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Yan H, He J, Li A, Wang D, Yao Y, Guo X, Zhang X, Jiang B. Tigroid Enhancement: A Characteristic Enhancement Pattern of the Cerebellar Hemisphere on MRI With Intracranial Dural Arteriovenous Fistulas. J Endovasc Ther 2024:15266028241246646. [PMID: 38624167 DOI: 10.1177/15266028241246646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
PURPOSE This study aims to investigate a characteristic cerebellar hemisphere enhancement pattern on magnetic resonance imaging (MRI) that could aid in early and specific diagnosis of intracranial dural arteriovenous fistulas (DAVFs). MATERIALS AND METHODS Pretreatment MR images of 57 patients with intracranial DAVFs between January 1, 2017, and February 28, 2023, were retrospectively analyzed. A total of 128 patients with confirmed alternative cerebellar lesions during the same period were included as a control group. All patients underwent enhanced MRI with a 3.0T scanner. The presence or absence of parallel enhanced linear striations on the surface of the cerebellar lesions was documented. Statistically significant differences were determined by the Fisher exact test. RESULTS Cerebellar lesions were identified in 4 intracranial DAVF patients (7.0%). All 4 patients were male, with an average age of 64 years (range: 58-76 years). The pretreatment MR images of all 4 DAVF patients with cerebellar lesions demonstrated the characteristic tigroid enhancement pattern. Tortuous flow voids were present in the MR images of 3 of the 4 patients. Tigroid enhancement pattern was not observed in the remaining 53 intracranial DAVF patients and all control patients. The differences in the incidence of the pattern were significant (p=0.01). CONCLUSION A characteristic tigroid enhancement pattern of the cerebellar hemisphere on MRI may aid in the early and specific diagnosis of intracranial DAVFs, allowing timely treatment and improving outcomes. CLINICAL IMPACT The identification of a characteristic tigroid enhancement pattern on MRI for cerebellar hemisphere lesions holds significant promise for clinical practice. This pattern serves as a distinctive marker aiding in the early and specific diagnosis of intracranial dural arteriovenous fistulas (DAVFs). Clinicians can now utilize this innovative finding to expedite diagnostic workflows, enabling timely intervention and management strategies. The incorporation of this novel imaging feature enhances diagnostic accuracy, potentially reducing misdiagnosis rates and preventing delays in treatment initiation. Ultimately, this advancement may lead to improved patient outcomes and quality of care in neurosurgical and neuroradiological practice.
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Affiliation(s)
- Hua Yan
- Department of Gastroenterology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Jingzhen He
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Anning Li
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Dawei Wang
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Yuan Yao
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Xiaoqin Guo
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Xiaoming Zhang
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Baodong Jiang
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
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Overview of multimodal MRI of intracranial Dural arteriovenous fistulas. J Interv Med 2022; 5:173-179. [DOI: 10.1016/j.jimed.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022] Open
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Risk Factors of Aggressive Clinical Presentation in Patients with Angiographically Aggressive Cranial Dural Arteriovenous Fistulas. J Clin Med 2021; 10:jcm10245835. [PMID: 34945132 PMCID: PMC8703894 DOI: 10.3390/jcm10245835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022] Open
Abstract
Compared to nonaggressive cranial dural arteriovenous fistulae (cDAVF), aggressive cDAVF carries leptomeningeal venous drainage (LVD) and has approximately 15% annual risk of hemorrhagic and non-hemorrhagic aggressive neurological presentations. In terms of aggressive clinical presentations, the previous classification does not adequately differentiate the higher risk group from the lower risk group. Herein, we retrospectively collected a series of patients with aggressive cDAVF and explored the risk factors for differentiating the higher-risk group from the lower-risk group with aggressive clinical presentations. We retrospectively collected patients with aggressive cDAVF from March 2011 to March 2019. The risk of aggressive clinical presentation was recorded. Risk factors were included in the analysis for aggressive clinical presentations. From March 2011 to March 2019, 37 patients had aggressive cDAVF. Among them, 24 presented with aggressive clinical presentation (20, hemorrhagic presentation; four, non-hemorrhagic presentation). In patients presenting with hemorrhage, four patients experienced early rebleeding after diagnosis. In the univariate analysis, risk location, directness of LVD, exclusiveness of LVD, and venous strain were significantly different in patients with aggressive clinical presentation. In the multivariate analysis, exclusiveness of LVD and venous strain were observed, with a significant difference between patients with aggressive clinical presentation and those with benign clinical presentation. Among patients with angiographically aggressive cDAVFs, approximately 65% presented with aggressive clinical presentations in our series. Among all potential risk factors, patients with exclusiveness of LVD and venous strain have even higher risk and should be treated aggressively and urgently.
