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1.
Rev. argent. neurocir ; 34(4): 289-299, dic. 2020. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1150438

ABSTRACT

Introducción: la fístula dural arteriovenosa espinal (FDAVE) es una enfermedad vascular rara, de etiología desconocida y frecuentemente subdiagnosticada. El tratamiento puede ser microquirúrgico o endovascular. Material y Método: Análisis retrospectivo de una serie de 8 pacientes consecutivos con FDAVE tratados por microcirugía entre 2010 y 2020. Fueron evaluados parámetros como edad, sexo, cuadro clínico pre y postoperatorio medido con las escalas de Aminoff-Logue y Rankin modificada. Los estudios diagnósticos con RMN (Resonancia Magnética Nuclear), ARM (Angio Resonancia Magnética) y ADM (Angiografía Digital Medular) se utilizaron para determinar nivel lesional y resultados quirúrgicos. Resultados: Fueron operados 8 pacientes (7 masculinos y 1 femenino) con un promedio de edad de 58 años. El tiempo de evolución del cuadro clínico al diagnóstico fue menor a 12 meses salvo un caso de 32 meses. Las FDAVE fueron localizadas en: 6 a nivel dorsal entre D6 y D12, una en L2 y la última en S1 (5 derechas y 3 izquierdas). La arteria de Adamkiewicz se identificó en: 4 casos en L1, 2 en D12, 1 en D10 y un caso en D7 (6 izquierdas y 2 derechas). De los 8 pacientes operados, 3 fueron embolizados previamente. La evolución postoperatoria del cuadro neurológico fue: 2 de 8 permanecieron estables y 6 de 8 mejoraron uno o más puntos en la escala de Rankin modificada; no hubo complicaciones en el postoperatorio. Todos los pacientes mejoraron las imágenes en RMN diferida y la ADM luego de los 6 meses fue negativa. El seguimiento promedio fue de 48 meses con un rango de 11 a 116 meses, ningún paciente presentó recidiva de la FDAVE. Conclusiones: El tratamiento quirúrgico de las FDAVE es un método muy eficaz, de baja morbilidad y menor tasa de recurrencia comparado con el tratamiento endovascular.


Introduction: Spinal dural arteriovenous fistula (SDAVF) is a rare vascular disease, of unknown etiology and frequently underdiagnosed. Treatment can be microsurgical or endovascular. Material and Method: Retrospective analysis of a series of 8 SDAVF patients treated by microsurgery between 2010 and 2020. Parameters including age, sex, pre and postoperative clinical condition were analyzed according to modified Aminoff-Logue and modified Rankin scales. Diagnostic studies such as MRI (Magnetic Resonance Imaging), MRA (Magnetic Resonance Angiogram) and spinal DSA (Digital Subtraction Angiography), were evaluated for lesion level, as were surgical results. Results: Eight patients (7 male and 1 female), average age of 58 years were operated. The interval from symptom onset to diagnosis was less than 12 months in all cases except one (32 months). SDAVF locations were thoracic in 6 cases between T6 and T12, at L2 in one and at S1 in one case (5 on the right and 3 on the left). The Adamkiewicz artery was identified in: 4 cases at L1, 2 at D12, 1 at D10 and in one case at D7 (6 left-sided and 2 right-sided). Three of the 8 patients operated had undergone prior embolization. Postoperative neurological outcomes showed: 2 patients remained stable and 6 had improved one or more points on the modified Rankin scale; no postoperative complications were observed. Follow-up MRI images improved in all cases and spinal DSA was negative at six months. Average follow-up was 48 months (range 11 to 116 months), no patient presented recurrence. Conclusions: Microsurgical treatment of SDAVF proved to be efficient, with low morbidity and lower recurrence rates compared to endovascular results.


