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Ibn Essayed W, Bernstock JD, Chen JA, Kappel AD, Ng PR, Du R. Cavernous venous malformations in and around the central nervous system. Part 1: Dural and extradural. J Neurosurg 2024; 140:735-745. [PMID: 37877991 DOI: 10.3171/2023.6.jns222878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/06/2023] [Indexed: 10/26/2023]
Abstract
Cavernous-type malformations are venous lesions that occur in multiple locations throughout the body, and when present in the CNS, they have canonically been referred to as cavernomas, cavernous angiomas, and cerebral cavernous malformations. Herein all these lesions are referred to as "cavernous venous malformations" (CavVMs), which is congruent with the current International Society for the Study of Vascular Anomalies classification system. Even though histologically similar, depending on their location relative to the dura mater, these malformations can have different features. In Part 1 of this review, the authors discuss and review pertinent clinical knowledge with regard to CavVMs as influenced by anatomical location, starting with the dural and extradural malformations. They particularly emphasize dural CavVMs (including those in the cavernous sinus), orbital CavVMs, and spinal CavVMs. The genetic and histopathological features of CavVMs in these locations are reviewed, and commonalities in their presumed mechanisms of pathogenesis support the authors' conceptualization of a spectrum of a single disease entity. Illustrative cases for each subtype are presented, and the pathophysiological and genetic features linking dural and extradural to intradural CavVMs are examined. A new classification is proposed to segregate CavVMs based on the location from which they arise, which guides their natural history and treatment.
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2
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López-Millán JM, Fernández AO, Fernández JM, Dueñas Díez JL. Differential efficacy with epi dural blood and fibrin patches for the treatment of post-dural puncture headache. Pain Pract 2024; 24:440-448. [PMID: 37970746 DOI: 10.1111/papr.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Accidental dural puncture (ADP) is the most frequent major complication when performing an epidural procedure in obstetrics. Consequently, loss of pressure in the cerebrospinal fluid (CSF) leads to the development of post-dural puncture headache (PDPH), which occurs in 16%-86% of cases. To date, the efficacy of epidural fibrin patches (EFP) has not been evaluated in a controlled clinical trial, nor in comparative studies with epidural blood patches (EBP). METHODS The objective of the present study was to compare the efficacy of EFP with respect to EBP for the treatment of refractory accidental PDPH. This prospective, randomized, open-label, parallel, comparative study included 70 puerperal women who received an EBP or EFP (35 in each group) after failure of the conventional analgesic treatment for accidental PDPH in a hospital. RESULTS A higher percentage of women with EFP than EBP achieved complete PDPH relief after 2 (97.1% vs. 54.3%) and 12 h (100.0% vs. 65.7%) of the patch injection. The percentage of patients who needed rescue analgesia was significantly lower with EFP after 2 (2.9% vs. 48.6%) and 12 h (0.0% vs. 37.1%). After 24 h, PDPH was resolved in all women who received EFP. The recurrence of PDPH was reported in one woman from the EBP group (2.9%), who subsequently required a second patch. The mean length of hospital stay was significantly lower with EFP (3.9 days) than EBP (5.9 days). Regarding satisfaction, the mean value (Likert scale) was significantly higher with EFP (4.7 vs. 3.0). CONCLUSIONS EFP provided better outcomes than EBP for the treatment of obstetric PDPH in terms of efficacy, safety, and patient satisfaction.
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Affiliation(s)
- José M López-Millán
- Department of Anesthesia, Critical Care and Pain Treatment; Department of Surgery, Virgen Macarena Hospital; University of Seville, Seville, Spain
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Essibayi MA, Vaishnav D, Holland R, Altschul DJ. Balloon-assisted U-turn Technique to Access Cortical Vein for Transvenous Embolization of Mixed Dural-pial Arteriovenous Malformation. Interv Neuroradiol 2024:15910199231226288. [PMID: 38225178 DOI: 10.1177/15910199231226288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Cerebral arteriovenous malformations can be classified into pure pial, mixed dural-pial, and pure dural types. Mixed pial-dural AVMs (DPAVM) are rare and often receive blood supply from dural meningeal arteries, including branches of the internal carotid, external carotid, and vertebral arteries.1- 6 DPAVMs, which are usually large and complex, require delicate endovascular and surgical treatment methods. The cure rate is low, and recurrence is very common, leading to high morbidity and mortality. In this case video, we present a case of PDAVM that recurred after initial endovascular onyx embolization, requiring additional endovascular coiling which resulted in obliteration of the DPAVM.
