Dural arteriovenous fistula presenting with exophthalmos and seizures.

Concomitant seizures and exophthalmos in the context of a temporal dural arteriovenous fistula (dAVF) has not been described before. Here, we report a 55-year-old-male who presented with an 8-month history of progressive painless exophthalmos of his left eye, conjunctival chemosis, reduced vision and new onset complex partial seizures. Cerebral angiography demonstrated Cognard Type IIa left cerebral dAVF fed by branches from the left occipital artery and an accessory meningeal artery, with drainage to the superior ophthalmic vein. Following surgical obliteration of dAVF feeding vessels, our patient had dramatic improvement in visual acuity, proptosis and chemosis along with cessation of clinical seizures.

Successful embolization of a large vein of galen malformation in a premature infant presenting with congestive heart failure and persistent pulmonary hypertension.

We report a case of a premature infant with a vein of Galen malformation (VGM) who presented with high-output heart failure, pulmonary hypertension, and respiratory distress. An echocardiogram showed normal cardiac anatomy, patent ductus arteriosus, and retrograde flow in the descending aorta. Ultrasonography and computed tomography of head confirmed the diagnosis of a large VGM. The patient developed multiorgan failure. Endovascular embolization of the VGM was successfully performed with an excellent outcome.

Subarachnoid and basal cistern navigation through the sacral hiatus with guide wire assistance.

BACKGROUND: Intraspinal navigation with catheters and fiberscopes has shown feasible results for diagnosis and treatment of intraspinal and intracranial lesions. The most common approach, lumbar puncture, has allowed access to the spinal cord, however, coming with the difficulties of fiberscope damage and decreased torque for guidance. Our objective in this study is to allow an alternate access, the sacral hiatus, with guide wire assistance into the subarachnoid and intracranial structures, while easing the angle of entry and increasing torque. METHODS: We advanced catheters with guide wire and fluoroscopy assistance into the sacral hiatus of three cadavers. After entry, the thecal sac was punctured and the catheter with guide wire was advanced rostrally until positioned in the basal cisterns of the brain. We confirmed catheter placement with contrast injection, autopsy, and dissection. RESULTS: In our study, the sacral hiatus was easily accessed, but resistance was found when attempting to puncture the thecal sac. The advancement of the catheter with guide wire assistance glided easily rostrally until some mild resistance was discovered at entry into the foramen magnum. With redirection, all catheters passed with ease into the basal cisterns. Positioning was confirmed with contrast injection with fluoroscopy evidence, autopsy, and dissection. There was no macroscopic or microscopic evidence of damage to the spinal roots, spinal cord, or cranial nerves. CONCLUSION: The sacral hiatus with guide wire assistance is an accessible conduit for uncomplicated entry into the subarachnoid and basal cistern space without damaging surrounding structures.

Bilateral isthmic L3 spondylolisthesis in an adult female.

OBJECTIVE: The purpose of this study is to describe an incidental finding of bilateral isthmic L3 spondylolysis in an adult female. CLINICAL FEATURES: A 26-year-old woman with sickle cell anemia was involved in a motor vehicle accident. Lumbar radiographs were reported normal. Computed tomography scan showed bilateral L3 spondylolysis of the pars interarticularis. INTERVENTIONS AND OUTCOMES: On the basis of the normal results of physical and neurologic examinations, the spondylolysis was considered to be an incidental finding. CONCLUSIONS: L3 spondylolysis is described very rarely in the literature. According to the unique features of L3 in the lumbar spine, which include its relatively horizontal position and its equal anterior and posterior diameters, we suggest that mechanical shearing forces may be less effective in causing spondylolysis in this area. This case is more suggestive of congenital and genetic causes as the contributing factors of spondylolysis.