1/122. Correlation between magnetic resonance images and draining patterns in dural arteriovenous fistulas with leptomeningeal venous drainage.OBJECTIVE: To compare abnormal intensity areas on intracranial magnetic resonance images (MRI) and the pattern of venous drainage in dural arteriovenous fistulas (DAVFs) with retrograde venous drainage. methods: Thirteen patients with retrograde venous drainage of DAVFs were divided into two groups based on the venous drainage pattern determined by detailed angiographic and MRI study. In group 1 there was an accessory route draining into another sinus besides the main draining sinus. In group 2 no such accessory route was present. RESULTS: In group 1 patients (n = 8), MRI detected no unusual intensity areas; 5 patients in this group had episodes of bleeding. Angiographically, in this group retrograde venous drainage tended to occur via multiple varices. On the other hand, none of the 5 group 2 patients experienced a bleeding episode. Angiographically, there was a low incidence of varices. On T2-weighted images, these patients had a hyperintensity area. Following treatment, these areas of abnormality disappeared on T2-weighted MRI. CONCLUSION: Among 13 patients with DAVFs which drained retrogradely, those with a variceal accessory route (Group 1, n = 8) had a higher incidence of haemorrhage. In patients without such an accessory route (Group 2, n = 5) abnormal signal intensity on MRI was indicative of venous congestion. Continuous-mode angiography and MRI study were useful in the precise identification of DAVFs with a venous drainage route.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/122. Colour Doppler flow imaging of the superior ophthalmic vein in dural arteriovenous fistulas before and after surgery.The aim of this study was to examine the clinical significance of the colour Doppler flow imaging (CDFI) findings of the superior ophthalmic vein (SOV) in intracranial dural arteriovenous fistulas (DAVF). The SOV was examined by CDFI in 12 cases of DAVF before and after surgery. Before surgery, the average SOV diameter was 3.57 /-1.18 mm (mean /- standard deviation, which was significantly wide (P<0.05) compared with the control value. One case showed reversed flow. Four cases showed an abnormal waveform. The cases with the more severe clinical symptoms showed wider SOV diameters and more abnormal waveforms than those with mild clinical symptoms. Postoperatively, the mean SOV diameter and mean resistance index improved significantly (P< 0.05); the flow direction and waveform became normal in each. The SOV CDFI findings were found to be useful as screening and follow-up techniques for the intracranial DAVFs.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
3/122. Surgery for dural arteriovenous fistula in superior sagittal sinus and transverse sigmoid sinus.The aim of this study was to evaluate the outcome of surgically treated dural arteriovenous fistula (DAVF). The authors performed surgical removal of DAVF in 12 patients. The locations of DAVF were the transverse sigmoid sinus in seven patients and superior sagittal sinus in five patients. These 12 patients had undergone endovascular embolisation prior to removal. Among them, six patients were completely cured, according to angiography immediately after embolisation, but these six patients showed the recurrence of DAVF within 1 year. The other six patients showed a decrease of feeding vessels. Therefore, all 12 patients underwent surgical removal of DAVF. The surgical strategies were as follows. The feeding vessels and the cortical veins with retrograde filling were occluded and cut. The affected sinus was skeletonised, and if it was occluded or almost occluded, the sinus was removed. Postoperatively, transient aphasia was seen in one patient. There was no surgical morbidity or mortality. During the follow-up period (mean 2.9 years), no recurrence of DAVF was seen. Surgical treatment is a safe and effective treatment manoeuvre for DAVF around the transverse sigmoid sinus and superior sagittal sinus.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