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Affiliation(s)
- Muhammed Amir Essibayi
- Department of Neurological Surgery & Montefiore Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dhrumil Vaishnav
- Department of Neurological Surgery & Montefiore Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan Holland
- Department of Neurological Surgery & Montefiore Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David J Altschul
- Department of Neurological Surgery & Montefiore Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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4
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Przepiorka L, Wójtowicz K, Camlet K, Jankowski J, Kujawski S, Grabowska-Derlatka L, Marchel A, Kunert P. Postoperative Cerebral Venous Sinus Thrombosis Following a Retrosigmoid Craniotomy-A Clinical and Radiological Analysis. Brain Sci 2023; 13:1039. [PMID: 37508971 PMCID: PMC10377583 DOI: 10.3390/brainsci13071039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Postoperative cerebral venous sinus thrombosis (CVST) is a rare complication of the retrosigmoid approach. To address the lack of literature, we performed a retrospective analysis. The thromboses were divided into those demonstrating radiological (rCVST) and clinical (cCVST) features, the latter diagnosed during hospitalization. We identified the former by a lack of contrast in the sigmoid (SS) or transverse sinuses (TS), and evaluated the closest distance from the craniotomy to quantify sinus exposure. We included 130 patients (males: 52, females: 78) with a median age of 46.0. They had rCVST in 46.9% of cases, most often in the TS (65.6%), and cCVST in 3.1% of cases. Distances to the sinuses were not different regarding the presence of cCVST (p = 0.32 and p = 0.72). The distance to the SS was not different regarding rCVST (p = 0.13). However, lower exposure of the TS correlated with a lower incidence of rCVST (p = 0.009). When surgery was performed on the side of the dominant sinuses, rCVSTs were more frequent (p = 0.042). None of the other examined factors were related to rCVST or cCVST. Surgery on the side of the dominant sinus, and the exposing of them, seems to be related with rCVST. Further prospective studies are needed to identify the risk factors and determine the best management.
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Affiliation(s)
- Lukasz Przepiorka
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Katarzyna Wójtowicz
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Katarzyna Camlet
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Jan Jankowski
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Sławomir Kujawski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, 85-077 Bydgoszcz, Poland
| | | | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warsaw, Poland
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5
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Elhalaby RE, Kavran CA, Vaubel RA, Vizcaino Villalobos MA. Left dural-based mass in a 62-year-old female. Brain Pathol 2023:e13145. [PMID: 36745463 DOI: 10.1111/bpa.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/14/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- Rofyda Essam Elhalaby
- Mayo Clinic, Laboratory medicine and pathology, Rochester, Minnesota, USA.,Pathology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt
| | | | - Rachael Ann Vaubel
- Mayo Clinic, Laboratory medicine and pathology, Rochester, Minnesota, USA
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6
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Banihani M, Malabeh Q, Shawaqfeh J, Khawaldeh M, AlHazaimeh M. Post -contrast Three -dimensional MP RAGE T1WI Sequence Compared to Brain MRV Sequence for Diagnosing Brain Sinus Venous Thrombosis. Acta Inform Med 2023; 32:43-46. [PMID: 38585597 PMCID: PMC10997175 DOI: 10.5455/aim.2024.32.43-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/24/2024] [Indexed: 04/09/2024] Open
Abstract
Background Dural sinus thrombosis is considered as a one of the clinical and radiological emergencies that require special attention and high index of suspicion and needs combined effort of both the treating physician and the radiologist to obtain proper diagnosis and subsequently proper management. Objective The aim of this article was to compare the accuracy of MRV TOF and post contrast MP-RAGE sequences in diagnosis of cerebral sinus venous thrombosis. Methods After all informed consents were obtained and upon ethical committee approval from the ethical committee in Joradanian Royal medical services in Amman we perform this study as a retrospective study done on 50 patients with cerebral sinus venous thrombosis with 50 pateints control group done at king Hussein medical center in Amman Jordan. Results The guidelines and regulations of studies conducted in Royal medical services were followed. 68 females and 32 males with age range between 19 and 52 years. All patients underwent brain MRI for evaluation of cerebral sinus thrombosis, all studies were done on seimens skyra 3 Tesla machine with standardized protocol including 2 D TOF MRV, axial T2WI, axial FLAIR, Axial T1, SWI and diffusion weighted images along with 3D MP-RAGE post contrast. Images were reviewed by two well experienced neuroradiologists (Maysoon and Qamar) in separate sessions, each MRI sequence was reported separately without knowing patients name or clinical history. Conclusion: The results for T2 WI, SWI, MRV TOF and MP-RAGE post contrast were reported. We used a confidence level score to standardize the results. Then the results were analyzed using simple statistical methods.
