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Liang H, Xu C, Xu J. Cerebral venous sinus thrombosis and dural arteriovenous fistula associated with protein S deficiency: a case series study. BMC Neurol 2022; 22:164. [PMID: 35501720 PMCID: PMC9059366 DOI: 10.1186/s12883-022-02693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe the characteristics of patients with cerebral venous sinus thrombosis (CVST) and dural arteriovenous fistula (AVF) associated with protein S (PS) deficiency. METHODS We conducted a search of medical records in Hainan General Hospital from January 2000 to December 2020 for coexistence of CVST and dural AVF associated with PS deficiency and searched PubMed、Embase and Chinese biomedical databases (CBM) for all literature describing CVST and dural AVF with PS. We analyzed clinical characteristics, location, sequence of CVST and dural AVF, level of PS, therapeutic methods and prognosis. RESULTS We presented 1 patient in our hospital's database combined CVST and dural AVF associated with PS, plus 5 cases reported in literature. The most common symptoms were headache, generalized seizure, disturbance of consciousness. The most frequent location of CVST was at internal cerebral vein, while transverse sinus, sigmoid sinus, parietal region in dural AVF. Two patients developed dural AVF several months or years after CVST. Clinical characteristics and level of PS were summarized. CONCLUSION These findings alert physicians to consider PS deficiency in patients who suffer from CVST, especially those combined with dural AVF.
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Affiliation(s)
- Hui Liang
- Department of Neurology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Supported by Hainan Province Clinical Medical Center, Haikou, China
| | - Congjie Xu
- Department of Urology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jiyi Xu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Yu J, Lv X, Li Y, Wu Z. Therapeutic progress in pediatric intracranial dural arteriovenous shunts: A review. Interv Neuroradiol 2016; 22:548-56. [PMID: 27306522 PMCID: PMC5072209 DOI: 10.1177/1591019916653254] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023] Open
Abstract
Pediatric dural arteriovenous shunts (dAVSs) are a rare form of vascular disease: Fewer than 100 cases are reported in PubMed and the understanding of pediatric dAVS is limited. For this study, we searched in PubMed, reviewed and summarized the literature related to pediatric dAVSs. Our review revealed that pediatric dAVSs have an unfavorable natural history: If left untreated, the majority of pediatric dAVSs deteriorate. In a widely accepted classification scheme developed by Lasjaunias et al., pediatric dAVSs are divided into three types: Dural sinus malformation (DMS) with dAVS, infantile dAVS (IDAVS) and adult-type dAVS (ADAVS). In general, the clinical manifestations of dAVS can be summarized as having symptoms due to high-flow arteriovenous shunts, symptoms from retrograde venous drainage, symptoms from cavernous sinus involvement and hydrocephalus, among other signs and symptoms. The pediatric dAVSs may be identified with several imaging techniques; however, the gold standard is digital subtraction angiography (DSA), which indicates unique anatomical details and hemodynamic features. Effectively treating pediatric dAVS is difficult and the prognosis is often unsatisfactory. Transarterial embolization with liquid embolic agents and coils is the treatment of choice for the safe stabilization and/or improvement of the symptoms of pediatric dAVS. In some cases, transumbilical arterial and transvenous approaches have been effective, and surgical resection is also an effective alternative in some cases. Nevertheless, pediatric dAVS can have an unsatisfactory prognosis, even when timely and appropriate treatment is administered; however, with the development of embolization materials and techniques, the potential for improved treatments and prognoses is increasing.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China Beijing Tiantan Hospital, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China Beijing Tiantan Hospital, Beijing, China
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China Beijing Tiantan Hospital, Beijing, China