4/122. Spinal intradural perimedullary arteriovenous fistula with varix in infant.A rare occurrence of type IV spinal arteriovenous malformation (intradural perimedullary arteriovenous fistula) is described in an 18-month-old boy initially misdiagnosed with guillain-barre syndrome. An intramedullary mixed-intensity mass lesion at Th1 was demonstrated by magnetic resonance imaging together with flow voids over the dorsal aspect of the swollen spinal cord. angiography demonstrated an intradural perimedullary arteriovenous fistula including an intraparenchymal vascular pocket. After partial embolisation of the posterior spinal arteries through the left intercostal-radicular artery, the arteriovenous fistula was removed completely together with an organised haematoma. The fistula directly opened into a vascular pocket, which was confirmed pathologically to be a varix. The postoperative course was uneventful, and the patient resumed ambulation within 4 months. The case, subclassifiable as a type IVb spinal perimedullary AVF, was unique given its location and the patient's age at presentation.- - - - - - - - - - ranking = 1.6keywords = fistula (Clic here for more details about this article) |
5/122. Intracranial dural arteriovenous fistula with spinal medullary venous drainage.We report on a 46-year-old patient in whom an intracranial dural arteriovenous (AV) fistula, supplied by a branch of the ascending pharyngeal artery, drained into spinal veins and produced rapidly progressive symptoms of myelopathy and brainstem dysfunction including respiratory insufficiency. magnetic resonance imaging studies demonstrated brainstem oedema and dilated veins of the brainstem and spinal cord. Endovascular embolization of the fistula led to good neurological recovery, although the patient had been paraplegic for 24 h prior to embolization. This case demonstrates the MRI characteristics of an intracranial dural AV fistula with spinal drainage and illustrates the importance of early diagnosis and treatment. Even paraplegia may be reversible, if angiography is performed and the fistula treated before ischaemic and gliotic changes become irreversible.- - - - - - - - - - ranking = 1.6keywords = fistula (Clic here for more details about this article) |
6/122. Cerebellar hemorrhage caused by dural arteriovenous fistula: a review of five cases.OBJECT: In this study the authors performed a retrospective analysis of five cases in which the patients (three women and two men) were treated for intracranial dural arteriovenous fistulas (AVFs) associated with cerebellar hemorrhage. On the basis of their findings, the authors evaluated the characteristics of this unusual symptom. methods: The dural AVFs were located in the right cavernous sinus in one patient, the left transverse-sigmoid sinus in three patients, and the right superior petrosal sinus (SPS) in one patient. All patients presented with severe headache and/or loss of consciousness. Computerized tomography scans revealed a small cerebellar hemorrhage near the fourth ventricle and hydrocephalus in four cases, and a massive hemispheric cerebellar hemorrhage in the remaining case. The four patients with small hemorrhages underwent ventriculostomy and endovascular treatment; all recovered. The patient suffering from a massive hemorrhage because of a dural AVF in the SPS was treated by suboccipital craniectomy, hematoma evacuation, and removal of the vascular anomaly. This patient remains in a persistent vegetative state. In four cases, results of angiography demonstrated retrograde leptomeningeal venous drainage through the SPS to the anastomotic lateral mesencephalic vein (ALMV) and/or to the vein of the lateral recess of the fourth ventricle (VLR4V). Retrograde leptomeningeal venous drainage to the ALMV and/or VLR4V was responsible for cerebellar hemorrhage in these cases. CONCLUSIONS: Thus, it is important to consider dural AVF in cases in which there is even a small hemorrhage near the fourth ventricle accompanied by intraventricular perforation and a decreased level of consciousness.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
7/122. Fatal progression of posttraumatic dural arteriovenous fistulas refractory to multimodal therapy. Case report.The authors report the case of a man who suffered from progressive, disseminated posttraumatic dural arteriovenous fistulas (DAVFs) resulting in death, despite aggressive endovascular, surgical, and radiosurgical treatment. This 31-year-old man was struck on the head while playing basketball. Two weeks later a soft, pulsatile mass developed at his vertex, and the man began to experience pulsatile tinnitus and progressive headaches. magnetic resonance imaging and subsequent angiography revealed multiple AVFs in the scalp, calvaria, and dura, with drainage into the superior sagittal sinus. The patient was treated initially with transarterial embolization in five stages, followed by vertex craniotomy and surgical resection of the AVFs. However, multiple additional DAVFs developed over the bilateral convexities, the falx, and the tentorium. Subsequent treatment entailed 15 stages of