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Affiliation(s)
- Maysoon Banihani
- Faculty 1Radiology Department at Royal Medical Services, Amman, Jordan
| | - Qamar Malabeh
- Faculty 1Radiology Department at Royal Medical Services, Amman, Jordan
| | - Jameel Shawaqfeh
- Faculty 1Radiology Department at Royal Medical Services, Amman, Jordan
| | - Maher Khawaldeh
- Faculty 1Radiology Department at Royal Medical Services, Amman, Jordan
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Cordeiro NL, Gupta SS, Kanwar A, Bendor-Grynbaum C, Sharma JB. Tuberculous Hypertrophic Pachymeningitis. Cureus 2021; 13:e17570. [PMID: 34513529 PMCID: PMC8405376 DOI: 10.7759/cureus.17570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/12/2021] [Indexed: 11/12/2022] Open
Abstract
Tuberculous pachymeningitis is a rare disease that should be suspected in patients with chronic headaches, focal neurological signs, and magnetic resonance imaging (MRI) findings of dural thickening. We report the case of a 62-year-old male who presented with chronic headaches for over a year, progressive right-sided vision and hearing loss for six months, and progressive dysphagia for a month. On investigation, MRI showed dural thickening, cerebrospinal fluid showed lymphocytic pleocytosis with high protein and normal glucose levels, and biopsy of the dural matter showed necrotizing granulomas with Langhans giant cells. The patient responded well to antitubercular treatment and steroids. Follow-up MRI 24 months later showed almost complete resolution of meningeal enhancement. Though tuberculosis is an uncommon cause of pachymeningitis, it should be considered, as it responds well to treatment.
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Affiliation(s)
| | | | - Anubhav Kanwar
- Infectious Disease, Tri-State Memorial Hospital, Clarkston, USA
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8
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Ahmed G, Sheikh U, Masri S, Joseph J, Sonwalker H. Predominantly Solid Hemangioblastoma Presenting as an Extra-Axial Cerebellopontine Angle Lesion. Cureus 2021; 13:e13071. [PMID: 33680613 PMCID: PMC7932826 DOI: 10.7759/cureus.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hemangioblastomas (HBs) are typically intra-axial, highly vascular tumors of the central nervous system and account for up to 2.5% of all intracranial tumors and up to 12% of posterior fossa neoplasms. Extra-axial HBs are rarely described in the literature. The radiological appearances of cerebellopontine angle (CPA) extra-axial HB can lead to a diagnostic conundrum as they may mimic the appearance of dural metastasis, vestibular schwannoma, or meningioma. Here, we describe a patient who presented with an extra-axial CPA HB and explore the literature of the condition.
