1/44. 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 = cord (Clic here for more details about this article) |
2/44. 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 = 294.04065126492keywords = spinal, spinal cord, cord (Clic here for more details about this article) |
3/44. 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 = 505.17468656509keywords = spinal, spinal cord, cord (Clic here for more details about this article) |
4/44. 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 = 140.75602353345keywords = spinal (Clic here for more details about this article) |
5/44. Spinal arteriovenous malformations: a review with case illustrations.Spinal arteriovenous malformations are united by the existence of arteriovenous shunting but are quite heterogeneous in terms of pathology. Until recently, the pathological confusion has been such that management has been poorly understood and this is magnified by the rarity of the lesions. Type 1 AVMs, where the fistula is located in the dura, usually present with a venous hypertensive myelopathy and are relatively easily dealt with surgically. Type 2 AVMs, most closely mimicking the parenchymal AVMs of the brain, usually present with haemorrhage and may be surgically remediable but with much greater risk than the type 1 lesions. Type 3 AVMs, with a diffuse location through both the cord and extra-CNS tissue, usually present early in life with a myelopathy and are often untreatable. Type 4 AVMs, with a fistula located on the pial surface of the cord, usually present with a venous hypertensive myelopathy or subarachnoid haemorrhage, can be treated relatively easily by surgery when small but may be better treated endovascularly when the fistula is large.The purpose of this review is to summarise the current pathological, clinical and management literature with illustrative cases underscoring the important features of this heterogeneous disorder.- - - - - - - - - - ranking = 2keywords = cord (Clic here for more details about this article) |
6/44. Symptomatic unruptured capillary telangiectasia of the brain stem: report of three cases and review of the literature.Three young patients with transient or intermittent focal neurological signs suggesting brain stem involvement are described, in whom high field MRI showed focal areas of hyperintensity in T2 weighted spin echo images, hypointensity in T2* weighted gradient echo images, and enhancement in postcontrast T1 weighted images consistent with unruptured capillary telangiectasia of the brain stem. The first patient was a 28 year old woman who complained of recurrent left ear tinnitus, exacerbated during the menstrual period; MRI demonstrated that the vascular anomaly involved the left acoustic pathway. The second patient was a 30 year old woman who had three episodes of paroxysmal left lip movement 4 weeks after child delivery; MRI showed capillary telangiectasia in the right corticonuclear pathway. The third patient, a 36 year old man, had a transient right Bell's palsy; MRI disclosed two circumscribed areas consistent with capillary telangiectasia in the left corticospinal tract and medial longitudinal fasciculus. Steroid receptors in the telangiectatic vessels walls might account for the recurrent and transient course seen in our two female patients. awareness of the MRI features of capillary telangiectasia may help in defining the real incidence, clinical correlation, and the risk of haemorrhagic complications of these vascular malformations.- - - - - - - - - - ranking = 70.378011766724keywords = spinal (Clic here for more details about this article) |
7/44. Spinal dural AV fistula mimicking a vertebral neoplasm.A middle-aged man with spinal dural arteriovenous fistula mimicking a vertebral neoplasm of Th11 is described. CT and MR imaging revealed the rare case of extensive vertebral destruction of Th11.- - - - - - - - - - ranking = 70.378011766724keywords = spinal (Clic here for more details about this article) |
8/44. Potential role of the anterior spinal artery in preventing propagation of thrombus in a therapeutically occluded vertebral artery: angiographic studies before and after endovascular treatment.therapeutic occlusion of the vertebral artery (VA) is one of the treatments for unclippable aneurysms and other lesions, although controversy still surrounds the appropriate site for occlusion to attain selective thrombosis of the lesion while avoiding ischaemic complications. The lower two-thirds of the lateral medulla are supplied by perforating branches of both the VA and the posterior inferior cerebellar artery (pica). However, in patients without a pica or in whom the origin of the pica is low (at or below the foramen magnum), the VA is usually the only source of perforating vessels. We retrospectively studied the results of VA occlusion on such anatomically high-risk patients, and propose a safer procedure. Five high-risk patients underwent therapeutic occlusion of the VA for dissecting aneurysms or arteriovenous fistula. A lateral medullary syndrome developed due to propagation of thrombus after the procedure in two patients in whom angiography did not demonstrate the anterior spinal artery (ASA) within the stump of the VA. Ischaemic signs did not develop in the other three patients, in whom the ASA was visible, and retrograde flow was observed proximal to the origin of the ASA. This suggests that the ASA may play a role in preventing propagation of thrombus in the VA distal to the site of occlusion and supply blood to its perforating arteries in high-risk patients. Angiographic assessment of the ASA may be useful for predicting the likelihood of the lateral medullary syndrome developing with therapeutic occlusion of the VA in patients without a pica or with one whose origin is low.