1/237. Spinal dural arteriovenous fistula with an associated feeding artery aneurysm: case report.OBJECTIVE AND IMPORTANCE: A case of a spinal dural arteriovenous fistula (DAVF) with two associated feeding artery aneurysms is reported. Intradural spinal arteriovenous malformations have been associated with aneurysms that present with subarachnoid hemorrhage and with venous varices that produce mass effect, but spinal DAVFs have not previously been described in association with feeding artery aneurysms. CLINICAL PRESENTATION: A 71-year-old man presented with progressive spastic paraparesis, constipation, and overflow incontinence. magnetic resonance imaging demonstrated a spinal vascular lesion and venous ischemia in the lower spinal cord. Diagnostic spinal angiography revealed a DAVF originating from the left T11 radicular artery and having the unusual feature of two proximal feeding artery aneurysms. INTERVENTION: The patient deteriorated neurologically after undergoing angiography, prompting emergent surgery. The DAVF was resected through a T11 transpedicular approach. One aneurysm was dolichoectatic and therefore unclippable, requiring proximal occlusion of the parent artery after establishing tolerance of test occlusion using somatosensory evoked potentials; the second aneurysm was adjacent to the fistula and was resected with the DAVF. CONCLUSION: Feeding artery aneurysms in association with spinal DAVFs have not been previously reported. They present additional risk to patients and, with simple modifications of the standard operative approaches, can easily be treated as part of the surgery for the DAVF.- - - - - - - - - - ranking = 1keywords = malformation (Clic here for more details about this article) |
2/237. 3D Ultrasound imaging--a useful non-invasive tool to detect AV fistulas in transplanted kidneys.BACKGROUND: A precise, non-invasive, non-toxic, repeatable, convenient and inexpensive follow-up of renal transplants, especially following biopsies, is in the interest of nephrologists. Formerly, the rate of biopsies leading to AV fistulas had been underestimated. Imaging procedures suited to a detailed judgement of these vascular malformations are to be assessed. methods: Three-dimensional (3D) reconstruction techniques of ultrasound flow-directed and non-flow-directed energy mode pictures were compared with a standard procedure, gadolinium-enhanced nuclear magnetic resonance imaging angiography (MRA) using the phase contrast technique. RESULTS: Using B-mode and conventional duplex information, AV fistulas were localized in the upper pole of the kidney transplant of the index patient. The 3D reconstruction provided information about the exact localization and orientation of the fistula in relation to other vascular structures, and the flow along the fistula. The MRA provided localization and orientation information, but less functional information. Flow-directed and non-flow-directed energy mode pictures could be reconstructed to provide 3D information about vascular malformations in transplanted kidneys. CONCLUSION: In transplanted kidneys, 3D-ultrasound angiography may be equally as effective as MRA in localizing and identifying AV malformations. Advantages of the ultrasound method are that it is cheaper, non-toxic, non-invasive, more widely availability and that it even provides more functional information. Future prospective studies will be necessary to evaluate the two techniques further.- - - - - - - - - - ranking = 3keywords = malformation (Clic here for more details about this article) |
3/237. Clinical findings in a patient with spontaneous arteriovenous fistulas of the orbit.PURPOSE: To report clinical and radiologic findings of a patient with spontaneous arteriovenous fistulas of the orbit. METHOD: Case report. RESULTS: A 73-year-old woman was initially examined with a 1-year history of mild proptosis of the right eye. She had no history of trauma. Neuro-ophthalmologic examination disclosed dilatation of conjunctival vessels, increased intraocular pressure, mild proptosis and bruit in the right eye, and ocular signs suggestive of carotid-cavernous sinus fistulas or orbital arteriovenous malformations. The patient exhibited dilation of the superior ophthalmic vein in enhanced computed tomography of the orbit. Selective cerebral angiography disclosed communications between branches of both ophthalmic and facial arteries and the superior ophthalmic vein in the orbit. CONCLUSION: Arteriovenous fistulas of the orbit must be considered in the differential diagnosis of carotid-cavernous sinus fistulas and arteriovenous malformations, although they are quite rare.- - - - - - - - - - ranking = 2keywords = malformation (Clic here for more details about this article) |
4/237. arteriovenous fistula with associated aneurysms coexisting with dural arteriovenous malformation of the anterior inferior falx. Case report and review of the literature.This 24-year-old man presented with an unusual case of a high-flow arteriovenous fistula (AVF). This lesion was similar to giant AVFs in children that have been previously described in the literature. In patients in whom abnormalities of the vein of Galen have been excluded and in whom presentation occurs after 20 years of age, a diagnosis of congenital AVF is quite unusual. The fistula in this case originated in an enlarged callosomarginal artery and drained into the superior sagittal sinus via a saccular vascular abnormality. Two giant aneurysmal dilations of the fistula were present. In an associated finding, a small falcine dural arteriovenous malformation (AVM) was also present. Arterial supply to the AVM arose from both external carotid arteries and the left vertebral artery, with drainage through an aberrant vein in the region of the inferior sagittal sinus into the vein of Galen. craniotomy with exposure and trapping of the AVF was performed, with subsequent radiosurgical (linear accelerator) treatment of the dural AVM. Through this combination of microsurgical trapping of the AVF and radiotherapy of the dural AVM, an excellent clinical outcome was achieved.- - - - - - - - - - ranking = 5keywords = malformation (Clic here for more details about this article) |