Subject(s)
Humans , Fistula , Spinal Cord Diseases , Vascular Diseases , Angiography , Central Nervous System Vascular Malformations , Microsurgery
3.
Kanem Journal of Medical Sciences ; 14(1): 24-30, 2020. ilus
Article in English | AIM, AIM | ID: biblio-1264614

ABSTRACT

Background: Central Nervous System (CNS) malformations rank among the commonest malformations. These may be identified in utero or noticed immediately after birth. Most studies showed Myelomeningocoele, a Neural Tube Defect (NTD) to be the commonest. Severe defects have a significant impact on long term disability. While some are preventable, most are surgically managed. Objective: To study the profile and management of CNS malformation in a tertiary hospital. Method: we undertook a 3-year retrospective study of the profile and surgical management, including the postoperative complications among Neonates admitted into the Special Care Baby Unit (SCBU). Data on place of delivery, Gender, Gestational age, Mode of delivery, Prenatal Diagnosis (Ultrasound Scan), types of malformations, types of surgeries, and postoperative complications were retrieved. Result: We found 71 patients with CNS anomalies (31.8% of all congenital anomalies), in delivery 10 (14.1%), out delivery 46(64.8%). Male=43, females=28. Term gestation 66 (93%), preterm 3(4.2%), post-term 2(2.8%). Delivered by Vagina (SVD) in 65(91.6%), Caesarean section 4(5.6%), and undocumented in 4(5.6%). Prenatal diagnosis in only 3(4.2%). Myelomeningocoele was 35(49.3%), meningocoele was 9(12.7%), Hydrocephalus was 18(25.3%), anencephaly was 1(1.4%), occipital Encephalocoele was 6(8.5%), Sincipital Encephalocoele was 2(2.8%). Operated on 53(75%), LAMA/lost to follow was 13(18%), preoperative death was 5(7%). Excision and closure of Neural Tube Defect were 34(64.2%), VP Shunt was 13(24.5%), Excision and closure of occipital Encephalocoele were 5(9.4%) craniofacial excision and repair of Sincipital Encephalocoele was 1(1.9%). CSF leak in 4(28.6%), wound infection in 3(21.4%), shunt infection and obstruction in 2(14.3%) each. meningitis, hypertrophied scar, and pseudo meningocoele in 1(7.1%) each. Conclusion: The commonest CNS anomaly is a Myelomeningocoele a preventable condition, Sincipital Encephalocoele is not common in our environment. Concomitant treatment of hydrocephalus averts post excision CSF Leak


Subject(s)
Central Nervous System Vascular Malformations/prevention & control , Central Nervous System/pathology , Neural Tube Defects/prevention & control , Tertiary Care Centers
4.
Yonsei Medical Journal ; : 1112-1115, 2019.
Article in English | WPRIM | ID: wpr-762046

ABSTRACT

Direct puncture and embolization of the transverse sinus (TS) for treatment of dural arteriovenous fistula (DAVF) is typically performed with coils with or without glue. We report a case of DAVF at the left TS that was treated with Onyx embolization via direct puncture of the TS. A 75-year-old woman presented with tremor, festinating gait, and dysarthria. A left TS-DAVF with retrograde superior sagittal sinus and cortical venous reflux (Cognard type IIa+b) was identified on cerebral angiography, and both TSs were occluded with thrombi. We considered that achieving complete cure by transvenous embolization via the femoral vein or transarterial embolization via occipital feeders would be difficult. Thus, we performed a small craniotomy at the occipital bone to puncture the TS. The midportion of the TS was directly punctured with a 21-G microneedle under fluoroscopic guidance. We inserted a 5-F sheath into the TS. A microcatheter was then navigated into the affected sinus. Coils were placed through the microcatheter to support Onyx formation by reducing the pressure of shunting flow. Onyx embolization was performed with the same microcatheter. The DAVF was almost completely occluded except for the presence of minimal shunting flow to the proximal TS. After 1 week, time-of-flight magnetic resonance angiography showed complete resolution of DAVF. The patient showed resolved tremor and markedly improved mental status at 1-month follow up. Direct puncture and embolization of the TS using coils and Onyx is effective and feasible method for the treatment of DAVF when other approaches seem difficult.