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Affiliation(s)
- Gasim Ahmed
- Radiology, Lancashire Teaching Hospital Foundation Trust, Preston, GBR.,Radiology, The Christie NHS Foundation Trust, Manchester, GBR
| | - Usman Sheikh
- Radiology, Lancashire Teaching Hospital Foundation Trust, Preston, GBR
| | - Souhyb Masri
- Radiology, Lancashire Teaching Hospital Foundation Trust, Preston, GBR
| | - Jacob Joseph
- Pathology, Lancashire Teaching Hospital Foundation Trust, Preston, GBR
| | - Hemant Sonwalker
- Radiology, Lancashire Teaching Hospital Foundation Trust, Preston, GBR
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9
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Starke RM, McCarthy DJ, Chen CJ, Kano H, McShane B, Lee J, Mathieu D, Vasas LT, Kaufmann AM, Wang WG, Grills IS, Patibandla MR, Cifarelli CP, Paisan G, Vargo JA, Chytka T, Janouskova L, Feliciano CE, Rodriguez-Mercado R, Tonetti DA, Lunsford LD, Sheehan JP. Evaluation of stereotactic radiosurgery for cerebral dural arteriovenous fistulas in a multicenter international consortium. J Neurosurg 2020; 132:114-121. [PMID: 30611144 DOI: 10.3171/2018.8.jns181467] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/16/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In this multicenter study, the authors reviewed the results obtained in patients who underwent Gamma Knife radiosurgery (GKRS) for dural arteriovenous fistulas (dAVFs) and determined predictors of outcome. METHODS Data from a cohort of 114 patients who underwent GKRS for cerebral dAVFs were compiled from the International Gamma Knife Research Foundation. Favorable outcome was defined as dAVF obliteration and no posttreatment hemorrhage or permanent symptomatic radiation-induced complications. Patient and dAVF characteristics were assessed to determine predictors of outcome in a multivariate logistic regression analysis; dAVF-free obliteration was calculated in a competing-risk survival analysis; and Youden indices were used to determine optimal radiosurgical dose. RESULTS A mean margin dose of 21.8 Gy was delivered. The mean follow-up duration was 4 years (range 0.5-18 years). The overall obliteration rate was 68.4%. The postradiosurgery actuarial rates of obliteration at 3, 5, 7, and 10 years were 41.3%, 61.1%, 70.1%, and 82.0%, respectively. Post-GRKS hemorrhage occurred in 4 patients (annual risk of 0.9%). Radiation-induced imaging changes occurred in 10.4% of patients; 5.2% were symptomatic, and 3.5% had permanent deficits. Favorable outcome was achieved in 63.2% of patients. Patients with middle fossa and tentorial dAVFs (OR 2.4, p = 0.048) and those receiving a margin dose greater than 23 Gy (OR 2.6, p = 0.030) were less likely to achieve a favorable outcome. Commonly used grading scales (e.g., Borden and Cognard) were not predictive of outcome. Female sex (OR 1.7, p = 0.03), absent venous ectasia (OR 3.4, p < 0.001), and cavernous carotid location (OR 2.1, p = 0.019) were predictors of GKRS-induced dAVF obliteration. CONCLUSIONS GKRS for cerebral dAVFs achieved obliteration and avoided permanent complications in the majority of patients. Those with cavernous carotid location and no venous ectasia were more likely to have fistula obliteration following radiosurgery. Commonly used grading scales were not reliable predictors of outcome following radiosurgery.
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Affiliation(s)
- Robert M Starke
- 1Department of Neurological Surgery, University of Miami, Florida
| | - David J McCarthy
- 1Department of Neurological Surgery, University of Miami, Florida
| | - Ching-Jen Chen
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Hideyuki Kano
- 3Department of Neurological Surgery, University of Pittsburgh
| | - Brendan McShane
- 4Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Lee
- 4Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Mathieu
- 5Department of Neurological Surgery, University of Sherbrooke, Quebec
| | - Lucas T Vasas
- 6Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada
| | - Anthony M Kaufmann
- 6Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada
| | - Wei Gang Wang
- 7Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Inga S Grills
- 7Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Mohana Rao Patibandla
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Gabriella Paisan
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - John A Vargo
- 9Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Tomas Chytka
- 10Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic; and
| | - Ladislava Janouskova
- 10Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic; and
| | - Caleb E Feliciano
- 11Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | | | | | - L Dade Lunsford
- 3Department of Neurological Surgery, University of Pittsburgh
| | - Jason P Sheehan
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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10
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Zhang CW, Fu W, Richard SA, Xie XD. Obstructive hydrocephalus associated with spontaneous dural arteriovenous fistula: A case report. Medicine (Baltimore) 2019; 98:e15026. [PMID: 30946337 PMCID: PMC6456206 DOI: 10.1097/md.0000000000015026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Dural arteriovenous fistulae (DAVF) are vascular disorders depicted with direct interconnection between dural arteries and cerebral venous sinuses and/or cortical veins. Only a hand full of cases have been reported in literature. DAVF obstructing the 3rd ventricle and quadrigeminal cistern resulting in hydrocephalus is very rare. PATIENT CONCERNS We present a 55-year-old female with 2 years history of headaches and blurring of vision. Cranial nerves examinations were unremarkable. DIAGNOSES Magnetic Resonance Imaging (MRI) and digital subtraction angiography showed multiple tortuous vascular malformation in the 3rd ventricle and quadrigeminal cistern resulting in obstructive hydrocephalus (OHC). INTERVENTIONS We utilized endovascular embolization treatment option to obliterate the lesion. We used Onyx embolization agent (ev3 Neurovascular, Irvine, CA) to embolize the lesion via the transarterial route. OUTCOMES The OHC resolved spontaneously after the endovascular embolization of the DAVF. The patient recovered with no further neurologic complication. Two years follow-up reveal no recurrence of the DAVF as well as hydrocephalus. LESSONS Adequate knowledge on the vascular anatomy is very crucial in managing DAVF.