transarterial embolization; seven stages of transvenous embolization, including complete occlusion of the sagittal sinus and partial occlusion of the straight sinus; three stages of stereotactic radiosurgery; and a second craniotomy with aggressive disconnection of the DAVFs. Unfortunately, the fistulas continued to progress, resulting in diffuse venous hypertension, multiple intracerebral hemorrhages in both hemispheres, and, ultimately, death nearly 5 years after the initial trauma. Endovascular, surgical, and radiosurgical treatments are successful in curing most patients with DAVFs. The failure of multimodal therapy and the fulminant progression and disseminated nature of this patient's disease are unique.- - - - - - - - - - ranking = 1.2keywords = fistula (Clic here for more details about this article) |
8/122. Dural arteriovenous fistulae at the foramen magnum.Spinal dural arteriovenous fistulae (DAVF) affect predominantly levels of the lower thoracic and lumbar segments; only 13 cases have been reported of DAVF at the foramen magnum. We present three surgically treated patients with DAVF at the foramen magnum. In none of our three patients could the site of the arteriovenous fistula be suspected from the clinical presentation. The clinical course varied from acutely developing signs and symptoms to a 10-year history of very slowly progressing symptoms. After neuroradiological diagnosis the patients were operated on direct microsurgical disconnection of the arteriovenous shunt via an enlargement of the foramen magnum and a hemilaminectomy of C1. DAVF at the foramen magnum may thus present with slowly to acutely progressing clinical symptoms and signs. Spinal angiographic examination should include the level of the foramen magnum if standard spinal angiography of thoracic, lumbar, and sacral segments is negative in suspected spinal DAVF since the nidus of the shunt can be situated remote from the level of neurological disorder. DAVF at the foramen magnum can be treated very effectively and with minimal surgical trauma by direct microsurgical disconnection of the shunt. This surgical procedure is indicated if embolization with glue is not possible or is unsuccessful.- - - - - - - - - - ranking = 1.2keywords = fistula (Clic here for more details about this article) |
9/122. classification of venous ischaemia with MRI.PURPOSE: Venous ischaemia is diagnosed by angiography and estimated with SPECT and PET. But venous ischaemia presents different features due to aetiology, type of onset, time course and collateral circulation. The purpose of this study was to analyse and to classify VI with MRI. methods: An analysis of 12 cases of dural arteriovenous fistula (DAVF) with venous ischaemia, 4 cases of sinus thrombosis, and a case of cortical venous thrombosis was performed. Venous ischaemia is classified with MRI as Type 1: no abnormality, Type 2: T2WI showed high signal intensity area and Gd-MRI showed no enhancement, Type 3: T2WI showed high signal intensity area and Gd-MRI showed enhancement, Type 4: venous infarction or haemorrhage. RESULTS: Type 1 was 8 cases. Type 2 was 3 cases and indicated cytotoxic oedema. Type 3 was 2 cases and indicated vasogenic oedema because of the destruction of blood brain barrier. Type 4 was 4 cases. CONCLUSIONS: The classification may be a useful indicator of severity of venous ischaemia and treatment.- - - - - - - - - - ranking = 0.2keywords = fistula (Clic here for more details about this article) |
10/122. The efficacy and safety of transvenous embolisation in the treatment of intracranial dural arteriovenous fistulas.To evaluate the role of transvenous embolisation including its efficacy and safety in the treatment of intracranial dural arteriovenous fistulas (DAVFs), we retrospectively analysed seven cases of intracranial DAVFs treated with transvenous embolisation in combination with arterial embolisation. Four DAVFs were in the cavernous sinus, two in the transverse-sigmoid sinus, and one in the inferior petrosal sinus. The transarterial and transvenous embolic agents included fibred platinum coils (FPC) and interlocking detachable coils (IDC). In all patients, the transarterial embolisation alone had failed to cure the DAVFs. After the combined transvenous embolisation, the anatomical cure was proven in five patients, and all patients were clinically cured. There were no complications in any patient. In conclusion, the transvenous embolisation is a useful and safe approach in the management of intracranial DAVFs.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
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