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Rare occurrence of dural arteriovenous fistula in a child: Multi-modality imaging and literature review. Radiol Case Rep 2021; 16:879-883. [PMID: 33552345 PMCID: PMC7850937 DOI: 10.1016/j.radcr.2021.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
A dural arteriovenous fistula (AVF) is a rare condition in a child and is not evident clinically. It is a type of an acquired cerebral vascular malformation that usually occurs after a thrombotic event of the cerebral venous sinuses. Dural AVF is not suspected clinically and is revealed through imaging done for evaluation of cranial symptoms. Therefore, it is essential to revisit the pathophysiology and the clinical situations leading to intracranial dural AVF. Equally crucial is identifying the imaging findings on computed tomography, or magnetic resonance imaging brain scans done as a preliminary work-up in these patients. However, for optimal management decision and prognostication of dural AVF, a digital subtraction angiography is essential. As the entire burden of establishing the diagnosis rests on the radiologists, we would like to present this rare case report highlighting both the clinical and imaging aspects and the management options available for dural AVFs.
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Melo Neto JFD, Pelinca da Costa EE, Pinheiro Junior N, Batista AL, Rodesch G, Bracard S, Oliveira AG. Cerebral venous drainage in patients with dural arteriovenous fistulas: correlation with clinical presentation. J Neurosurg 2020; 135:440-448. [PMID: 33186916 DOI: 10.3171/2020.6.jns20922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dural arteriovenous fistulas (DAVFs) are abnormal, acquired arteriovenous connections within the dural leaflets. Their associated symptoms may be mild or severe and are related to the patient's venous anatomy. With the hypothesis that the patient's venous anatomy determines the development of symptoms, the authors aimed to identify which venous anatomy elements are important in the development of major symptoms in patients with a DAVF. METHODS A multicenter study was performed based on the retrospective analysis of cerebral angiographies with systematic assessment of brain drainage pathways (including fistula drainage) in patients over 18 years of age with a single DAVF. The patients were divided into two groups: those with minor (group 1, n = 112) and those with major (group 2, n = 89) symptoms. Group 2 was subdivided into two groups: patients with hemorrhage (group 2a, n = 47) and patients with severe nonhemorrhagic symptoms (group 2b, n = 42). RESULTS The prevalence of stenosis in DAVF venous drainage and the identification of tiny anastomoses between venous territories were significantly higher in group 2 (32.6% and 19.1%, respectively) compared with group 1 (2.68% and 5.36%, respectively). Stenosis of DAVF venous drainage was significantly more frequent in group 2a than in group 2b (51.1% vs 11.9%, p < 0.001). Group 2b patients had increased prevalence of shared use of the cerebral main drainage pathway (85.0% vs 53.2%, p = 0.002), the absence of an alternative route (45.0% vs 17.0%, p = 0.004), and the presence of contrast stagnation (62.5% vs 29.8%, p = 0.002) compared with group 2a patients. In patients with high-grade fistulas, the group with major symptoms had increased prevalence of a single draining direction (31.3% vs 8.33%, p = 0.003), stenosis in the draining vein (35.0% vs 6.25%, p = 0.000), the absence of an alternative pathway for brain drainage (31.3% vs 12.5%, p = 0.017), and the presence of contrast stagnation (48.8% vs 22.9%, p = 0.004). CONCLUSIONS Major symptoms were observed when normal brain tissue venous drainage was impaired by competition with DAVF (predominance in group 2b) or when DAVF venous drainage had anatomical characteristics that hindered drainage, with consequent venous hypertension on the venous side of the DAVF (predominance in group 2a). The same findings were observed when comparing two groups of patients with high-grade lesions: those with major versus those with minor symptoms.