- - - - - - - - - - ranking = 351.89005883362keywords = spinal (Clic here for more details about this article) |
9/44. Sacral origin of a spinal dural arteriovenous fistula: case report and review.STUDY DESIGN: A case of spinal dural arteriovenous fistula arising from a branch of the internal iliac artery is reported. OBJECTIVE: To report a rare case of spinal dural arteriovenous fistula supplied by a lateral sacral artery and treated with endovascular therapy. SUMMARY OF BACKGROUND DATA: Spinal dural arteriovenous fistulas usually occur in the thoracic and lumbosacral regions and arise from the intercostal and lumbar arteries. Rarely, they may occur in the sacral region, as in the reported case. methods: A 60-year-old man presented with progressive lower extremity paresis and decreased sensation below the waist of 6 months duration, which had progressed to paraparesis. diagnostic imaging included magnetic resonance imaging and spinal angiography. RESULTS: A sacral spinal dural arteriovenous fistula was diagnosed with spinal angiography, which showed the spinal dural arteriovenous fistula arising from the right lateral sacral artery branches at S2, and magnetic resonance imaging, which showed enlarged pial vessels along the surface of the spinal cord and central cord hyperintensity, with peripheral hypointensity on T2-weighted images. The patient was definitively treated with endovascular therapy using polyvinyl alcohol particles and Tornado coils. His symptoms almost completely resolved within 6 months of therapy. CONCLUSIONS: Although surgical ligation is the treatment of choice, endovascular therapy may be an effective treatment for patients with sacral region spinal dural arteriovenous fistula in cases of high surgical risk. Spinal angiography remains the definitive diagnostic examination for pinpointing the site of the dural arteriovenous fistula.- - - - - - - - - - ranking = 858.06474539871keywords = spinal, spinal cord, cord (Clic here for more details about this article) |
10/44. Intracranial extra-axial cavernous (HEM) angiomas: tumors or vascular malformations?INTRODUCTION: Extra-axial cavernous hemangiomas or angiomas [(hem)angiomas] are relatively rare lesions. They usually arise in relation to the dura mater intracranially or at the spinal level. Most of these lesions have been described in the middle cranial fossa at level of the cavernous sinus. Controversy still exists regarding the exact nature of these extra-axial cavernous angiomas: vascular tumor versus vascular malformation similar to intra-axial cavernomas. It has been suggested that they could represent an adult form of the hemangioma of infancy. Extra-axial cavernous (hem)angiomas often mimic meningiomas and their clinical behavior and imaging appearance are quite different than those of intra-axial cavernous angiomas. SUBJECTS AND methods: Five patients ranging in age from 24 to 63 years with a histologically proven dural cavernous angioma were retrospectively included. The lesions were located at level of the cavernous sinus (4 cases) and falx. CT and MR scans were performed in all cases and angiography in three patients. Four patients underwent surgery and a biopsy was performed in one case. One lesion was embolized before biopsy. histology was available in all patients. RESULTS: In the operated patients, the lesion was totally resected in 2 cases and partially in the other 2. No postsurgical complication was noted. histology revealed a vascular malformation composed of large vascular channels lined by flat endothelium and separated by fibroconnective tissue stroma. The pathological diagnosis was cavernous angioma. CONCLUSION: On the basis of the analysis of the literature and of our cases, intra-cranial extra-cerebral so-called cavernous (hem)angiomas present findings suggesting that they are vascular malformative lesions, analogous to the intra-axial cavernous angioma. A relationship with the hemangiomas of infancy seems unlikely. Correct terms for extra-cerebral cavernous (hem)angiomas are cavernoma, cavernous angioma, or venous vascular malformation of cavernous type . The term hemangioma should be avoided and reserved for the common vascular tumor of infancy.- - - - - - - - - - ranking = 70.378011766724keywords = spinal (Clic here for more details about this article) |
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