Papilledema revisiting after sinus angioplasty of chronic cerebral venous sinus thrombosis

This case series aimed to review the significance of revisiting papilledema after successful cerebral venous sinus thrombosis (CVST) management with sinus angioplasty. Four patients presented with blurring and transient obscuration of vision with papilledema, headache, tinnitus, and vomiting. On magnetic resonance venography and digital subtraction angiography, chronic transverse sinus thrombosis was diagnosed for which patients underwent endovascular intervention (stenting). After the resolution of CVST, patients developed the recurrence of symptoms which on digital subtraction angiography revealed dural arteriovenous malformation (DAVM). DAVM and papilledema resolved with endovascular embolization. This case series highlights a need of constant monitoring of CVST cases after the endovascular intervention.

Dural arteriovenous fistulas with direct cortical venous drainage treated with Onyx®: a case series / Fístulas arteriovenosas durais com drenagem cortical direta tratadas com Onyx®: casuística

Dural arteriovenous fistulas (DAVFs) may have aggressive symptoms, especially if there is direct cortical venous drainage. We report our preliminary experience in transarterial embolization of DAVFs with direct cortical venous drainage (CVR) using Onyx®. METHOD: Nine patients with DAVFs with direct cortical venous drainage were treated: eight type IV and one type III (Cognard). Treatment consisted of transarterial embolization using Onyx-18®. Immediate post treatment angiographies, clinical outcome and late follow-up angiographies were studied. RESULTS: Complete occlusion of the fistula was achieved in all patients with only one procedure and injection in only one arterial pedicle. On follow-up, eight patients became free from symptoms, one improved and no one deteriorated. Late angiographies showed no evidence of recurrent DAVF. CONCLUSION: We recommend that transarterial Onyx® embolization of DAVFs with direct cortical venous drainage be considered as a treatment option, while it showed to be feasible, safe and effective.

As fistulas arteriovenosas durais (FAVDs) podem se manifestar com sintomas agressivos, especialmente se existe drenagem cortical direta. Relatamos nossa experiência preliminar na embolização transarterial de FAVDs com drenagem cortical direta usando Onyx®. MÉTODO: Nove pacientes com FAVDs com drenagem cortical direta foram tratados: oito do tipo IV e uma do tipo III (Cognard). O tratamento consistiu na embolização transarterial usando Onyx-18®. Angiografias imediatas pós-tratamento, evolução clínica e angiografias de controle tardias foram estudadas. RESULTADOS: A oclusão completa da fístula foi alcançada em todos pacientes através de um só procedimento e injeção em apenas um pedículo arterial. No seguimento, oito pacientes ficaram livres de sintomas, um melhorou e nenhum deteriorou. Angiografias tardias de controle não mostraram evidência de FAVD recorrente. CONCLUSÃO: Nós recomendamos que a embolização transarterial com Onyx® das FAVDs com drenagem cortical direta, seja considerada como uma opção terapêutica, uma vez que mostrou ser factível, segura e efetiva.

Dural Arteriovenous Malformation Associated with Meningioma: Spontaneous Disappearance after Tumor Removal: Case Report

Dural arteriovenous malformations may be congenital, but most dural arteriovenous malformations are acquired lesions. The acquired dural arteriovenous malformations are rarely associated with brain tumors. We describe a case of dural arteriovenous malformation at the non-dominant transverse-sigmoid sinus associated with a convexity meningioma on the same side. The lesion was spontaneously disappeared after removal of the meningioma, even though the dural arteriovenous malformation was not manipulated. The authors describe a possible pathophysiology of dural arteriovenous malformations associated with tumors at the remote area and spontaneous closure after tumor resection.

Dural Arteriovenous Malformation on the Anterior Cranial Fossa

Dural arteriovenous malformations(AVM) are not uncommon. Reports of intracranial dural AVM have been increasing but most of them deal with dural AVM in the region of the cavernous sinus, posterior fossa and tentorium, but those of the anterior cranial fossa are very rare. Recently, we experienced two cases of right frontal dural arteriovenous malformation fed mainly by both ethmoidal arteries. The angiographic appearance in these two cases is quite uniform. The nidus was located in the frontal dura, although their main feeders were dural arteries. They were drained through an intracerebral cortical vein associated with aneurysmal dilatation of proximal portion into superior sagittal sinus. Spontaneous intracerebral hematoma was the cause of the clinical symptoms. We report two cases of intracerebral hematoma, caused by dural AVM, which was successfully managed by surgical treatment.