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Affiliation(s)
- João Ferreira de Melo Neto
- 1Department of Neurosurgery, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal/RN, Brazil
| | - Eduardo E Pelinca da Costa
- 1Department of Neurosurgery, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal/RN, Brazil
| | - Nilson Pinheiro Junior
- 1Department of Neurosurgery, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal/RN, Brazil
| | - André L Batista
- 1Department of Neurosurgery, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal/RN, Brazil
| | - Georges Rodesch
- 2Department of Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Serge Bracard
- 3Department of Diagnostic and Interventional Neuroradiology, Université de Lorraine, Inserm, IADI, CHRU Nancy, France; and
| | - Antônio G Oliveira
- 4Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal/RN, Brazil
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Lubicz B, Christiaens F. Endovascular treatment of intracranial vascular malformations in children. Dev Med Child Neurol 2020; 62:1124-1130. [PMID: 32533582 DOI: 10.1111/dmcn.14589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
Paediatric intracranial vascular malformations are rare and different from adult ones in vascular anatomy, pathophysiology, and symptoms. Their impact on the brain and their symptoms will differ in the antenatal period, in neonates, infants, and children. Clinical presentation includes seizures, focal neurological deficit, haemorrhage, congestive heart failure, hydrovenous disorder, and developmental delays. These malformations are thus associated with a poor prognosis if left untreated. Therefore, aggressive management is generally recommended and must be performed by a multidisciplinary team with extensive experience. Endovascular treatment is the first-choice treatment for most paediatric intracranial vascular malformations. Indication and timing for treatment should be decided on the basis of a careful assessment of neurological symptoms, growth and development, cardiac and other systemic manifestations, and imaging of the malformation and the brain tissue. WHAT THIS PAPER ADDS: Paediatric intracranial vascular malformations are rare, but their prognosis is poor if left untreated. Improved clinical, anatomical, and pathophysiological understanding of these complex lesions has improved prognosis.
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Affiliation(s)
- Boris Lubicz
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Florence Christiaens
- Department of Pediatric Neurology, Erasme University Hospital, Brussels, Belgium
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Hori S, Shimo D, Bando T, Mikami K, Yasuda T, Kuroyama T, Hirai O, Ueno Y. Fatal Hemorrhage Immediately after Transvenous Embolization of Transverse-sigmoid Sinus Dural Arteriovenous Fistulas: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:319-325. [PMID: 37502171 PMCID: PMC10370603 DOI: 10.5797/jnet.cr.2019-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/22/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a case of intracerebral hemorrhage following emergency transvenous embolization for an acute symptomatic non-hemorrhagic dural arteriovenous fistula (dAVF). Case Presentation An 83-year-old woman demonstrated gait disorder and disturbance of consciousness. A transverse-sigmoid dAVF with retrograde deep venous drainage was detected on DSA. The left sigmoid sinus-jugular vein and the sinus confluence were occluded and the dAVF drains via the straight sinus (SS), medial superior cerebral veins and deep veins to the superior sagittal sinus (SSS). The dAVF was emergently treated by sinus packing of the transverse-sigmoid sinus with coils with contralateral approach via the occluded sinus confluence. Although the dAVF was markedly regressed, massive cerebral hemorrhage developed in the left parietal lobe immediately after embolization. Conclusion Although early treatment is required for dAVFs with aggressive symptoms, precious evaluation of their hemodynamics, particularly for drainage pattern, is mandatory to avoid a serious complication.
