Venous sinus stenting for treatment of idiopathic intracranial hypertension / 国际脑血管病杂志

Idiopathic intracranial hypertension (IIH) is an unexplained clinical syndrome with intracranial hypertension as the main sign, often accompanied by headache, pulsating tinnitus, vision and visual field changes and other clinical manifestations. A large number of studies have shown that cerebral venous sinus stenosis is closely associated with IIH, and more than 90% of IIH patients are accompanied by cerebral venous sinus stenosis. Although the causal relationship between the two is still uncertain, a comprehensive surgical treatment system with venous sinus stenting as the core is gradually formed. This article reviews the stenting treatment of IIH complicated with cerebral venous sinus stenosis.

Impact of stent porosity on hemodynamics in simulated sigmoid sinus diverticulum / 中国介入影像与治疗学

Objective: To investigate the impact of stent porosity on hemodynamics in the simulated sigmoid sinus diverticulum. Methods: An idealized hemodynamic model of sigmoid sinus diverticulum (S0 model, no stent) was constructed based on computational fluid dynamics (CFD). The hemodynamic changes in models stented with different porosities of 75%, 50% and 25% (corresponding to S1, S2, S3 model) were observed. Results: The mean flow velocities in sigmoid sinus diverticulum of model S0, S1, S2 and S3 was 12.65, 4.68, 2.20 and 0.41 mm/s, respectively. Compared with model S0, the velocities in model S1, S2 and S3 decreased by 63.00%(7.97/12.65), 82.61%(10.45/12.65) and 96.76%(12.24/12.65), respectively. The area of high pressure and high wall shear stress (WSS) in diverticulum distal wall reduced gradually with the decrease of stent porosity. Meanwhile, the pressure and WSS tended to distribute uniformly in the entire diverticulum. However, the mean pressures for model S0, S1, S2 and S3 in diverticulum (64.04, 63.86, 62.54 and 60.95 Pa, respectively) showed no significant change. Conclusion: Stent with lower porosity can significantly improve blood flow and hemodynamic stress conditions in the simulated sigmoid sinus diverticulum.

Déficit de proteína S en un caso pediátrico de trombosis de senos venosos cerebrales / Protein S deficiency in a pediatric case of cerebral venous sinus thrombosis

RESUMEN La trombosis venosa cerebral (TVC) representa el 0,5 % de todos los eventos vasculares cerebrales a nivel mundial; es una entidad compleja y de difícil diagnóstico, dada la variabilidad en el modo de presentación, el pronóstico y la diversidad de condiciones médicas que la originan. Ocurre por obstrucción del drenaje venoso cerebral. Su principal manifestación en lactantes y niños son las convulsiones. Este es el caso de una TVC por déficit de proteína S en un paciente pediátrico, el objetivo de este caso es destacar la importancia de la sospecha e identificación temprana de la enfermedad, así como la búsqueda del factor desencadenante. La TVC es una entidad grave, es potencialmente tratable y su pronóstico dependerá de la oportunidad del diagnóstico e intervención.

SUMMARY Cerebral venous sinus thrombosis represents 0.5 % of all cases worldwide. Is a complex pathology cause the variability in presentation mode, prognosis and different medical conditions that cause it. The cause is the obstruction of cerebral venous drainage, the main manifestation in infants and children are seizures. This is the case of cerebral venous sinus thrombosis in a pediatric patient with protein S deficiency, the goal of this case is to recognize the importance of suspicion and early identification of the disease and the search of the trigger. The cerebral venous sinus thrombosis is a serious entity, but potentially treatable and prognosis depend on the timing of diagnosis and intervention.

Cranial venous sinus dominance: what to expect? Analysis of 100 cerebral angiographies / Dominância dos seios venosos cranianos: o que esperar? Análise de 100 angiografias cerebrais

ABSTRACT We report an analysis of the cranial venous sinuses circulation, emphasizing morphological and angiographic characteristics. Methods Data of 100 cerebral angiographies were retrospectively analyzed (p = 0.05). Results Mean age was 56.3 years, 62% female and 38% male. Measurements and dominance are shown in the Tables. There was no association between age or gender and dominance. Right parasagittal division of the superior sagittal sinus was associated with right dominance of the transverse sinus, sigmoid sinus and internal jugular vein; and left parasagittal division of the superior sagittal sinus was associated with left dominance of the transverse sinus, sigmoid sinus and internal jugular vein. Conclusion A dominance pattern of cranial venous sinuses was found. Age and gender did not influence this pattern. Angiographic findings, such as division of the superior sagittal sinus, were associated with a pattern of cranial venous dominance. We hope this article can add information and assist in preoperative venous analysis for neurosurgeons and neuroradiologists.