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Matsubara S, Satoh K, Satomi J, Shigekiyo T, Kinouchi T, Miyake H, Nagahiro S. Acquired pial and dural arteriovenous fistulae following superior sagittal sinus thrombosis in patients with protein S deficiency: a report of two cases. Neurol Med Chir (Tokyo) 2013; 54:245-52. [PMID: 24162240 PMCID: PMC4533415 DOI: 10.2176/nmc.cr2012-0311] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two patients with protein S deficiency with acquired multiple pial and dural arteriovenous fistulae (AVFs) following superior sagittal sinus (SSS) thrombosis are reported. Case 1 is a 38-year-old male with protein S deficiency who developed generalized seizure due to SSS thrombosis. Local fibrinolysis was achieved in the acute stage. His 10-month follow-up angiogram revealed an asymptomatic acquired dural AVF arising from the middle meningeal artery and the anterior cerebral artery with drainage to the thrombosed cortical vein in the right frontal lobe. Furthermore, his 2-year follow-up angiogram revealed a de novo pial AVF from the middle cerebral artery in the Sylvian fissure with drainage to the cortical vein initially thrombosed. However, this asymptomatic pial AVF caused bleeding in the ipsilateral cerebral hemisphere 12 years after onset, whereas the dural AVF spontaneously disappeared. Surgical disconnection was successfully performed to eliminate the source of hemorrhage. Case 2 is a 50-year-old male with a past history of SSS thrombosis with protein S deficiency who developed pulsatile tinnitus and generalized seizure. His angiogram showed a cortical dural AVF in the left parietal lobe and a sporadic dural AVF involving the right sigmoid sinus. The parietal lesion was eliminated by transarterial embolization followed by craniotomy. However, a de novo pial AVF emerged from the middle cerebral artery adjacent to the previously treated lesion. Of four cortical AVFs in two patients, thrombosis of cortical veins caused by protein S deficiency might play an important role in their formation. Long-term follow-up is required because this peculiar disorder has an unusual clinical course.
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Affiliation(s)
- Shunji Matsubara
- Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School
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Gerlach R, Yahya H, Rohde S, Böhm M, Berkefeld J, Scharrer I, Seifert V, Raabe A. Increased incidence of thrombophilic abnormalities in patients with cranial dural arteriovenous fistulae. Neurol Res 2013; 25:745-8. [PMID: 14579793 DOI: 10.1179/016164103101202101] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Cranial dural arteriovenous fistulae (DAVF) may occur post-traumatic or sporadic. The physiopathologic mechanisms of sporadic DAVF are still unclear. A dural sinus thrombosis followed by an increase in venous pressure and/or an increased procoagulatory activity of the coagulation system are associated at least with some DAVF. The objective of this study was to investigate the coagulation profile in patients with DAVF. Thus the association of thrombophilic abnormalities, sinus thrombosis and DAVF should be analyzed. A total of 15 patients with cranial DAVF were included in this study. Blood samples were analyzed for 20210A mutation of the prothrombin gene, resistance to activated protein C and factor V Leiden mutation. Fibrinogen (Fib), Textarin time (TT), antithrombin (AT), protein C and protein S activity, von Willebrand factor antigen (vWF:Ag), Ristocetin cofactor activity (vWF:RCo), D-Dimer (DD) and coagulation factor VIII-activity (F VIII) were determined in all patients. Blood was screened for the occurrence of lupus antiphospholipid antibodies and cardiolipin antibodies. Thrombophilic risk factors were found in 5 (33%) of the 15 patients with cranial DAVF. Four patients had a heterozygote 20210A mutation of the prothrombin gene and one patient had a heterozygote FV Leiden mutation. Sinus thrombosis was detected in two patients with grade 2b DAVF and was associated with a 20210A mutation of the prothrombin gene in both patients. Additionally, one patient had deficient protein C activity and screening for cardiolipin antibodies was positive in three patients. In the current series the frequency of prothrombin Gene 20210A mutation was higher in patients with DAVF compared to the general population, whereas the incidence of Factor V Leiden mutation was not. Therefore in patients with cranial DAVF thrombophilic abnormalities should be considered in the post-operative/post-interventional management.
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Affiliation(s)
- Rüdiger Gerlach
- Department of Neurosurgery, Johann Wolfgang Goethe-University, Schleusenweg 2-16, 60528 Frankfurt/Main, Germany.
