11/122. 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 = 1keywords = fistula (Clic here for more details about this article) |
12/122. Diffuse white matter changes caused by dural arteriovenous fistula.We present two patients with progressive dementia who showed diffuse white matter changes on magnetic resonance imaging (MRI) associated with dural arteriovenous fistula (DAVF) involving the transverse-sigmoid sinuses. angiography of both patients revealed that DAVF was associated with multiple occlusive changes in the dural venous sinus. The associated occlusive changes isolated the straight sinus and the DAVF from the other venous sinuses, and concentrated the drainage of the DAVF in the straight sinus. We postulate that the venous hypertension of the straight sinus resulted in the venous ischemia of the white matter, diffuse white matter changes on MRI, and progressive neurological signs including dementia. Treatment of the DAVF reversed white matter changes and neurological signs. Associated with the venous sinus occlusions, the DAVF caused dementia with diffuse white matter changes due to the venous ischemia.- - - - - - - - - - ranking = 1.6666666666667keywords = fistula (Clic here for more details about this article) |
13/122. A tentorial dural arteriovenous fistula successfully treated with interruption of leptomeningeal venous drainage using microvascular Doppler sonography: case report.BACKGROUND: Complete interruption of a dural arteriovenous fistula (DAVF) has been confirmed intraoperatively by visual inspection and intraoperative angiography. To confirm complete interruption of the shunt flow during the surgical treatment of a tentorial DAVF, we used intraoperative microvascular doppler monitoring. CASE DESCRIPTION: A 71-year-old man suffered from severe subarachnoid hemorrhage. angiography showed a tentorial DAVF with pure leptomeningeal drainage associated with a venous pouch. After the patient's neurologic condition had improved, he underwent interruption of the draining vein via a right suboccipital approach. An arterialized drainage vein was easily identified by applying the microvascular doppler probe to the shunting vessels and was completely obliterated by clipping. There were no complications associated with use of the microvascular doppler. The postoperative course was uneventful and follow-up angiography showed complete obliteration of the DAVF. CONCLUSION: Intraoperative microvascular doppler monitoring is a useful technique not only for evaluating arterialized leptomeningeal drainage veins but also for confirming the complete obliteration of these vessels.- - - - - - - - - - ranking = 1.6666666666667keywords = fistula (Clic here for more details about this article) |
14/122. Successful transarterial glue embolisation by wedged technique for a tentorial dural arteriovenous fistula presenting with a conjunctival injection.Many tentorial dural arteriovenous fistulae (TDAVF) present with intracranial haemorrhage. We report a patient who presented with conjunctival injection. Transarterial embolisation of the TDAVF was undertaken with a wedged injection of a low concentration of N-butyl cyanoacrylate, arresting the flow next to the proximal segment of the venous outlet. After three sessions, a complete cure was achieved. We present a useful method which has not been reported previously.- - - - - - - - - - ranking = 1.6666666666667keywords = fistula (Clic here for more details about this article) |
15/122. Dural arteriovenous fistula of the cavernous sinus with cortical venous reflux of the posterior fossa via a bridging vein.We describe a patient who had a dural arteriovenous fistula of the cavernous sinus with cortical venous reflux into the lateral mesencephalic vein and cerebellar hemispheric veins via a bridging vein connected with the basilar plexus. The fistula and reflux disappeared after transvenous embolization using interlocking detachable coils.- - - - - - - - - - ranking = 2keywords = fistula (Clic here for more details about this article) |
16/122. Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein.BACKGROUND: Treatment of choice for symptomatic carotid-cavernous and cavernous-dural fistulas is neuroradiologic intervention via the femoral artery. Owing to the location of the fistula and/or to anatomic variations, a direct surgical approach via the superior ophthalmic vein may be necessary for embolization. methods: Three patients presented with exophthalmos, episcleral venous congestion, chemosis, restricted eye movement, and secondary glaucoma. One patient had visual impairment and scotoma due to compression of the optic nerve by the fistula. The tentative diagnosis of an arteriovenous fistula was confirmed in two cases by color Doppler imaging and in all three cases with cerebral arterial angiography (two carotid-cavernous fistulas, one cavernous-dural fistula). After an unsuccessful transarterial attempt, embolization via the superior ophthalmic vein was chosen. RESULTS: In all three patients the preparation of the superior ophthalmic vein was performed without any complications. In two cases the fistula could be embolized completely with platinum coils. In one patient the placement of the microcatheter was impossible, because of an abnormal vascular pattern. Later on the fistula was successfully embolized by an approach via the femoral vein. All three patients had complete resolution of symptoms. There were no recurrences. CONCLUSION: Embolization of carotid-cavernous and cavernous-dural fistulas by a surgical approach via the superior ophthalmic vein represents safe and effective treatment when standard transarterial access is impossible. The cooperation of an orbital surgeon and an invasive neuroradiologist can be of benefit for this rare group of patients.- - - - - - - - - - ranking = 4.3333333333333keywords = fistula (Clic here for more details about this article) |
17/122. Venous cerebral infarction due to simultaneous occurrence of dural arteriovenous fistula and developmental venous anomaly.A case of a left frontal lobe infarction in a 31-year-old male patient is presented. This patient had bilateral frontal dural arteriovenous fistulae (DAVF) and a left frontal developmental venous anomaly (DVA). It is suggested that the simultaneous occurrence of these vascular anomalies was the cause of his infarction.- - - - - - - - - - ranking = 1.6666666666667keywords = fistula (Clic here for more details about this article) |
18/122. 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 = 1.6666666666667keywords = fistula (Clic here for more details about this article) |
19/122. The importance of venous hypertension in the formation of dural arteriovenous fistulas: a case report of multiple fistulas remote from sinus thrombosis.Various hypotheses have been reported concerning the pathogenesis of dural arteriovenous fistulas (DAVFs). However, it is still controversial whether sinus thrombosis or venous hypertension has a greater influence on the formation of DAVFs. We present a rare case of multiple DAVFs that developed after sinus thrombosis. Chronic venous hypertension secondary to sinus thrombosis in the left transverse-sigmoid sinus induced the multiple DAVFs, including one in the right cavernous sinus, which was remote from the occluded sinus. This case indicates the importance of venous hypertension in the formation of DAVFs.- - - - - - - - - - ranking = 3keywords = fistula (Clic here for more details about this article) |
20/122. Treatment of dural arteriovenous fistulae (dAVF's) at the superior sagittal sinus (SSS) using embolisation combined with micro- or radiosurgery.DAVF's at the SSS are extremely rare and usually present with intracranial haemorrhage (ICH) or a progressive neurological deficit. Due to their midline location and multiple arterial supply, endovascular treatment alone often fails in eliminating the fistula. Therefore, endovascular, combined with neurosurgical and/or radiosurgical treatment is often needed to cure the patient. We summarized our experience with three male patients over a ten-year period who suffered from dAVF's involving the middle and posterior third of the SSS. Two of them presented with an ICH during the clinical course. Despite multiple transarterial embolisations, complete fistula occlusion could not be achieved in any of them. Nevertheless, neurological symptoms improved in all cases. One patient refused further treatment and died six years later due to an ICH. Another patient was finally cured by microsurgical coagulation of the fistula. In the remaining patient stereotactic radiosurgery (SRS) was performed after nearly complete endovascular occlusion. We strongly recommend microsurgery and/or radiosurgery as adjunctive measures, if embolisation alone fails to eliminate these dangerous fistulae.- - - - - - - - - - ranking = 2.6666666666667keywords = fistula (Clic here for more details about this article) |
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