Subject(s)
Adhesives , Aged , Central Nervous System Vascular Malformations , Cerebral Angiography , Craniotomy , Dysarthria , Female , Femoral Vein , Follow-Up Studies , Gait Disorders, Neurologic , Humans , Magnetic Resonance Angiography , Methods , Occipital Bone , Punctures , Superior Sagittal Sinus , Tremor
5.
Article in English | WPRIM | ID: wpr-765360

ABSTRACT

OBJECTIVE: We retrospectively assessed the efficacy of stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (DAVFs) involving the transverse-sigmoid sinus and analyzed the angiographic and clinical results with our 8-year experience. METHODS: Nine patients with intracranial DAVFs involving the transverse-sigmoid sinus underwent SRS using a Gamma Knife® (Elekta Inc., Atlanta, GA, USA) between 2009 and 2016. Five patients underwent SRS for residual DAVFs after embolization and four patients were treated with SRS alone. The median target volume was 1.9 cm3 (range, 0.8–14.2) and the median radiation dose of the target was 17 Gy (range, 16–20). The median follow-up period was 37 months (range, 7–81). RESULTS: Pulsating tinnitus (33%) was the most common symptom. DAVFs were completely obliterated in four patients (44%) and subtotally obliterated in five (56%). Six patients (67%) showed complete recovery of symptoms or signs, and three (33%) showed incomplete recovery. One patient experienced a recurrent seizure. Adverse radiation effects after SRS occurred in one patient (11%). The total obliteration rates after SRS were 16.7%, 37.5%, and 68.7% at 1, 2, and 3 years, respectively. The median interval from SRS to total obliteration of the fistula was 31 months (range, 12–38). The rates at which the symptoms started to improve were 40% at 1 month and 80% at 2 months after SRS. Symptoms started to improve at a median of 5 weeks after SRS (range, 3–21). CONCLUSION: SRS with or without embolization is a safe and effective treatment to relieve symptoms and obliterate DAVFs on the transverse-sigmoid sinus.


Subject(s)
Central Nervous System Vascular Malformations , Fistula , Follow-Up Studies , Humans , Radiation Effects , Radiosurgery , Retrospective Studies , Seizures , Tinnitus , Transverse Sinuses
7.
Neurointervention ; : 9-16, 2019.
Article in English | WPRIM | ID: wpr-741678

ABSTRACT

Intracranial and spinal dural arteriovenous fistulas (DAVFs) are vascular pathologies of the dural membrane with arteriovenous shunts. They are abnormal communications between arteries and veins or dural venous sinuses that sit between the two sheets of the dura mater. The dura propria faces the surface of brain, and the osteal dura faces the bone. The location of the shunt points is not distributed homogeneously on the surface of the dural membrane, but there are certain areas susceptible to DAVFs. The dura mater of the olfactory groove, falx cerebri, inferior sagittal sinus, tentorium cerebelli, and falx cerebelli, and the dura mater at the level of the spinal cord are composed only of dura propria, and these areas are derived from neural crest cells. The dura mater of the cavernous sinus, transverse sinus, sigmoid sinus, and anterior condylar confluence surrounding the hypoglossal canal are composed of both dura propria and osteal dura; this group is derived from mesoderm. Although the cause of this heterogeneity has not yet been determined, there are some specific characteristics and tendencies in terms of the embryological features. The possible reasons for the segmental susceptibility to DAVFs are summarized based on the embryology of the dura mater.


Subject(s)
Arteries , Brain , Cavernous Sinus , Central Nervous System Vascular Malformations , Colon, Sigmoid , Dura Mater , Embryology , Membranes , Mesoderm , Neural Crest , Pathology , Population Characteristics , Spinal Cord , Veins
8.
Article in English | WPRIM | ID: wpr-788787