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Bendok BR, El Tecle NE, El Ahmadieh TY, Park AE. Cranial fistulae: venous occlusion, the road to cure and misery. World Neurosurg 2013; 80:e213. [PMID: 23541746 DOI: 10.1016/j.wneu.2013.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 03/21/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Bernard R Bendok
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Iizuka Y, Koda E, Tsutsumi Y, Konishi Y, Ashida H, Nakanishi T, Funabiki M. Neonatal dural arteriovenous fistula at the confluence presenting with paralysis of the orbicularis oris muscle. Neuroradiol J 2013; 26:47-51. [PMID: 23859167 PMCID: PMC5278863 DOI: 10.1177/197140091302600108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 01/27/2013] [Indexed: 11/15/2022] Open
Abstract
A male neonate presented a dural arteriovenous fistula (DAVF) at the confluence with paralysis of the orbicularis oris muscle. The interesting features in our case were the clinical symptoms (orbicularis oris muscle paralysis at birth), angioarchitecture (high-flow arteriovenous shunts at the confluence) and the size and hemodynamic flow (mid-sized venous pouch) of the fistula. Additionally, the embolization technique (i.e., occipital artery approach, closing shunts with pure glue) automatically resulted in the immediate and complete closure of accessory feeders without any additional treatment, and the midterm clinical outcome was good. We succeeded improving the symptoms of a neonate with a congenital high-flow DAVF by closing a fistula using a small amount of glue.
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Affiliation(s)
- Y Iizuka
- Department of Radiology, Toho University Ohashi Medical Center; Tokyo, Japan.
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S Miyachi E, Izumi T, Matsubara N, Naito T, Haraguchi K, Wakabayashi T. Mechanism of the formation of dural arteriovenous fistula: the role of the emissary vein. Interv Neuroradiol 2011; 17:195-202. [PMID: 21696658 DOI: 10.1177/159101991101700209] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 11/07/2010] [Indexed: 11/15/2022] Open
Abstract
Dural arteriovenous fistula (DAVF) can be separated into two types: DAVF which drains through an affected sinus (sinus type) and DAVF with direct reflux to the cortical vein (non-sinus type). The present report attempted to clarify the mechanism of formation and development of DAVF focusing on the emissary vein (EV) hypothesis.First, inflammation occurs at the penetrating point of the EV on the dura due to idiopathic or secondary causes. Local inflammatory reactions induce vessel dilatation and neovascularization, and subsequently create arteriovenous (AV) connections on the arteriole level. Although EV communicating with dural arteries might play a role as draining routes at first, they start to degrade due to compression of enlarged emissary arteries or to a hemodynamic shift to the drainage pathway of least resistance. Following the occlusion of drainage pathway through EV into the sinus or cortical veins may form, resulting in clinically detectable DAVF. The AV shunt then expands to the surrounding dura associated with recruitment of feeders from distant sites induced by expression of angiogenetic factors and a shift in the hemodynamic balance. In sinus type DAVF, the sinus is progressively compartmentalized and finally occludes due to thrombogenesis with activated coagulopathy or to hemodynamic hypertrophy of the sinus wall. This progression results in the mature, aggressive DAVF with drainage impairments. Previous mechanistic hypotheses focusing on sinus hypertension and sinus thromboses cannot explain the pathogenesis of non-sinus type of DAVF. Although the etiology of DAVF may be concerned by the thrombo-occlusive change of sinus, the unique theory presented in this report may enable an understanding of the common etiology of both types of DAVF.
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Affiliation(s)
- E S Miyachi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Japan.
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Ko A, Filardi T, Giussani C, Ghodke R, Browd SR. An intracranial aneurysm and dural arteriovenous fistula in a newborn. Pediatr Neurosurg 2010; 46:450-6. [PMID: 21540622 DOI: 10.1159/000323420] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 12/03/2010] [Indexed: 11/19/2022]
Abstract
The authors present the case of a newborn with an intracerebral aneurysm and a dural arteriovenous fistula. The patient initially presented with intraventricular hemorrhage and hydrocephalus, with evidence of remote subarachnoid hemorrhage, left hemispheric stroke, and sagittal sinus thrombosis. He was treated with a ventriculoperitoneal shunt and subsequent staged endovascular obliteration of both the aneurysm and fistula. Interestingly, the aneurysm did not appear on an artery feeding the abnormal fistula. Intracerebral aneurysms in the neonatal population are rare, and dural arteriovenous fistulae even more so; we present a case of a 2-month-old infant with both, as well as a review of the literature concerning these rare vascular abnormalities.