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Affiliation(s)
- Shinya Hori
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | - Daisuke Shimo
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | - Toshiaki Bando
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | - Kazuyuki Mikami
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | - Takaya Yasuda
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | | | - Osamu Hirai
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | - Yasushi Ueno
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
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Padilha IG, Pacheco FT, Araujo AIR, Nunes RH, Baccin CE, Conti MLM, Maia ACM, Rocha AJD. Tips and tricks in the diagnosis of intracranial dural arteriovenous fistulas: A pictorial review. J Neuroradiol 2019; 47:369-381. [PMID: 31279838 DOI: 10.1016/j.neurad.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/25/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) are complex vascular abnormalities that account for 10-15% of intracranial vascular malformations. DAVFs are typically encountered in middle-aged adults, with a slightly female predominance. The causative factors are still uncertain; however, abnormal local hemodynamics and neoangiogenesis related to dural sinus or venous thrombosis can contribute to DAVF occurrence. The diagnosis is dependent on a high level of clinical suspicion and high-resolution imaging techniques. Computed tomography and/or magnetic resonance imaging aid in the diagnosis, but conventional angiography remains the most accurate method for the complete characterization and classification of DAVFs. The therapeutic approach can be conservative or more aggressive, based on symptom severity, sequelae risk and patient characteristics. This article is a pictorial review of adult intracranial DAVFs that highlights some tips and tricks for recognizing useful red flags in the suspicion of DAVFs.
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Affiliation(s)
- Igor Gomes Padilha
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil.
| | - Felipe Torres Pacheco
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
| | - Alan Iuno Rios Araujo
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
| | - Renato Hoffmann Nunes
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
| | - Carlos Eduardo Baccin
- Division of Interventional Neuroradiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, 05652-900 Sao Paulo SP, Brazil
| | - Mario Luiz Marques Conti
- Division of Interventional Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil
| | - Antônio Carlos Martins Maia
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Fleury Medicina e Saúde, Rua Cincinato Braga, 282 - Bela Vista, 01333-910 Sao Paulo SP, Brazil
| | - Antônio José da Rocha
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
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Eskey CJ, Meyers PM, Nguyen TN, Ansari SA, Jayaraman M, McDougall CG, DeMarco JK, Gray WA, Hess DC, Higashida RT, Pandey DK, Peña C, Schumacher HC. Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e661-e689. [PMID: 29674324 DOI: 10.1161/cir.0000000000000567] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intracranial endovascular interventions provide effective and minimally invasive treatment of a broad spectrum of diseases. This area of expertise has continued to gain both wider application and greater depth as new and better techniques are developed and as landmark clinical studies are performed to guide their use. Some of the greatest advances since the last American Heart Association scientific statement on this topic have been made in the treatment of ischemic stroke from large intracranial vessel occlusion, with more effective devices and large randomized clinical trials showing striking therapeutic benefit. The treatment of cerebral aneurysms has also seen substantial evolution, increasing the number of aneurysms that can be treated successfully with minimally invasive therapy. Endovascular therapies for such other diseases as arteriovenous malformations, dural arteriovenous fistulas, idiopathic intracranial hypertension, venous thrombosis, and neoplasms continue to improve. The purpose of the present document is to review current information on the efficacy and safety of procedures used for intracranial endovascular interventional treatment of cerebrovascular diseases and to summarize key aspects of best practice.
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LaHue SC, Kim H, Pawlikowska L, Nelson J, Cooke DL, Hetts SW, Singh V. Frequency and characteristics associated with inherited thrombophilia in patients with intracranial dural arteriovenous fistula. J Neurosurg 2018:1-5. [PMID: 29624150 DOI: 10.3171/2017.10.jns171987] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 10/16/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe pathogenesis of dural arteriovenous fistulas (DAVFs) remains poorly defined. Prior studies on thrombophilia as a risk factor for DAVF development are limited by small sample sizes and poor generalizability.METHODSIn this longitudinal observational study, all patients with intracranial DAVFs evaluated at the University of California, San Francisco from December 1994 through April 2014 were identified. After obtaining patient consent, 3 thrombophilic mutations, factor V Leiden (rs6025), MTHFR (rs1801133), and prothrombin G20210A, were genotyped. The authors evaluated the association of thrombophilia status (presence of any thrombophilic mutation) and clinical and angiographic characteristics using either a 2-sample t-test or Fisher's exact test.RESULTSA total of 116 patients with diagnosed intracranial DAVFs were included in the study. Twenty-five (22%) patients met criteria for thrombophilia. Focal neurological deficits tended to occur more frequently in the thrombophilia group (78% vs 57%, p = 0.09). Angiographic characteristics of DAVFs, including high-risk venous flow pattern, multiplicity of DAVF, and the presence of venous sinus thrombosis, did not differ significantly between the 2 groups but tended to be more common in the thrombophilic than in the nonthrombophilic group.CONCLUSIONSThis study is one of the largest of thrombophilia and DAVF to date. The frequency of mutations associated with thrombophilia in this study was higher than that in the general population.