ABSTRACT

OBJECTIVE: We retrospectively assessed the efficacy of stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (DAVFs) involving the transverse-sigmoid sinus and analyzed the angiographic and clinical results with our 8-year experience.METHODS: Nine patients with intracranial DAVFs involving the transverse-sigmoid sinus underwent SRS using a Gamma Knife® (Elekta Inc., Atlanta, GA, USA) between 2009 and 2016. Five patients underwent SRS for residual DAVFs after embolization and four patients were treated with SRS alone. The median target volume was 1.9 cm3 (range, 0.8–14.2) and the median radiation dose of the target was 17 Gy (range, 16–20). The median follow-up period was 37 months (range, 7–81).RESULTS: Pulsating tinnitus (33%) was the most common symptom. DAVFs were completely obliterated in four patients (44%) and subtotally obliterated in five (56%). Six patients (67%) showed complete recovery of symptoms or signs, and three (33%) showed incomplete recovery. One patient experienced a recurrent seizure. Adverse radiation effects after SRS occurred in one patient (11%). The total obliteration rates after SRS were 16.7%, 37.5%, and 68.7% at 1, 2, and 3 years, respectively. The median interval from SRS to total obliteration of the fistula was 31 months (range, 12–38). The rates at which the symptoms started to improve were 40% at 1 month and 80% at 2 months after SRS. Symptoms started to improve at a median of 5 weeks after SRS (range, 3–21).CONCLUSION: SRS with or without embolization is a safe and effective treatment to relieve symptoms and obliterate DAVFs on the transverse-sigmoid sinus.


Subject(s)
Central Nervous System Vascular Malformations , Fistula , Follow-Up Studies , Humans , Radiation Effects , Radiosurgery , Retrospective Studies , Seizures , Tinnitus , Transverse Sinuses
9.
Cambios rev. méd ; 17(2): 23-27, 28/12/2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1005227

ABSTRACT

INTRODUCCIÓN. La morbimortalidad de las malformaciones arterio-venosas cerebrales se encuentra dada principalmente por hemorragias. OBJETIVO. Conocer la situación de la embolización de malformaciones arterio-venosas en el Hospital de Especialidades Carlos Andrade Marín. MATERIALES Y MÉTODOS. Estudio observacional, retrospectivo en pacientes con diagnóstico de malformaciones arterio-venosas cerebral que fueron sometidos a intervención radiológica, durante el período de enero 2016 a diciembre 2017, en el Hospital de Especialidades Carlos Andrade Marín. RESULTADOS. 17 pacientes con criterios de inclusión, la mayoría con malformaciones arterio-venosas única y clasificación Spetzler Martin tipo I y II. El 52,9% fue sometido al procedimiento con antecedente de hemorragia intracerebral. Luego del procedimiento se alcanzó el 61,5% de obliteración en promedio, con 5,8% de pacientes que tuvo hemorragia intracerebral postprocedimiento. DISCUSIÓN. El uso de la embolización permite la oclusión del nido vascular displásico y del flujo de arterias nutricias profundas, disminuyendo la hemorragia intracerebral como complicación, siendo un tratamiento precursor de complementos quirúrgicos o como tratamiento único. El promedio de obliteración se encuentra dentro del rango reportado en la literatura, con un solo caso que tuvo complicación post procedimiento. Son necesarios estudios complementarios donde se especifiquen las variables de los tratamientos post procedimiento y un seguimiento para valorar supervivencia. CONCLUSIÓN. Resultados similares a los reportados en la literatura, se consideró la embolización como una alternativa del tratamiento, principalmente como precursor a la cirugía en malformaciones arterio-venosas con clasificación Spetzler Martin mayor a III.


INTRODUCTION. The morbidity and mortality of cerebral arteriovenous malformations is mainly due to hemorrhages. OBJECTIVE. To know the situation of the embolization of arterio-venous malformations in the Carlos Andrade Marín Specialties Hospital. MATERIALS AND METHODS. Observational, retrospective study in patients with a diagnosis of cerebral arteriovenous malformations who underwent radiological intervention, during the period from January 2016 to December 2017, at the Carlos Andrade Marín Specialties Hospital. RESULTS 17 patients with inclusion criteria, most with single arteriovenous malformations and Spetzler Martin type I and II classification. 52,9% underwent the procedure with a history of intracerebral hemorrhage. After the procedure, 61,5% of obliteration was achieved on average, with 5,8% of patients having post-procedural intracerebral hemorrhage. DISCUSSION. The use of embolization allows the occlusion of the dysplastic vascular nest and the flow of deep nutritional arteries, decreasing intracerebral hemorrhage as a complication, being a precursor treatment of surgical complements or as a single treatment. The average of obliteration is within the range reported in the literature, with only one case that had post procedure complication. Complementary studies are needed where the variables of the post-procedure treatments and a follow-up to assess survival are specified. CONCLUSION. Results similar to those reported in the literature, embolization was considered as an alternative treatment, mainly as a precursor to surgery in arteriovenous malformations with Spetzler Martin classification greater than III.