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Affiliation(s)
- Chang Wei Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Fu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Medicine, Princefield University, Ghana, West Africa
| | - Xiao Dong Xie
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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11
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Starke RM, McCarthy DJ, Chen CJ, Kano H, McShane BJ, Lee J, Patibandla MR, Mathieu D, Vasas LT, Kaufmann AM, Wang WG, Grills IS, Cifarelli CP, Paisan G, Vargo J, Chytka T, Janouskova L, Feliciano CE, Sujijantarat N, Matouk C, Chiang V, Hess J, Rodriguez-Mercado R, Tonetti DA, Lunsford LD, Sheehan JP. Hemorrhage risk of cerebral dural arteriovenous fistulas following Gamma Knife radiosurgery in a multicenter international consortium. J Neurosurg 2019; 132:1209-1217. [PMID: 30875690 DOI: 10.3171/2018.12.jns182208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/12/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The authors performed a study to evaluate the hemorrhagic rates of cerebral dural arteriovenous fistulas (dAVFs) and the risk factors of hemorrhage following Gamma Knife radiosurgery (GKRS). METHODS Data from a cohort of patients undergoing GKRS for cerebral dAVFs were compiled from the International Radiosurgery Research Foundation. The annual posttreatment hemorrhage rate was calculated as the number of hemorrhages divided by the patient-years at risk. Risk factors for dAVF hemorrhage prior to GKRS and during the latency period after radiosurgery were evaluated in a multivariate analysis. RESULTS A total of 147 patients with dAVFs were treated with GKRS. Thirty-six patients (24.5%) presented with hemorrhage. dAVFs that had any cortical venous drainage (CVD) (OR = 3.8, p = 0.003) or convexity or torcula location (OR = 3.3, p = 0.017) were more likely to present with hemorrhage in multivariate analysis. Half of the patients had prior treatment (49.7%). Post-GRKS hemorrhage occurred in 4 patients, with an overall annual risk of 0.84% during the latency period. The annual risks of post-GKRS hemorrhage for Borden type 2-3 dAVFs and Borden type 2-3 hemorrhagic dAVFs were 1.45% and 0.93%, respectively. No hemorrhage occurred after radiological confirmation of obliteration. Independent predictors of hemorrhage following GKRS included nonhemorrhagic neural deficit presentation (HR = 21.6, p = 0.027) and increasing number of past endovascular treatments (HR = 1.81, p = 0.036). CONCLUSIONS Patients have similar rates of hemorrhage before and after radiosurgery until obliteration is achieved. dAVFs that have any CVD or are located in the convexity or torcula were more likely to present with hemorrhage. Patients presenting with nonhemorrhagic neural deficits and a history of endovascular treatments had higher risks of post-GKRS hemorrhage.