5/237. A case of a pulmonary arteriovenous malformation treated by lobectomy.We present a case of pulmonary arteriovenous malformation (PAVM) in central localisation (type IIIa) of the upper lobe of the left lung. We discuss diagnostic (Doppler ultrasonography, CT, MRI, angiography) and therapeutic (embolization therapy) options and a current role of surgery in this uncommon clinical condition. Our patient underwent left upper lung lobectomy as an ultimate therapeutic method without subsequent morbidity. We conclude that surgery is a safe method of treatment of pulmonary arteriovenous malformations in selected cases i.e. when PAVM is solitary and of great diameter (more than two centimeters) and where the risks of embolotherapy are high.- - - - - - - - - - ranking = 6keywords = malformation (Clic here for more details about this article) |
6/237. Extraspinal dural arteriovenous fistula in a patient with lipomyelodysplasia: value of MRI and MRA.Spinal dural arteriovenous fistulae are extremely rare in spinal dysraphism. A fistulous malformation within a lipomyelomeningocele has not been reported previously. A 50-year-old man presented with progressive paraparesis and bladder dysfunction. MRI revealed a large lumbar lipomyelomeningocele. A vascular malformation was indicated by abnormal signal in the thoracolumbar spinal cord and dilated perimedullary veins. Phase-contrast MRA demonstrated only the slow-flow veins of the fistula and an intradural ascending vein. Contrast-enhanced ultra-fast MRA gave excellent delineation of all parts of the fistula within the dysraphic lesion.- - - - - - - - - - ranking = 2keywords = malformation (Clic here for more details about this article) |
7/237. Embolization of a giant torcular dural arteriovenous fistula in a neonate.We treated a neonatal infant who presented with heart failure and a giant torcular dural arteriovenous fistula by staged transtorcular embolization with two guidewires, 95 platinum microcoils, and tissue glues through a needle-size craniotomy. blood loss was minimal. The patient was stable without heart failure after a three-staged embolization. The lesion disappeared on the follow-up angiography done at the age of 3 years. This is the first documented case of neonatal giant torcular dural arteriovenous malformation cured by interventional neuroradiology. The dilemma and strategy in managing this patient will be presented and discussed.- - - - - - - - - - ranking = 1keywords = malformation (Clic here for more details about this article) |
8/237. Slender versus threatening angiodysplasias: observe, operate or obturate? A delusive decision.Beside the immediate success of surgery and of embolization of angiodysplasias, certain number of patients return to medical consultation, because recanalization of the arteriovenous fistulae after their resection or obturation. From the presentation of two clinical cases of thoracic angiodysplasia: one of them slender, and threatening the other, the authors point out the complications and recurrence after surgical resection or arterial embolization. The recurrence takes place even when only one artery remains permeable after resection or embolization of the fistula. There are cases where the affected limb has to be amputated. However, angiodysplasia shows itself in the stump of the amputee limb. Uncontrolled angio-genesis is the natural history or postoperatory evolution of angiodysplasias, probably originated by an erroneous genetic program, which persist in spite of resection of the vascular malformation, causing a therapeutic failure.- - - - - - - - - - ranking = 1keywords = malformation (Clic here for more details about this article) |
9/237. Arterioportal hypertension: a rare complication of partial hepatectomy.An arterioportal fistula (APF) with arterialisation of the portal-venous system is a rare cause of portal hypertension (PH) in children. The condition may be a congenital isolated fistula or occur as part of a more generalised haemangiomatous malformation. We report a case of PH secondary to an APF, which presented with bleeding gastric varices 6 years after partial hepatectomy for hepatoblastoma. The diagnosis was established by angiography and the fistula occluded by embolisation.- - - - - - - - - - ranking = 1keywords = malformation (Clic here for more details about this article) |
10/237. Lateral decubitus pneumoencephalography-angiography for localizing atrial and paraatrial vascular lesions.In two cases where computed tomography (CT) and cerebral angiography failed to determine whether an arteriovenous malformation was within or directly adjacent to the atrium of a lateral ventricle, lateral decubitus pneumoencephalography combined with cerebral angiography successfully localized the lesions. This procedure may be necessary in the workup of angiographically vascular lesions in the atrial-paraatrial region if on CT the ventricular surface is poorly defined or surgical clips from a previous operation obscure the lesion or the adjacent ventricle. Interpretation of this study involves triangulation of the vascular lesions relative to the ventricle or observation of the movement of the lesion relative to the movement of the ventricle on differently angulated frontal projections. Since the surgical approach is influenced by the radiographic differentiation of an intraventricular from a paraventricular mass, this procedure is crucial in evaluating these vascular abnormalities.- - - - - - - - - - ranking = 1keywords = malformation (Clic here for more details about this article) |
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