Subject(s)
Humans , Male , Female , Cerebral Angiography , Intracranial Hemorrhages , Central Nervous System Vascular Malformations , Embolization, Therapeutic , Radiology, Interventional , Indicators of Morbidity and Mortality , Endovascular Procedures
10.
Rev. chil. radiol ; 24(3): 112-116, jul. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-978164

ABSTRACT

Se presenta el caso de una paciente de sexo femenino, de 69 años, que refiere tinnitus pulsátil de dos meses de evolución percibido en la región retroauricular derecha. Se presentan los hallazgos en estudios de imágenes, diagnóstico y se presenta una corta revisión del tema.


We present the case of a female patient, 69 years old, who reported pulsatile tinnitus since two months ago perceived in the right retroauricular region. We present the findings in image studies, diagnosis and a short review about the topic.


Subject(s)
Humans , Female , Aged , Arteriovenous Fistula/diagnostic imaging , Central Nervous System Vascular Malformations/diagnostic imaging , Tinnitus/etiology , Tomography, X-Ray Computed , Arteriovenous Fistula/classification , Ultrasonography, Doppler , Magnetic Resonance Angiography
11.
West Afr. j. radiol ; 25(1): 45-51, 2018. ilus
Article in English | AIM, AIM | ID: biblio-1273545

ABSTRACT

Context: Congenital brain anomalies are of diverse types however few are seen in clinical practice. They are associated with high morbidity and mortality; prompt diagnosis and management aid in mitigating some of their adverse effects. Magnetic resonance imaging (MRI) is ideal for imaging these conditions, especially in pediatric cases due to its lack of ionizing radiation and excellent soft-tissue delineation. Not much literature exists for Nigeria due to challenges with statistics and record keeping. Aim: The aim of this study is to document the common congenital brain anomalies encountered using MRI in our environment. Settings and Design: A 5-year retrospective study of all pediatric brain MRI conducted and reviewed in Lagos University Teaching Hospital. 73 pediatric brain MRI scans were reviewed. Materials and Methods: Morphologic evaluation of all pediatric brain MRI conducted in the last 5 years (March 2012­February 2016) was reviewed, retrospectively, by three independent radiologists. Clinical presentations were also documented. Statistical Analysis Used: Descriptive statistics was done using SPSS: PASW Statistics for Windows, Version 18.0 Results: Seventy-three pediatric brain MRI scans were conducted in the last 5 years with congenital brain anomalies seen in 19 (26.0%) of the cases. Their ages ranged from 3 months to 17 years with a mean age of 6.7 ± 6.1 years. There were 9 (47.4%) males and 10 (52.6%) females. The common anomalies are congenital hydrocephalus 7 (35%), of which aqueductal stenosis was 6 (32%), arteriovenous malformations 3 (16%), cerebral atrophy 3 (16%), and arachnoid cysts 2 (11%). Predominant clinical features were delayed developmental milestones, macrocephaly, seizures, headaches, and vomiting. Conclusion: The common congenital brain anomalies in our environment are congenital hydrocephalus, aqueductal stenosis, arteriovenous malformations, cerebral atrophy and arachnoid cysts. MRI is useful in evaluating these anomalies; early diagnosis and prompt intervention can be offered to mitigate adverse effects


Subject(s)
Central Nervous System Vascular Malformations/congenital , Hospitals, Teaching , Magnetic Resonance Imaging , Neurosurgical Procedures , Nigeria
12.
Article in English | WPRIM | ID: wpr-765271