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Affiliation(s)
- Robert M Starke
- 1Department of Neurological Surgery, University of Miami, Florida
| | - David J McCarthy
- 1Department of Neurological Surgery, University of Miami, Florida
| | - Ching-Jen Chen
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Hideyuki Kano
- 3Department of Neurological Surgery, University of Pittsburgh
| | - Brendan J McShane
- 4Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Lee
- 4Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mohana Rao Patibandla
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - David Mathieu
- 5Department of Neurological Surgery, University of Sherbrooke, Quebec, Canada
| | - Lucas T Vasas
- 6Department of Neurological Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony M Kaufmann
- 6Department of Neurological Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Wei Gang Wang
- 7Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Inga S Grills
- 7Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | | | - Gabriella Paisan
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - John Vargo
- 9Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Tomas Chytka
- 10Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Ladislava Janouskova
- 10Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Caleb E Feliciano
- 11Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico; and
| | - Nanthiya Sujijantarat
- 12Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Charles Matouk
- 12Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Veronica Chiang
- 12Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Judith Hess
- 12Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut
| | | | | | - L Dade Lunsford
- 3Department of Neurological Surgery, University of Pittsburgh
| | - Jason P Sheehan
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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12
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Abstract
Spinal dural arteriovenous fistulas (AVFs), being the most commonly encountered spinal vascular malformations, result in considerable morbidity with progressive spinal cord symptoms. A selective spinal digital subtraction angiography (DSA) is needed to confirm the diagnosis, to better evaluate the fine vascular structures and to plan therapy. With the introduction of three-dimensional rotational angiography (3D-RA), the information available for the treating physician has vastly increased. In the following article, we present a case series of four patients, in which the advantages of 3D-RA over the conventional biplane projections could be observed clearly.
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13
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Abstract
A 43-year-old man arrived at the emergency department following a syncopal episode. Computed tomography and magnetic resonance images demonstrated a small interhemispheric, anterior parafalcine mass that mimicked a meningioma. Surgical excision and subsequent pathologic evaluation revealed an angioleiomyoma and the patient recovered without incident. Angioleiomyomas are classified as benign smooth muscle tumors and are classically seen in adult females arising in the soft tissues of the lower extremities. Although rare, these masses have been described in various intracranial locations, usually extra-axially. A comprehensive review of the literature and discussion are provided, emphasizing histopathologic and imaging features of this uncommon intracranial neoplasm.
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Affiliation(s)
- Susana Calle
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David Louis
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Richard Westmark
- Department of Neurosurgery, Bay Area Regional Medical Center, Webster, TX, USA
| | - Kaye Westmark
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
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14
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Abstract
Dural cavernous haemangiomas are rare, and they do not display a classical ring of haemosiderin on MRI as parenchymal cavernous haemangiomas. Sometimes, they are misinterpreted as meningiomas with a dural tail sign. In this short report, a 37-year-old woman was diagnosed with a convexity cavernous haemangioma, and the tumour was totally resected.
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Affiliation(s)
- Xiang Wang
- a Department of Neurosurgery , West China Hospital of Sichuan University , Chengdu , China
| | - Jian-Ping Liu
- b Department of Pathology , West China Hospital of Sichuan University , Chengdu , China
| | - Chao You
- a Department of Neurosurgery , West China Hospital of Sichuan University , Chengdu , China
| | - Qing Mao
- a Department of Neurosurgery , West China Hospital of Sichuan University , Chengdu , China
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15
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Abstract
Dural metastasis from prostate cancer is rare and may mimic a subdural hematoma (SDH). Preoperatively diagnosis may be difficult and only reveal its presence during surgery. We present such a case and review the literature to identify common characteristics. A 65-year-old man presented with headache, confusion, and progressive right upper limb weakness. Past history included a prostate adenocarcinoma with bone metastasis 3 years earlier. Head computed tomography (CT) scan without contrast revealed a multinodular bilateral hyperdense extra-axial lesion interpreted as acute SDH. At surgery planned for SDH drainage no blood was found; instead there was an en plaque subdural yellowish tumor. Histopathologic examination was consistent with metastatic adenocarcinoma of the prostate. We found 11 cases reported as dural metastasis of prostate cancer mimicking SDH. Surgery was performed on nine cases with no suspicion of dural metastasis. On preoperative nonenhanced CT scan images, three types of image patterns can be described: a nodule in SDH, multinodular metastasis surrounded by SDH, and large en plaque subdural tumor. The latter group consists of those cases where no blood but rather an en plaque subdural tumor was found at surgery. Even though rare, dural metastasis should be considered among the differential diagnoses in a patient known for prostate cancer.
