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1.
Yonsei Medical Journal ; : 1112-1115, 2019.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-762046

RESUMO

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.


Assuntos
Adesivos , Idoso , Malformações Vasculares do Sistema Nervoso Central , Angiografia Cerebral , Craniotomia , Disartria , Feminino , Veia Femoral , Seguimentos , Transtornos Neurológicos da Marcha , Humanos , Angiografia por Ressonância Magnética , Métodos , Osso Occipital , Punções , Seio Sagital Superior , Tremor
2.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-788787

RESUMO

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.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Fístula , Seguimentos , Humanos , Efeitos da Radiação , Radiocirurgia , Estudos Retrospectivos , Convulsões , Zumbido , Seios Transversos
4.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-765360

RESUMO

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.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Fístula , Seguimentos , Humanos , Efeitos da Radiação , Radiocirurgia , Estudos Retrospectivos , Convulsões , Zumbido , Seios Transversos
5.
Neurointervention ; : 9-16, 2019.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-741678

RESUMO

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.


Assuntos
Artérias , Encéfalo , Seio Cavernoso , Malformações Vasculares do Sistema Nervoso Central , Colo Sigmoide , Dura-Máter , Embriologia , Membranas , Mesoderma , Crista Neural , Patologia , Características da População , Medula Espinal , Veias
6.
Rev. chil. radiol ; 24(3): 112-116, jul. 2018. tab, ilus
Artigo em Espanhol | LILACS (Américas) | ID: biblio-978164

RESUMO

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.


Assuntos
Humanos , Feminino , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Zumbido/etiologia , Tomografia Computadorizada por Raios X , Fístula Arteriovenosa/classificação , Ultrassonografia Doppler , Angiografia por Ressonância Magnética
7.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-788701

RESUMO

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.


Assuntos
Instituições de Assistência Ambulatorial , Infartos do Tronco Encefálico , Malformações Vasculares do Sistema Nervoso Central , Angioma Venoso do Sistema Nervoso Central , Veias Cerebrais , Seguimentos , Humanos , Estudos Retrospectivos , Seio Pericrânio , Varizes , Veias
8.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-765271

RESUMO

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.


Assuntos
Instituições de Assistência Ambulatorial , Infartos do Tronco Encefálico , Malformações Vasculares do Sistema Nervoso Central , Angioma Venoso do Sistema Nervoso Central , Veias Cerebrais , Seguimentos , Humanos , Estudos Retrospectivos , Seio Pericrânio , Varizes , Veias
9.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-714856

RESUMO

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.


Assuntos
Angiografia , Artérias , Malformações Vasculares do Sistema Nervoso Central , Diagnóstico , Fístula , Forame Magno , Mãos , Hipertensão , Incidência , Doenças Raras , Doenças da Medula Espinal , Hemorragia Subaracnóidea , Varizes
10.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-713863

RESUMO

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.


Assuntos
Fístula Arteriovenosa , Grupo com Ancestrais do Continente Asiático , Seio Cavernoso , Malformações Vasculares do Sistema Nervoso Central , Doenças dos Nervos Cranianos , Procedimentos Endovasculares , Fístula , Seguimentos , Humanos
11.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-106734

RESUMO

For dural arteriovenous fistula (DAVF), when the usual endovascular or neurosurgical approaches are difficult to treat, multi-modal treatment can be helpful. We present a case of a 71-year-old woman with DAVF, who presented with an intracerebral haemorrhage. Digital subtraction angiography revealed a DAVF of the transverse sinus, with cortical venous reflux. Transvenous and transarterial approaches for coil embolization failed. In the operating room, a small craniotomy was performed, and coil embolization was done under fluoroscopy. Transcranial venous embolization might be a useful method to occlude DAVF in a case that is difficult to access by usual surgical or endovascular approaches.


Assuntos
Idoso , Angiografia Digital , Fístula Arteriovenosa , Malformações Vasculares do Sistema Nervoso Central , Craniotomia , Embolização Terapêutica , Procedimentos Endovasculares , Feminino , Fluoroscopia , Humanos , Métodos , Procedimentos Neurocirúrgicos , Salas Cirúrgicas , Seios Transversos
12.
Neurointervention ; : 50-53, 2017.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-730366

RESUMO

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.