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Affiliation(s)
- Sara C LaHue
- 1Department of Neurology.,2Department of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Helen Kim
- 3Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care.,4Institute for Human Genetics; and
| | - Ludmila Pawlikowska
- 3Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care.,4Institute for Human Genetics; and
| | - Jeffrey Nelson
- 3Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care
| | - Daniel L Cooke
- 5Department of Radiology and Biomedical Imaging, University of California, San Francisco; and
| | - Steven W Hetts
- 5Department of Radiology and Biomedical Imaging, University of California, San Francisco; and
| | - Vineeta Singh
- 1Department of Neurology.,2Department of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, California
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Hetts SW, Yen A, Cooke DL, Nelson J, Jolivalt P, Banaga J, Amans MR, Dowd CF, Higashida RT, Lawton MT, Kim H, Halbach VV. Pial Artery Supply as an Anatomic Risk Factor for Ischemic Stroke in the Treatment of Intracranial Dural Arteriovenous Fistulas. AJNR Am J Neuroradiol 2017; 38:2315-2320. [PMID: 28970244 DOI: 10.3174/ajnr.a5396] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 08/03/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although intracranial dural arteriovenous fistulas are principally supplied by dural branches of the external carotid, internal carotid, and vertebral arteries, they can also be fed by pial arteries that supply the brain. We sought to determine the frequency of neurologic deficits following treatment of intracranial dural arteriovenous fistulas with and without pial artery supply. MATERIALS AND METHODS One hundred twenty-two consecutive patients who underwent treatment for intracranial dural arteriovenous fistulas at our hospital from 2008 to 2015 were retrospectively reviewed. Patient data were examined for posttreatment neurologic deficits; patients with such deficits were evaluated for imaging evidence of cerebral infarction. Data were analyzed with multivariable logistic regression. RESULTS Of 122 treated patients, 29 (23.8%) had dural arteriovenous fistulas with pial artery supply and 93 (76.2%) had dural arteriovenous fistulas without pial arterial supply. Of patients with pial artery supply, 4 (13.8%) had posttreatment neurologic deficits, compared with 2 patients (2.2%) without pial artery supply (P = .04). Imaging confirmed that 3 patients with pial artery supply (10.3%) had cerebral infarcts, compared with only 1 patient without pial artery supply (1.1%, P = .03). Increasing patient age was also positively associated with pial supply and treatment-related complications. CONCLUSIONS Patients with dural arteriovenous fistulas supplied by the pial arteries were more likely to experience posttreatment complications, including ischemic strokes, than patients with no pial artery supply. The approach to dural arteriovenous fistula treatment should be made on a case-by-case basis so that the risk of complications can be minimized.
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Affiliation(s)
- S W Hetts
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.)
| | - A Yen
- School of Medicine (A.Y., J.B.)
| | - D L Cooke
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.)
| | - J Nelson
- Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.)
| | - P Jolivalt
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.).,Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.)
| | | | - M R Amans
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.)
| | - C F Dowd
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.).,Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.).,Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.).,Neurology (C.F.D., R.T.H., V.V.H.), University of California, San Francisco, San Francisco, California
| | - R T Higashida
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.).,Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.).,Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.).,Neurology (C.F.D., R.T.H., V.V.H.), University of California, San Francisco, San Francisco, California
| | - M T Lawton
- Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.)
| | - H Kim
- Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.)