Malformação arteriovenosa dural do seio transverso-sigmóide causando neuralgia trigeminal / Transverse-sigmoid sinus dural arteriovenous malformation presenting as trigeminal neuralgia

Os autores relatam um caso raro de malformação arteriovenosa dural (MAVD) do seio transverso-sigmóide esquerdo, causando neuralgia do trigêmeo. O paciente foi submetido a cirurgia para esqueletização do seio transversosigmóide com ressecção dos dois terços distais do seio transverso e dos dois terços proximais do seio sigmóide. O procedimento cirúrgico foi suficiente para proporcionar a cura angiográfica e clínica, com um seguimento de oito meses. Foi realizada uma completa revisão bibliográfica encontrando-se apenas cinco casos descritos de pacientes com MAVD e neuralgia trigeminal.

The authors report a rare case of transverse-sigmoid dural arteriovenousmalformation (DAVM) presenting as trigeminal neuralgia in the distribution of left V3. The patient was treated surgically by the sinus skeletonization technique with the resection of the distal 2/3 of the transverse sinus and the proximal 2/3 of the sigmoid sinus. Clinical and angiographic cure was achieved in our patient with a folow-up of 8 months. Furthermore, a thorough review of the English language literature was carried out, compiling only five cases of trigeminal neuralgia due to DAVM.

A Case of Occipital Dural Arteriovenous Malformation Presenting Visual Field Defect and Positive Visual Phenomena

Although dural arteriovenous malformations(DAVM) involving the occipital lobe can be the cause of variable posi-tive visual phenomena, the mechanism of these visual disturbances is not fully understood. We report a 42-year-old man with a left occipital DAVM presenting headache and positive visual phenomena in the right hemianopic field. Occipital DAVM was not accompanied by parenchymal lesions in a brain magnetic resonance imaging. The cerebral angiography demonstrated the retrograde flow into the dilated occipital cortical veins as well as the left occipital DAVM having multiple arterial feeders and the drainage into the left transverse sinus. All clinical symptoms disap-peared after a transarterial embolization. Brain 99mTc-ECD single photon emission computed tomography also showed the improvement of hypoperfusion on the left occipital area after the embolization. We believe that the venous hyper-tension by occipital DAVM impeding the perfusion to the occipital lobe plays an important role in producing positive visual phenomena on the hemianopic field.

A Case of Occipital Dural Arteriovenous Malformation Presenting Visual Field Defect and Positive Visual Phenomena

Although dural arteriovenous malformations(DAVM) involving the occipital lobe can be the cause of variable posi-tive visual phenomena, the mechanism of these visual disturbances is not fully understood. We report a 42-year-old man with a left occipital DAVM presenting headache and positive visual phenomena in the right hemianopic field. Occipital DAVM was not accompanied by parenchymal lesions in a brain magnetic resonance imaging. The cerebral angiography demonstrated the retrograde flow into the dilated occipital cortical veins as well as the left occipital DAVM having multiple arterial feeders and the drainage into the left transverse sinus. All clinical symptoms disap-peared after a transarterial embolization. Brain 99mTc-ECD single photon emission computed tomography also showed the improvement of hypoperfusion on the left occipital area after the embolization. We believe that the venous hyper-tension by occipital DAVM impeding the perfusion to the occipital lobe plays an important role in producing positive visual phenomena on the hemianopic field.

Surgical Treatment of Carotid-Cavernous Fistula and Intracranial Dural Arteriovenous Malformations / 대한뇌혈관학회지

Dural arteriovenous malformations(DAVM) or Dural Arteriovenous fistulas(DAVF) consists of multiple arteriovenous shunt between arteries and a dural venous sinuses or a meningeal vein, constitute 10% to 15% of all intracranial arteriovenous malformations Most commonly they involve the transverse, the sigmoid and the cavernous sinuses. Other locations include the tentorial incisure, the superior sagittal sinus, the torcular Herophili, anterior cranial fossa, the convexity dura mater, and the foramen magnum. In angiographic features, leptomeningeal retrograde venous drainage, variceal or aneurysmal venous structure, and galenic venous drainage are significantly associated with aggressive neurological course caused by intracranial hemorrhage(ICH or SAH). Lesion at tentorial incisura and anterior cranial fossa has a tendency to have aggressive neurological course. Dural AVM located at cavernous sinus are classified as 4 types according to arterial distribution. Treatment of Dural AVF or CCF includes conservative monitoring, manual compression, arterial embolization, transvenous occlusion, surgical excision and radiation therapy. Surgical therapy with or without preparatory embolization remains the most versatile and effective therapeutic option. It is usually aimed at resecting the dural leaflets harboring the AVM(and adjacent sinus) and at disconnecting leptmeningeal draining pathways which are typically the source of serious neurological sequelae. In Tentorial AVF or anterior cranial fossa AVF the first choice of treatment is surgery because of difficulty in accessibility through transarterial or transvenous embolization.

