1/56. 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 = 1keywords = giant (Clic here for more details about this article) |
2/56. 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 = 3keywords = giant (Clic here for more details about this article) |
3/56. Combination of intraoperative embolisation with surgical resection for treatment of giant cerebral arteriovenous malformations.Objective: To reduce the risk of surgical resection of giant arteriovenous malformation (AVM) and prevent normal perfusion pressure breakthrough (NPPB) and thus to lower postoperative mortality.methods: During the operation, which was carried out under general anaesthesia, the proximal ends of the feeding arteries were first ligated and 0.5 ml IBCA mixed with 0.5 ml of 5% glucose was injected into the vessels towards the AVM, then the malformed vessels were totally resected. Postoperative digital subtraction angiography (DSA) of the four vessels was performed in all patients.Results: Fifty patients with giant AVMs survived after operation, only 6 (12.0%) had transient neurological dysfunction and 44 (88.0%) recovered after a follow-up of 6-36 months. No patient suffered from NPPB.Conclusions: The embolisation could block the arteriovenous shunts sufficiently to decrease the blood flow away from the normal areas of the brain so as to prevent the incidence of intra- and post-operative rebleeding, especially in NPPB. Therefore, the combination of intraoperative embolisation with surgical resection is an effective strategy in the treatment of giant cerebral AVMs, which makes it possible to operate on patients who used to be regarded as inoperable cases.- - - - - - - - - - ranking = 3.5keywords = giant (Clic here for more details about this article) |
4/56. Resection of a giant intracranial dural arteriovenous fistula with the use of low-flow deep hypothermic cardiopulmonary bypass after partial embolization: technical case report.OBJECTIVE AND IMPORTANCE: To describe the surgical resection of a giant intracerebral arteriovenous fistula with involvement of dura mater and surrounding bone. Intraoperative bleeding was controlled by hypothermic circulatory arrest. CLINICAL PRESENTATION: This 46-year-old woman complained of persistent headache for 1 year; her diagnostic workup revealed the presence of an arteriovenous fistula in the dura mater of the left temporal region fed by the meningeal artery of the external and internal carotid arteries, with normal run-off into Labbe's and Trolard's veins. magnetic resonance imaging depicted a Chiari I malformation that was most likely a result of insufficient cerebral venous drainage. INTERVENTION: In preparation for surgery, staged embolization of feeders from the left meningeal artery and the left occipital artery was performed under controlled hypotension. This procedure failed to achieve a significant reduction in flow because of the immediate recruitment of internal branches of the internal carotid artery and dural branches of the right external carotid artery. Surgical treatment was undertaken without further embolization. Because of involvement of surrounding bone and the high risk of uncontrollable bleeding, the procedure was carried out with the patient under deep hypothermic cardiopulmonary bypass. Forty-five minutes of low flow (1.5 L/min) at 18 degrees C allowed total resection of the involved dura mater and surrounding bone. Postoperative recovery was marked by left brain edema that disappeared within 10 days. Findings on follow-up angiography were normal, and the patient was discharged with no neurological deficit. CONCLUSION: Low-flow deep hypothermic cardiopulmonary bypass can be used to control intraoperative bleeding for surgical excision of a giant intracerebral dural arteriovenous fistula.- - - - - - - - - - ranking = 3keywords = giant (Clic here for more details about this article) |
5/56. Combination of intraoperative embolization with surgical resection for treatment of giant cerebral arteriovenous malformation.OBJECTIVE: To reduce the risk of surgical resection of giant arteriovenous malformation (AVM) (> 6.0 cm) and prevent normal perfusion pressure breakthrough (NPPB) for lowering the postoperative mortality. methods: During the operation under barbiturate anesthesia, the proximal end of the feeding arteries were ligated at first, and 0.5 ml isobutyl 12-cyanoacrylate (IBCA) with 0.5 ml 5% glucose was injected into the vessels towards the AVM, then the malformed vessels were resected totally. Postoperative digital subtraction angiography of the four vessels was performed in all patients. RESULTS: 50 patients with giant AVM survived after operation, only 6 (12.0%) had transient neurological dysfunction and 44 (88.0%) recovered after a follow-up of 6-36 months. No patient suffered from normal perfusion pressure breakthrough (NPPB). CONCLUSIONS: The embolization could block the arteriovenous shunts sufficiently to decrease the blood flow away from the normal areas of the brain so as to prevent the incidence of intra- and postoperative rebleeding, especially in NPPB. Therefore, the combination of intraoperative embolization with surgical resection is an effective strategy in the treatment of giant cerebral AVMs, which make it operable for those used to be regarded as inoperable cases.- - - - - - - - - - ranking = 3.5keywords = giant (Clic here for more details about this article) |