ABSTRACT

OBJECTIVE: Cerebral varices (CVs) without an arteriovenous shunt, so called nonfistulous CVs, are very rare, and their etiology and natural course are not well understood. The aim of this study is to evaluate the clinical outcomes of nonfistulous CVs by the analysis of 39 cases. METHODS: From 2000 to 2015, 22 patients with 39 nonfistulous CVs (≥5 mm) were found by searching the medical and radiologic records of our institute. Clinical data and radiological data including numbers, sizes and locations of CVs and associated anomalies were retrospectively collected and analyzed. Previously reported cases in literature were reviewed as well. RESULTS: The mean age of the patients was 21 years (range, 0–78 years). On average, 1.8±1.2 CVs were found per patient. CVs were categorized as either fusiform or saccular depending on their shapes. Two patients had saccular type CVs, seventeen patients had fusiform types, and three patients had both fusiform and saccular CVs. Eight patients had associated compromise of the vein of Galen and the straight sinus. Four of those patients had sinus pericranii, as well. Five patients had CVs that were distal draining veins of large developmental venous anomalies. One patient had associated migration anomaly, and two patients had Sturge- Weber syndrome. Six patients with an isolated cerebral varix were observed. Of the 39 CVs in 22 patients, 20 lesions in 14 patients were followed up in outpatient clinics with imaging studies. The average follow-up duration was 6.6 years. During this period, no neurological events occurred, and all the lesions were managed conservatively. CONCLUSION: Nonfistulous CVs seemed to be asymptomatic in most cases and remained clinically silent. Hence, we suggest conservative management.


Subject(s)
Ambulatory Care Facilities , Brain Stem Infarctions , Central Nervous System Vascular Malformations , Central Nervous System Venous Angioma , Cerebral Veins , Follow-Up Studies , Humans , Retrospective Studies , Sinus Pericranii , Varicose Veins , Veins
13.
Article in English | WPRIM | ID: wpr-714856

ABSTRACT

Dural arteriovenous fistula (D-AVF) at the foramen magnum is an extremely rare disease entity. It produces venous hypertension, and can lead to progressive cervical myelopathy thereafter. On the other hand, the venous hypertension may lead to formation of a venous varix, and it can rarely result in an abrupt onset of subarachnoid hemorrhage (SAH) when the venous varix is ruptured. The diagnosis of D-AVF at the foramen magnum as a cause of SAH may be difficult due to its low incidence. Furthermore, when the D-AVF is fed solely by the ascending pharyngeal artery (APA), it may be missed if the external carotid angiography is not performed. The outcome could be fatal if the fistula is unrecognized. Herein, we report on a rare case of SAH caused by ruptured venous varix due to D-AVF at the foramen magnum fed solely by the APA. A review of relevant literatures is provided, and the treatment modalities and outcomes are also discussed.


Subject(s)
Angiography , Arteries , Central Nervous System Vascular Malformations , Diagnosis , Fistula , Foramen Magnum , Hand , Hypertension , Incidence , Rare Diseases , Spinal Cord Diseases , Subarachnoid Hemorrhage , Varicose Veins
14.
Article in English | WPRIM | ID: wpr-713863

ABSTRACT

OBJECTIVE: Bilateral cavernous sinus dural arteriovenous fistula (CSdAVF) is very rare, even in Asian countries. The research intended to present clinical and radiologic outcomes of treating such fistulas through endovascular embolization. MATERIALS AND METHODS: Data was obtained from 220 consecutive patients, with CSdAVF, who were treated from January 2004 to December 2015. Bilateral CSdAVF was identified in 17 patients (7.7%). The clinical and radiologic outcomes of the fistulas were assessed with an emphasis on the technical aspects of treatment. RESULTS: At the time of treatment, 7 and 10 patients presented with bilateral and unilateral symptoms, respectively. In the former cases, 4 patients had progressed from unilateral to bilateral symptoms. Bilateral fistulas were treated with a single-stage transvenous embolization (TVE) in 15 patients, via bilateral inferior petrosal sinuses (IPS) (n = 9) and unilateral IPS (n = 6). In the other 2 patients with one-sided dominance of shunting, only dominant fistula was treated. Two untreated lesions were found on follow-up to have spontaneously resolved after treatment of the dominant contralateral fistula. Of the 34 CSdAVF lesions, complete occlusion was achieved in 32 lesions after TVE. Seven patients (41.2%) developed worsening of cranial nerve palsy after TVE. During the follow-up period, 4 patients obtained complete recovery, whereas the other 3 remained with deficits. CONCLUSION: With adjustments of endovascular procedures to accommodate distinct anatomical configurations, endovascular treatment for bilateral CSdAVF can achieve excellent angiographic occlusion results. However, aggravation of symptoms after TVE may occur frequently in bilateral CSdAVF. In the patients with one-sided dominance of shunt, treatment of only dominant fistula might be an alternative option.