Clinical Characteristics of Cerebral Dural Arteriovenous Malformations

Intracranial dural arteriovenous malformation(AVM) is an uncommon neurosurgical condition; in particular, it has been infrequently reported in Korea. To understand the general clinical characteristics of dural AVMs, the authors reviewed 41 cases and analysed the factors affecting hemorrhage of dural AVMs. Since 1980 we have encountered 320 pial and 41 dural AVM, a ratio of 7.8 to 1. The age of these patients ranged from 3 months to 70 years, the most common being the 6th decade, and female exceeded males by a ratio of 1.56 to 1. All lesions except one was single, and symptoms were related to it's location and the venous drainage pattern. The most common location was the cavernous sinus, accounting for about 70% of cases, so the most common clinical symptoms of dural AVMs were ocular, namely-proptosis and chemosis. The next was tinnitus found in transverse/sigmoid sinus dural AVMs. Intracranial hemorrhage was seen in six cases(14.6%), the primary cause of hemorrhage was retrograde intracranial venous drainage(p=0.001), and no hemorrhage was observed in cases with no intracranial venous drainage. And intracranial hemorrhage was more frequent in transverse/sigmoid than cavernous sinus dural AVMs, and this was so even where there was intracranial venous drainage(p<0.001). However two of 28 patients with cavernous dural AVMs became blind in one eye, demonstrating that in such patients, the clinical course could be aggressvie. The majority of cases were treated by endovascular therapy: surgical excision was performed in only one patient with tentorial dural AVM. Eight patients were treated conservatively. Three died of hemorrhage, 3 who had had fixed deficit had neurologic deficits even after a definite treatment, and 35(85%) showed clinical improvement. During intervention, there was one hemorrhagic complication, due to obstruction of venous outflow with embolic materials.

Extrasinusal Dural Arteriovenous Malformation Misdiagnosed as Intraorbital Tumor

Dural arteriovenous malformations are rare, accounting for 10-15% of all intracranial arteriovenous malformation and are thought to be acquired lesion caused by dural sinus thrombosis. The authors report a rare case of extrasinusal dural arteriovenous fistula in the right middle fossa adjacent to the superior orbital fissure. During the preceding 17 years, this 31-year-old female had complained of proptosis and ocular pain in the right eye. Computed tomography and magnetic resonance imaging showed a retrobular intraconal mass in the right orbit; Angiography revealed an extrasinusal dural arteriovenous fistula in the right middle fossa adjacent to the superior orbital fissure, which drains into the superior ophthalmic and inferior temporal vein. After embolization of the fistula by injection of N-butylcyanoacrylate(NBCA), we intended to remove the retrobulbar intraconal mass seen on CT and MRI by means of a unilateral partial orbitotomy on the supraorbital rim and orbital roof, and to this end, explored the right orbit. We were unable, however, to locate any mass lesion in the orbital cavity, and postoperative CT and MRI showed no such lesion. We were of the opinion that the mass shown on preoperative CT and MRI was a dilated intraorbital vein structure which disappeared after embolization, operative ligation and cutting of the dural arterivenous fistula. Finally, proptosis and ocular pain disappeared, and the patient recovered with any no neurologic deficit.

Intracranial Dural Arteriovenous Malfirmation: Report of Three Cases

Most of dural arteriovenous malformations(D-AVM's) are known to be an acquired lesion developed by a previously thrombosed dural sinus. They are usually no greater than 1 or 2 cm in size and most often present as spontaneous intracranial hematoma in fifth and sixth decades of life. We had surgical experiences of an unusual case of a 8 cm sized dural AVM in an infancy presented with a large scalp mass and two other cases presented with spontaneous intracerebral hemorrhage and subdural hematoma.