6/56. Venous malformations associated with central pain: report of a case.IMPLICATIONS: The authors describe an unusual case of central pain (CP) that resulted from giant venous hemangiomas. The patient was treated with a variety of medications, including the N-methyl-D-aspartate antagonist dextromethorphan. We report the first known association between venous malformations and CP and briefly describe why the use of dextromethorphan in this disorder requires further evaluation.- - - - - - - - - - ranking = 0.5keywords = giant (Clic here for more details about this article) |
7/56. Spontaneous disappearance of vein of galen malformation and posterior fossa venous pouch.Cerebrovascular anomalies remain an issue of controversy regarding diagnosis, classification, and treatment. We report the first case of total and asymptomatic regression and disappearance of a vein of Galen malformation associated with a posterior fossa venous pouch. Different aspects of the vein of Galen are discussed together with emphasis on the underlying mechanisms of spontaneous thrombosis and regression.A 4-month-old boy presented with macrocrania and signs of intracranial hypertension. Computerized tomography disclosed two masses, the first was a giant aneurysmal dilatation in the posterior fossa, and the second was a gigantic pouch at the level of the vein of Galen. hydrocephalus was treated by ventriculo-peritoneal shunting. Two months later, the shunt was revised, and posterior fossa was explored without active treatment. Both abnormalities regressed spontaneously. No recurrence occurred, and the child remained neurologically intact. Total disappearance of the masses as well as normal brain and cerebrovascular anatomy were confirmed by angiography, MRI, and MRA. Over a follow-up period of 17 years, the patient did not develop complications. He had perfect clinical tolerance and resumed a normal life.- - - - - - - - - - ranking = 0.5keywords = giant (Clic here for more details about this article) |
8/56. Successful endovascular treatment of cerebral arteriovenous fistula.Childhood intracranial varix is rare and has been associated mostly with vein of Galen fistula or arteriovenous malformation. We present one patient with intracranial arteriovenous fistula with concomitant giant varix in a child. We treated the patient with endovascular embolization and obtained complete closure of fistula without morbility and mortality. The main radiologic and pathophysiologic features of this unusual entity, as well as the available therapeutic options, are discussed.- - - - - - - - - - ranking = 0.5keywords = giant (Clic here for more details about this article) |
9/56. Obliteration of giant corpus callosum AVM with linac based stereotactic radiosurgery.Successful management of large AVMs is difficult. Traditionally they are considered less responsive and even unsuitable for radiosurgery. This case report demonstrates total angiographic obliteration in a complex, large corpus callosum AVM (volume 36.52 cc) in a 39-year-old male. Stereotactic radiation was delivered with a Linear Accelerator using ultra conformal treatment planning. Large volume AVMs can be subjected to stereotactic radiosurgery if the shape and location makes it possible to deliver an adequate radiation dose.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
10/56. Rendu-Osler-Weber disease with a giant intracerebral varix secondary to a high-flow pial AVF: case report.BACKGROUND: Intracranial varices are rare and most are associated with vein of Galen arteriovenous malformations (AVM) or fistulas (AVF). DESCRIPTION: A 43-year-old left-handed man presented with right hemihypesthesia and spastic gait. Neuroradiological examination revealed a spinal AVF and a giant intracerebral varix associated with a high-flow pial AVF. He had recurrent episodes of nasal bleeding, which were also confirmed in his mother's medical history, and telangiectases in the tip of his tongue and fingers. He was diagnosed with Rendu-Osler-Weber disease. After resection of the spinal AVF that produced his symptoms, we surgically exposed and obliterated the giant varix and AVF under intra- and postoperative hypotension and mild barbiturate therapy. The arteriovenous shunt was completely obliterated without hyperperfusion of the surrounding brain. CONCLUSION: This is an extremely rare case of Rendu-Osler-Weber disease with a giant intracerebral varix secondary to a high-flow pial AVF that did not involve the vein of Galen.- - - - - - - - - - ranking = 3.5keywords = giant (Clic here for more details about this article) |
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