Assuntos
Adulto , Artérias , Encéfalo , Malformações Vasculares do Sistema Nervoso Central , Angiografia Cerebral , Colo Sigmoide , Demência , Embolização Terapêutica , Humanos , Infarto , Imagem por Ressonância Magnética , Masculino , Memória Episódica , Memória de Longo Prazo , Artérias Meníngeas
13.
15.
Neurointervention ; : 125-129, 2017.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-730354

RESUMO

Intracranial dural arteriovenous fistulae (DAVF) are acquired fistulous communications between dural arterial branches and dural venous sinuses or cortical veins with the nidus located within the leaflets of the duramater. Dementia and Parkinsonism are amongst the rarest of clinical presentations in DAVFs and are important to diagnose early, being treatable with timely intervention. We present an interesting case of a patient who presented with rapidly progressive dementia and features of parkinsonism who was diagnosed to have extensive DAVF and made remarkable recovery after embolization of the fistulae.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Demência , Fístula , Humanos , Transtornos Parkinsonianos , Veias
16.
Journal of Stroke ; : 11-27, 2017.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-121546

RESUMO

Intracranial hemorrhage is common and is caused by diverse pathology, including trauma, hypertension, cerebral amyloid angiopathy, hemorrhagic conversion of ischemic infarction, cerebral aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistula, vasculitis, and venous sinus thrombosis, among other causes. Neuroimaging is essential for the treating physician to identify the cause of hemorrhage and to understand the location and severity of hemorrhage, the risk of impending cerebral injury, and to guide often emergent patient treatment. We review CT and MRI evaluation of intracranial hemorrhage with the goal of providing a broad overview of the diverse causes and varied appearances of intracranial hemorrhage.


Assuntos
Malformações Arteriovenosas , Malformações Vasculares do Sistema Nervoso Central , Angiopatia Amiloide Cerebral , Infarto Cerebral , Traumatismos Craniocerebrais , Hematoma Subdural , Hemorragia , Humanos , Hipertensão , Aneurisma Intracraniano , Hemorragias Intracranianas , Imagem por Ressonância Magnética , Neuroimagem , Patologia , Trombose dos Seios Intracranianos , Hemorragia Subaracnóidea , Vasculite
17.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-148435

RESUMO

OBJECTIVE: Tentorial dural arteriovenous fistulas usually drain into cortical veins and often present with hemorrhage. Treatment goal is occlusion of the draining vein, either by surgery or endovascular techniques. We present the multimodality treatment results of 12 patients with tentorial dural arteriovenous fistulas. MATERIALS AND METHODS: Between January 2007 and January 2017, 12 consecutive patients with tentorial dural arteriovenous fistulas were treated. There were 11 men and 1 woman with a mean age of 62 years (range 44–85). Clinical presentation was hemorrhage in 8 (67%), pulsatile tinnitus in 2 (17%) and an incidental finding in 2 (17%). The fistula location was at the tentorium cerebelli in 5 (42%), the torcula Herophilii in 4 (33%) and petroclival in 3 (25%). RESULTS: In 11 patients, arterial embolization with Onyx or PHIL was the primary treatment. Complete obliteration was achieved in one session in 5 (45%) and in 2 sessions in 4 (36%). In 2 patients additional surgery was needed. Primary surgery was performed in 1 patient followed by endovascular coil occlusion via the venous route. One patient with exclusive pial feeders from the posterior inferior cerebellar artery had a clinically silent P3 occlusion during trans arterial embolization. Finally, all 12 fistula were completely occluded, confirmed with angiography after 8–12 weeks. There were no permanent procedural complications. CONCLUSION: Patients with tentorial dural arteriovenous fistulas were effectively and safely cured with a strategy of endovascular treatment with various techniques and surgery. Surgical and endovascular techniques are complementary in the treatment of these challenging vascular disorders.


Assuntos
Angiografia , Artérias , Malformações Vasculares do Sistema Nervoso Central , Estudos de Coortes , Procedimentos Endovasculares , Feminino , Fístula , Hemorragia , Humanos , Achados Incidentais , Masculino , Medula Espinal , Zumbido , Veias
18.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-163474

RESUMO

Traumatic pseudoaneurysms of middle meningeal artery (MMA) and medial sphenoid wing dural arteriovenous fistula (dAVF) are rare. These lesions usually result from traumatic brain injury, and associated with skull fracture. In this paper, the authors report a case of a patient with a ruptured traumatic pseudoaneurysm of MMA and medial sphenoid wing dAVF presented with an intracerebral hemorrhage in the left temporal region and subarachnoid hemorrhage. These lesions were completely obliterated by endovascular treatment, and the patient was recovered without any neurologic deficit. However, 18-day after the procedure, delayed neurologic deficits were developed due to cerebral vasospasm.


Assuntos
Falso Aneurisma , Fístula Arteriovenosa , Lesões Encefálicas , Malformações Vasculares do Sistema Nervoso Central , Hemorragia Cerebral , Humanos , Artérias Meníngeas , Manifestações Neurológicas , Fraturas Cranianas , Hemorragia Subaracnóidea , Hemorragia Subaracnoídea Traumática , Lobo Temporal , Vasoespasmo Intracraniano
19.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-139518

RESUMO

Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.


Assuntos
Fístula Arteriovenosa , Malformações Vasculares do Sistema Nervoso Central , Humanos , Métodos , Pessoa de Meia-Idade , Radiocirurgia , Zumbido
20.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-139516

RESUMO

Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.


Assuntos
Fístula Arteriovenosa , Malformações Vasculares do Sistema Nervoso Central , Humanos , Métodos , Pessoa de Meia-Idade , Radiocirurgia , Zumbido
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