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Affiliation(s)
- Andrew Ko
- Department of Neurological Surgery, Seattle Children's Hospital, Seattle, WA 98105, USA
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9
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Abstract
OBJECTIVE Dural arteriovenous fistulae (DAVF) of the hypoglossal canal region are rare lesions. We describe three cases of DAVF of the hypoglossal canal presenting with ocular symptoms and discuss the endovascular management options. METHODS Three consecutive patients with DAVF of the hypoglossal canal region presented with proptosis, chemosis and disturbances of extra-ocular mobility. Each patient was treated using a different endovascular approach, based on variations of the vascular access. RESULTS The cases and treatments are reviewed, with a literature review on the subject. Endovascular treatment, transvenous or trans-arterial was curative in all cases. CONCLUSION DAVF of the hypoglossal canal region can present with ocular manifestations very similar to DAVF of the cavernous sinus or carotid-cavernous fistulas. Endovascular treatment is usually feasible and effective, but an understanding of the vascular anatomy and pathophysiology of the disease are of utmost importance when planning the approach.
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Aboian MS, Daniels DJ, Rammos SK, Pozzati E, Lanzino G. The putative role of the venous system in the genesis of vascular malformations. Neurosurg Focus 2009; 27:E9. [PMID: 19877799 DOI: 10.3171/2009.8.focus09161] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recent clinical and experimental evidence has challenged the traditional concept of the venous system as a “passive” element in the genesis and evolution of intracranial vascular malformations. The authors review the clinical and experimental evidence linking the venous system and its anomalies to the genesis of various intracranial vascular malformations, including dural arteriovenous fistulas, cavernous malformations, parenchymal arteriovenous malformations, and capillary telangiectasia. They also describe the potential significance of different associations of these vascular anomalies.
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Affiliation(s)
| | - David J. Daniels
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Stylianos K. Rammos
- 3Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine at Peoria, Illinois; and
| | - Eugenio Pozzati
- 4Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy
| | - Giuseppe Lanzino
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Documented development of a dural arteriovenous fistula in an infant subsequent to sinus thrombosis: case report and review of the literature. Neuroradiology 2009; 52:225-9. [DOI: 10.1007/s00234-009-0608-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 10/02/2009] [Indexed: 11/25/2022]
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Gerlach R, Boehm-Weigert M, Berkefeld J, Duis J, Raabe A, Seifert V, Marquardt G. THROMBOPHILIC RISK FACTORS IN PATIENTS WITH CRANIAL AND SPINAL DURAL ARTERIOVENOUS FISTULAE. Neurosurgery 2008; 63:693-98; discussion 698-9. [DOI: 10.1227/01.neu.0000325730.77263.7e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
OBJECTIVE
Numerous studies have reported the technical aspects and results of surgical and/or endovascular treatment of cranial dural arteriovenous fistulae (cDAVF) and spinal dural arteriovenous fistulae (sDAVF). Only a few of them have addressed the question of thrombophilic conditions, which may be relevant as pathogenetic factors or can increase the risk for venous thromboembolic events. Therefore, the objective of this study is to compare thrombophilic risk factors in patients with cDAVF and sDAVF with no history of trauma.
METHODS
A total of 43 patients (25 with cDAVF and 18 with sDAVF) were included in this study. Blood samples were analyzed for G20210A mutation of the prothrombin gene and factor V Leiden mutation. In all patients, prothrombin time, international normalized ratio, fibrinogen, antithrombin, protein C and S activity, von Willebrand factor antigen, ristocetin cofactor activity, D-dimer, coagulation factor VIII activity, and tissue factor pathway inhibitor were determined. Screening was performed for the occurrence of lupus antiphospholipid and cardiolipin antibodies.