| | - V V Halbach
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.).,Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.).,Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.).,Neurology (C.F.D., R.T.H., V.V.H.), University of California, San Francisco, San Francisco, California
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Grady C, Gesteira Benjamin C, Kondziolka D. Radiosurgery for dural arteriovenous malformations. HANDBOOK OF CLINICAL NEUROLOGY 2017; 143:125-131. [PMID: 28552134 DOI: 10.1016/b978-0-444-63640-9.00012-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Intracranial dural arteriovenous malformations (DAVFs) are relatively uncommon vascular lesions characterized by the direct connection of dural arteries into dural venous sinuses or leptomeningeal veins. Strategies for the treatment of these complex lesions have evolved significantly over the past three decades, and include open surgical disconnection, endovascular embolization, stereotactic radiosurgery (SRS), or a combination of these approaches. Radiosurgical intervention is unique in offering significant benefits to patients while exposing them to few of the risks associated with more invasive interventions. In this chapter we provide an overview of DAVFs and discuss the features of these lesions that affect management. We focus, in particular, on radiosurgical management of these lesions, describing present treatment paradigms, the procedure for the treatment of DAVFs with SRS, and expected clinical outcomes using SRS.
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Affiliation(s)
- Conor Grady
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | | | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA; Center for Advanced Radiosurgery, NYU Langone Medical Center, New York, NY, USA.
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Hetts SW, Moftakhar P, Maluste N, Fullerton HJ, Cooke DL, Amans MR, Dowd CF, Higashida RT, Halbach VV. Pediatric intracranial dural arteriovenous fistulas: age-related differences in clinical features, angioarchitecture, and treatment outcomes. J Neurosurg Pediatr 2016; 18:602-610. [PMID: 27540826 DOI: 10.3171/2016.5.peds15740] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial dural arteriovenous fistulas (DAVFs) are rare in children. This study sought to better characterize DAVF presentation, angioarchitecture, and treatment outcomes. METHODS Children with intracranial DAVFs between 1986 and 2013 were retrospectively identified from the neurointerventional database at the authors' institution. Demographics, clinical presentation, lesion angioarchitecture, treatment approaches, angiographic outcomes, and clinical outcomes were assessed. RESULTS DAVFs constituted 5.7% (22/423) of pediatric intracranial arteriovenous shunting lesions. Twelve boys and 10 girls presented between 1 day and 18 years of age; boys presented at a median of 1.3 years and girls presented at a median of 4.9 years. Four of 8 patients ≤ 1 year of age presented with congestive heart failure compared with 0/14 patients > 1 year of age (p = 0.01). Five of 8 patients ≤ 1 year old presented with respiratory distress compared with 0/14 patients > 1 year old (p = 0.0021). Ten of 14 patients > 1 year old presented with focal neurological deficits compared with 0/8 patients ≤ 1 year old (p = 0.0017). At initial angiography, 16 patients harbored a single intracranial DAVF and 6 patients had 2-6 DAVFs. Eight patients (38%) experienced DAVF obliteration by the end of treatment. Good clinical outcome (modified Rankin Scale score 0-2) was documented in 77% of patients > 1 year old at presentation compared with 57% of patients ≤ 1 year old at presentation. Six patients (27%) died. CONCLUSIONS Young children with DAVFs presented predominantly with cardiopulmonary symptoms, while older children presented with focal neurological deficits. Compared with other pediatric vascular shunts, DAVFs had lower rates of angiographic obliteration and poorer clinical outcomes.
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Affiliation(s)
| | | | - Neil Maluste
- Department of Neurology, University of California, Los Angeles, California
| | | | | | | | - Christopher F Dowd
- Departments of 1 Radiology and Biomedical Imaging.,Neurology.,Neurological Surgery, and.,Anesthesia and Perioperative Care, University of California, San Francisco; and
| | - Randall T Higashida
- Departments of 1 Radiology and Biomedical Imaging.,Neurology.,Neurological Surgery, and.,Anesthesia and Perioperative Care, University of California, San Francisco; and
| | - Van V Halbach
- Departments of 1 Radiology and Biomedical Imaging.,Neurology.,Neurological Surgery, and.,Anesthesia and Perioperative Care, University of California, San Francisco; and
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