepsy, migraine and tension-type headache, and meningitis, encephalitis, and tetanus. While confirming previous observations of the so-called stroke belt mortality in the southeastern United States, unlike previous estimates that identified North Carolina, South Carolina, and Georgia with a higher stroke mortality rate than the other states of the stroke belt, this 2017 GBD stroke mortality estimates show that the stroke belt is now in Alabama, Mississippi, and South Carolina.

3 large figures and

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14 April 2021, 2:55 pm

The life and times of Arthur Schüller (1874–1957) are the subject of a new book entitled Arthur Schüller: Founder of Neuroradiology, A Life on Two Continents and an accompanying documentary called Xrays to Exile. Schüller was a distinguished pioneer in the field of neuroradiology. His research rapidly made him the pre-eminent authority on radiology of the skull and brain, particularly after the publication of his monograph on diseases of the head, which became the standard textbook throughout the “classic era” of neuroradiology. He authored another book and more than 300 scientific articles and is credited with the first descriptions of 3 diseases and 3 operations.

Schüller was a refugee, fleeing Austria with his wife and settling in Melbourne in 1939. The narrative of his career is woven into the personal history of his family. Tragically, his later years were darkened by the news from Europe that his 2 sons had perished in a concentration camp.

The biography was written by Keith Henderson (1923–2017) who, as a young neurosurgical trainee at St. Vincent’s Hospital in Melbourne, met and worked with Schüller. Later, Henderson served for many years as the Head of the Neurosurgery Unit at St. Vincent’s. Keith’s son, Michael, Professor of Surgery at the University of Melbourne, completed the book after his father’s death.

The 30-minute documentary film on Schüller’s career and family history is available for free viewing at https://youtu.be/YhRLobn-Ubw and provides a rich visual backdrop to Schüller’s story…

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