RESULTS
The prevalence of G20210A mutation of the prothrombin gene was significantly higher in patients with cDAVF (n = 6) compared with patients with sDAVF (n = 0; P < 0.05, Fisher's exact test). A factor V Leiden mutation was found in 3 patients with sDAVF and in 1 patient with cDAVF (P = 0.29, Fisher's exact test). No significant difference was found for other parameters, except for fibrinogen, but decreased protein C activity was more frequent in patients with cDAVF compared with patients with sDAVF (4 versus 1). Decreased protein S activity was encountered in 3 patients (2 with sDAVF and 1 with cDAVF). Cardiolipin antibodies were found in 2 patients with cDAVF but in none with sDAVF, whereas only 1 patient with sDAVF had lupus antiphospholipid antibodies.
CONCLUSION
In both groups of patients with dural arteriovenous fistulae, genetic thrombophilic abnormalities occurred in a higher percentage than in the general population. The differences of the genetic abnormalities may be involved in different pathophysiological mechanism(s) in the development of these distinct neurovascular entities.
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Affiliation(s)
- Rüediger Gerlach
- Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Martina Boehm-Weigert
- Department of Medicine, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Joachim Berkefeld
- Neuroradiological Institute, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Judith Duis
- Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Andreas Raabe
- Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
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Erdogan B, Caner H, Aydin MV, Yildirim T, Kahveci S, Sen O. Hemispheric cerebrovascular venous thrombosis due to closed head injury. Childs Nerv Syst 2004; 20:239-42. [PMID: 14605837 DOI: 10.1007/s00381-003-0845-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2003] [Indexed: 10/26/2022]
Abstract
CASE REPORT We present the case of an 8-month-old infant who was admitted to our Neurosurgery Department with venous infarction related to sagittal sinus thrombosis. The infarction was radiologically detected 5 days after the baby had undergone surgery for acute subdural hematoma due to a closed head injury. RESULTS AND CONCLUSIONS Cerebrovascular venous thrombosis is a rare clinical entity that has multiple causes and variable presenting symptoms. There is no consensus on overall strategy concerning surgical, radiosurgical, or medical therapy (anti-coagulation, thrombolytic, and anti-edema treatment), and exactly how, when, or in which cases these should be applied. The treatment planning should be based on clinical findings, and should be modified according to the clinical course. In this case, the clinical and radiological findings regressed with symptomatic treatment alone.
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Affiliation(s)
- Bulent Erdogan
- Department of Neurosurgery, Baskent University Faculty of Medicine, Baskent Hastanesi, 01250 Yuregir, Adana, Turkey.
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Yassari R, Jahromi B, Macdonald R. Dural arteriovenous fistula after craniotomy for pilocytic astrocytoma in a patient with protein S deficiency. SURGICAL NEUROLOGY 2002; 58:59-64; discussion 64. [PMID: 12361657 DOI: 10.1016/s0090-3019(02)00730-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We report an unusual case, which may provide insight into the etiology and pathogenesis of dural arteriovenous malformation. CASE DESCRIPTION A 24-year-old woman presented with hemorrhage into a pilocytic astrocytoma of the collicular plate. Angiography was normal and the tumor was surgically resected. She developed sigmoid sinus thrombosis and a transverse/sigmoid sinus dural arteriovenous fistula 11 months after this and was found to have protein S deficiency. The fistula was not treated. Angiography 4 years later was unchanged. CONCLUSION This report illustrates an acquired etiology of a dural arteriovenous fistula. To our knowledge this is the first reported case of postoperative sigmoid sinus thrombosis along with arteriovenous fistula in a patient with previously undetected protein S deficiency.