Subject(s)
Arteriovenous Fistula , Asian Continental Ancestry Group , Cavernous Sinus , Central Nervous System Vascular Malformations , Cranial Nerve Diseases , Endovascular Procedures , Fistula , Follow-Up Studies , Humans
15.
Article in English | WPRIM | ID: wpr-788701

ABSTRACT

OBJECTIVE: Cerebral varices (CVs) without an arteriovenous shunt, so called nonfistulous CVs, are very rare, and their etiology and natural course are not well understood. The aim of this study is to evaluate the clinical outcomes of nonfistulous CVs by the analysis of 39 cases.METHODS: From 2000 to 2015, 22 patients with 39 nonfistulous CVs (≥5 mm) were found by searching the medical and radiologic records of our institute. Clinical data and radiological data including numbers, sizes and locations of CVs and associated anomalies were retrospectively collected and analyzed. Previously reported cases in literature were reviewed as well.RESULTS: The mean age of the patients was 21 years (range, 0–78 years). On average, 1.8±1.2 CVs were found per patient. CVs were categorized as either fusiform or saccular depending on their shapes. Two patients had saccular type CVs, seventeen patients had fusiform types, and three patients had both fusiform and saccular CVs. Eight patients had associated compromise of the vein of Galen and the straight sinus. Four of those patients had sinus pericranii, as well. Five patients had CVs that were distal draining veins of large developmental venous anomalies. One patient had associated migration anomaly, and two patients had Sturge- Weber syndrome. Six patients with an isolated cerebral varix were observed. Of the 39 CVs in 22 patients, 20 lesions in 14 patients were followed up in outpatient clinics with imaging studies. The average follow-up duration was 6.6 years. During this period, no neurological events occurred, and all the lesions were managed conservatively.CONCLUSION: Nonfistulous CVs seemed to be asymptomatic in most cases and remained clinically silent. Hence, we suggest conservative management.


Subject(s)
Ambulatory Care Facilities , Brain Stem Infarctions , Central Nervous System Vascular Malformations , Central Nervous System Venous Angioma , Cerebral Veins , Follow-Up Studies , Humans , Retrospective Studies , Sinus Pericranii , Varicose Veins , Veins
17.
Rev. medica electron ; 39(2): 322-329, mar.-abr. 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-845403

ABSTRACT

El mielomeningocele es una malformación congénita por defecto del cierre del tubo neural, se produce en las primeras semanas de crecimiento intrauterino. Consiste en una masa quística que incluye tejido nervioso y meninges, acompañadas de una fusión incompleta de los arcos vertebrales. Produce severos daños neurales y puede asociarse a otras malformaciones. Su reparación, en las primeras horas de vida, es necesaria para evitar complicaciones que pueden comprometer la vida del niño o causar mayor discapacidad. Se reportó un caso de un recién nacido con diagnóstico de mielomeningocele fisurado, a nivel lumbar. Se intervino quirúrgicamente en las primeras 6 h de vida; se disecó el saco dural y se separaron las raíces, logrando el cierre completo de la duramadre. Se reparó la piel con afrontamiento de los bordes y adecuada cicatrización de la herida. Fue aplicada antibioticoterapia profiláctica con cefalosporina de tercera generación. El infante egresó a los 10 días de operado sin complicaciones neuroquirúgicas asociadas (AU).


Meningomyelocele is a congenital malformation by defect of neural tube closing, produced in the first weeks of intrauterine grow. It is a cystic mass that includes nervous tissues and meninges, together with an incomplete fusion of the vertebral arches. It produces severe neural damages and could be associated to other malformations. It is necessary to repair it during the first hours after birth to avoid complications that could compromise the child’s life or cause more disability. The case of a new-born child diagnosed with fissured meningomyelocele at the lumbar level is presented. He was operated in the first six hours after birth; the dural sac was dissected and the roots separated, reaching the complete dura mater closure. The skin was repaired with edges affronting and adequate wound healing. Prophylactic antibiotic therapy with third generation cephalosporin was applied. The child was discharged 10 days alter the surgery without associated neurosurgical complications (AU).