RESUMO Relatamos uma análise da circulação dos seios venoso cranianos, enfatizando características morfológicas e angiográficas. Métodos Dados de 100 angiografias cerebrais foram retrospectivamente analisados (p = 0,05). Resultados Média de idade 56,3 anos, 62% feminino e 38% masculino. Medições e dominância expostos em tabelas. Sem associação entre idade ou sexo e dominância. Divisão parassagittal direita do Seio Sagital Superior (SSS) foi associada com dominância direita do Seio Transverso (ST), Seio Sigmóide (SS) e Veia Jugular Interna (VJI), e divisão parassagittal esquerda do SSS foi associada com dominância esquerda do ST, SS e VJI. Conclusão Um padrão de dominância dos seios venosos do crânio foi encontrado. Idade e sexo não influenciaram esse padrão. Achados angiográficos, como divisão do SSS, foram associados com o padrão de dominância venoso cerebral. Esperamos que este artigo acrescente informações e auxilie na análise venosa pré-operatória para neurocirurgiões e neuroradiologistas.

Trombosis venosa intracraneal: signos imaginológicos y errores frecuentes / Intracranial venous thrombosis: imaging signs and common errors

Although intracranial venous thrombosis is a relatively rare disease, it constitutes an entity that must be timely and accurately diagnosed in emergency services, given the need for prompt treatment to avoid serious complications, including neurological deficits or even death. There are several imaging signs provided by both CT and magnetic resonance imaging scans that allow this early diagnosis. On the other hand, some differential diagnoses need to be performed to prevent the error of mistaking intracranial venous thrombosis for any other entity.

Si bien la trombosis venosa intracraneal es una patología relativamente poco frecuente, es una entidad que debe ser diagnosticada a tiempo y con certeza en los servicios de urgencia, dada la necesidad de pronto tratamiento para evitar complicaciones graves que incluyen déficit neurológicos e incluso muerte. Existen varios signos imaginológicos que nos permiten hacer este diagnóstico, tanto en tomografía computarizada como en resonancia magnética. Por otra parte, es necesario considerar algunos diagnósticos diferenciales para no cometer errores, confundiendo esta patología con otras entidades.

MR angiography appearance of venous sinuses in the region of the torcular Herophili / 中华放射学杂志

Objective To investigate the anatomic appearance in the region of the torcular Herophili by using MR and to evaluate its clinical significance Methods This study involved 123 healthy subjects All subjects underwent initial T 1W and T 2W MR examination in order to exclude intracranial occupying disease and vascular malformation Then, images of venous sinuses were obtained in the region of the torcular Herophili 72 of these subjects were examined with coronal 2D TOF MR venography (MRV), 44 cases were examined with coronal 3D PC angiography, and other 7 volunteers were examined with both of the two aforementioned methods Results (1) The venous drainage dominance showed mainly to the right side in 84 cases, mainly to the left side in 23 cases, equal drainage in 16 cases (2) According to the relation among the sinuses in the region of the torcular Herophili, all subjects in this study could be grouped into 4 types: Type 1, including those subjects in which a confluence of sinuses existed or the superior sagittal sinus and the straight sinus forked, and the forking of both sinuses joined to form the lateral sinuses Type 2, including those subjects in which the sagittal sinus drained into one side and the straight sinus drained into the other Type 3, including those subjects in which the superior sagittal sinus and the straight sinus joined and mainly drained into the right side Type 4, including those subjects in which the superior sagittal sinus and the straight sinus joined and mainly drained into the left side Conclusions MR angiography provides a useful method to show the anatomic features in the region of the torcular Herophili The pattern of the classification is considered important to assess the venous drainage dominance and helpful to deduce existent and/or potential collateral pathway These findings may be useful for diagnostic and operative procedure