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Affiliation(s)
- Reza Yassari
- Section of Neurosurgery, Department of Surgery and Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA
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Goddard AJP, Khangure MS. Multiple dural arteriovenous fistulas. Radiologic progression and endovascular cure. Case report. Interv Neuroradiol 2002; 8:183-91. [PMID: 20594527 DOI: 10.1177/159101990200800210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2002] [Accepted: 05/09/2002] [Indexed: 11/16/2022] Open
Abstract
SUMMARY Dural arteriovenous fistulas are most probably acquired lesions. However, they have been rarely encountered de novo.We present a unique case of a 71-year-old woman who initially presented with right-sided dural arteriovenous fistula (DAVF), which spontaneously resolved after diagnostic arteriography. She later developed asymptomatic occlusion of the left transverse sinus. Five years after her initial presentation she developed left-sided pulse-synchronous tinnitus. MRA and catheter angiography showed a complex type IV DAVF between the left transverse sinus and multiple dural branches arising from both left and right external carotid arteries. The left transverse sinus was isolated from the torcula herophili, with stenosis of the sigmoid sinus. Extensive cortical venous drainage was demonstrated. Endovascular cure was effected by polyvinyl alcohol particle and absolute alcohol occlusion of the dominant dural supply, and transvenous coil occlusion of the left transverse sinus. The patient's symptoms resolved almost immediately. This unique case demonstrates that dural sinus occlusion and DAVFs may co-exist, but there may not be a causal relationship. It is likely that both DAVFs and sinus occlusion are manifestations of the same disease process characterised by a pro-thrombotic state and secondary angiogenesis. It is important to recognise that changes in symptomatology, even long after apparent disappearance of a lesion may indicate recurrence, and careful follow up is advocated.
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Affiliation(s)
- A J P Goddard
- Department of Neuroradiology, Royal Perth Hospital, Wellington Street; Perth, Western Australia -
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Singh V, Meyers PM, Halbach VH, Gress DR, Higashida RT, Dowd CF, Smith WS. Dural arteriovenous fistula associated with prothrombin gene mutation. J Neuroimaging 2001; 11:319-21. [PMID: 11462303 DOI: 10.1111/j.1552-6569.2001.tb00055.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
An association between dural arteriovenous fistula and cerebral sinus thrombosis is reported. It is clear in several cases that thrombosis precedes the development of the fistula while it is unclear that it occurs in every case. The authors report a case of a woman with sinus thrombosis and presence of prothrombin gene mutation who subsequently developed a large dural arteriovenous fistula. Various possible factors involved in the pathogenesis of a dural fistula are discussed, with emphasis on underlying thrombophilia and oral contraceptive use in this patient.
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Affiliation(s)
- V Singh
- Department of Neurology, Box 0114, University of California, San Francisco, 505 Parnassus Avenue, M-798, San Francisco, CA 94143-0114, USA.
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Phatouros CC, Halbach VV, Dowd CF, Lempert TE, Malek AM, Meyers PM, Higashida RT. Acquired pial arteriovenous fistula following cerebral vein thrombosis. Stroke 1999; 30:2487-90. [PMID: 10548689 DOI: 10.1161/01.str.30.11.2487] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We report a unique case of an acquired pial arteriovenous fistula occurring after an asymptomatic thrombosis of a superficial cerebral vein. CASE DESCRIPTION A cerebral angiogram performed in a 51-year-old man with subarachnoid hemorrhage revealed a 10-mm ruptured anterior communicating artery aneurysm and a thrombosed left superficial middle cerebral vein. Coil embolization of the anterior communicating aneurysm was performed. Follow-up angiography 18 months later revealed a new, asymptomatic, pial arteriovenous fistula between the previously thrombosed left superficial middle cerebral vein and a small sylvian branch of the left middle cerebral artery. CONCLUSIONS This case provides evidence that pial arteriovenous fistulas may develop as acquired lesions and furthermore may rarely follow cerebral vein thrombosis. Several cases of dural arteriovenous fistulas, as well as a single case of a mixed pial-dural arteriovenous fistula, occurring after dural sinus thrombosis have been reported previously. However, to our knowledge, this is the first report of an acquired pial arteriovenous fistula following a cerebral vein thrombosis.
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Affiliation(s)
- C C Phatouros
- Division of Interventional Neurovascular Radiology, University of California at San Francisco Medical Center 94143-0628, USA.
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