Subject(s)
Humans , Male , Infant, Newborn , Infant, Newborn/physiology , Meningomyelocele/surgery , Meningomyelocele/complications , Meningomyelocele/diagnosis , Meningomyelocele/epidemiology , Central Nervous System Vascular Malformations/surgery , Central Nervous System Vascular Malformations/mortality , Central Nervous System Vascular Malformations/therapy , Neural Tube/abnormalities , Spinal Cord/abnormalities , Folic Acid/genetics
18.
Rev. bras. anestesiol ; 67(2): 199-204, Mar.-Apr. 2017. graf
Article in English | LILACS | ID: biblio-843383

ABSTRACT

Abstract Background and objectives: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. Case report: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. Conclusion: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.


Resumo Justificativa e objetivos: Fístulas arteriovenosas durais (FAVD) são comunicações anômalas entre os canais venosos e arteriais da dura-máter cujo centro está localizado entre os folhetos da dura-máter. Para as circunstâncias nas quais o tratamento invasivo é obrigatório, as técnicas endovasculares se tornaram os pilares da prática, escolha atribuível a relatos de sua segurança e eficácia. Descrevemos o caso único e raro de uma FAVD tratada por embolização transarterial (ETA) e complicada por uma hemorragia intraventricular (HIV). Nosso objetivo foi destacar alguns aspectos centrais do manejo perioperatório desses pacientes para ajudar a melhorar uma futura abordagem de casos semelhantes. Relato de caso: Paciente do sexo feminino, 59 anos, com diagnóstico prévio de FAVD tipo IV (Cognard), apresentou-se para ETA, realizada fora da sala de cirurgia soBanestesia venosa total. O procedimento transcorreu sem complicações, e a angiografia intraoperatória revelou obliteração completa da fístula. No período pós-operatório imediato, a paciente apresentou sinais clínicos de aumento da pressão intracraniana (PIC) atribuíveis a uma HIV posteriormente diagnosticada, o que condicionou a colocação de um dreno ventricular, internação em Unidade de Terapia Intensiva (UTI), vasoespasmo cerebral e internação hospitalar prolongada. Durante todo o período perioperatório, não houve alterações na oximetria cerebral. A paciente recebeu alta sem sequelas neurológicas. Conclusão: HIV pode ser uma complicação grave após o tratamento endovascular de FAVD. A observação e o monitoramento cuidadosos no pós-operatório permitem o diagnóstico precoce e o tratamento que aumenta as chances de um resultado melhor.


Subject(s)
Humans , Female , Cerebral Hemorrhage/etiology , Central Nervous System Vascular Malformations/therapy , Embolization, Therapeutic/adverse effects , Oximetry/methods , Angiography/methods , Embolization, Therapeutic/methods , Anesthesia, Intravenous , Length of Stay , Middle Aged
19.
Neurointervention ; : 50-53, 2017.
Article in English | WPRIM | ID: wpr-730366

ABSTRACT

A 43-year-old male presented with daytime sleepiness at work and indifferent behavior like never before. Two weeks prior to hospital admission, he had episodic memory loss with well preserved remote memory. Brain MRI showed a dural arteriovenous fistula (DAVF) in the right lateral transverse sinus with a bilateral thalamic venous infarction. Cerebral angiography confirmed a right transverse sigmoid dural arteriovenous fistula with a feeding artery of the right occipital artery and left posterior meningeal artery. The DAVF was completely eliminated through multiple endovascular interventions. Recently, endovascular treatment has become one of the main therapeutic options to obliterate a fistulous site, which has led to a rapid diagnostic approach and management of DAVFs with high curative rates. We report a rare case of posterior fossa located at a dural arteriovenous fistula that caused rapid progressive dementia and was successfully eliminated through only endovascular treatment.


Subject(s)
Adult , Arteries , Brain , Central Nervous System Vascular Malformations , Cerebral Angiography , Colon, Sigmoid , Dementia , Embolization, Therapeutic , Humans , Infarction , Magnetic Resonance Imaging , Male , Memory, Episodic , Memory, Long-Term , Meningeal Arteries
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