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Affiliation(s)
- Andre Nzokou
- Department of Surgery, Section of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Elsa Magro
- Department of Surgery, Section of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - François Guilbert
- Department of Radiology, Section of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Jean Yves Fournier
- Department of Surgery, Section of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada ; Department of Neurosurgery, Hôpital Cantonal, St. Gall, Switzerland
| | - Michel W Bojanowski
- Department of Surgery, Section of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
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16
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Zaidi HA, Kalani MYS, Spetzler RF, McDougall CG, Albuquerque FC. Multimodal treatment strategies for complex pediatric cerebral arteriovenous fistulas: contemporary case series at Barrow Neurological Institute. J Neurosurg Pediatr 2015; 15:615-24. [PMID: 25815632 DOI: 10.3171/2014.11.peds14468] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Pediatric cerebral arteriovenous fistulas (AVFs) are rare but potentially lethal vascular lesions. Management strategies for these lesions have undergone considerable evolution in the last decade with the advent of new endovascular, surgical, and radiosurgical technologies. This study sought to review current treatment strategies and long-term clinical outcomes at a high-volume cerebrovascular institute. METHODS A retrospective chart review was performed on patients with a diagnosis of cerebral AVF from 1999 to 2012. Patients with carotid-cavernous fistulas, vein of Galen malformations, and age > 18 years were excluded from final analysis. Medical history, surgical and nonsurgical treatment, and clinical outcomes were documented. Pre- and postoperative angiograms were analyzed to assess for obliteration of the fistula. RESULTS Seventeen patients with pial AVFs (29.4%), dural AVFs (64.7%), or mixed pial/dural AVFs (5.9%) were identified. The majority of lesions were paramedian (70.6%) and supratentorial (76.5%). The study population had a mean age of 6.4 years, with a slight male predominance (52.9%), and the most common presenting symptoms were seizures (23.5%), headaches (17.6%), congestive heart failure (11.7%), and enlarging head circumference (11.7%). Among patients who underwent intervention (n = 16), 56.3% were treated with endovascular therapy alone, 6.3% were treated with open surgery alone, and 37.5% required a multimodal approach. Overall, 93.8% of the treated patients received endovascular treatment, 43.8% received open surgery, and 12.5% received radiosurgery. Endovascular embolysates included Onyx (n = 5), N-butyl cyanoacrylate (NBCA; n = 4), or coil embolization (n = 7) with or without balloon assistance (n = 2). Complete angiographic obliteration was achieved in 87.5% at the last follow-up evaluation (mean follow-up 3.1 years). One infant with incomplete AVF obliteration died of congestive heart failure, and 1 patient with complete obliteration died of acute sinus thrombosis, with an overall complication rate of 18.8%. CONCLUSIONS Pediatric cerebral AVFs are challenging neurosurgical lesions. Although advancements in endovascular therapy in the last decade have greatly changed the natural course of this disease, a multidisciplinary approach remains necessary for a large subset of patients. Surgeon experience with a thorough analysis of preoperative imaging is paramount to achieving acceptable clinical outcomes.
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Affiliation(s)
- Hasan A Zaidi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - M Yashar S Kalani
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Cameron G McDougall
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Felipe C Albuquerque
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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17
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Abstract
Ever since the first spinal anesthetic in the late 19th century, the problem of "spinal headache" or post-dural puncture headache (PDPH) has plagued clinicians, and more importantly, patients. It has long been realized that the headache and other symptoms that often occur after the entry of a needle into the subarachnoid space is somehow related to fluid loss, although the exact pathophysiology of the headache has really never been defined. With the introduction of pencil-point spinal needles for spinal anesthesia in pregnant women over the past 2 decades, the problem of PDPH in obstetrics has been more associated with accidental dural puncture during attempted epidural procedures. Accidental puncture probably occurs in about 1% of procedures, so with over 60% of pregnant women receiving epidural analgesia for labor, there are probably 20,000-50,000 obstetric patients with PDPH in the United States each year. In this article, we will discuss the current state of knowledge in this area, suggesting that the PDPH syndrome is more severe and often more long-lasting, with some potentially life-threatening complications (cerebral hemorrhage) than usually appreciated or admitted. While prevention and treatment options are still limited, with the only clearly effective treatment being the epidural blood patch, recognition of the PDPH syndrome in postpartum women by anesthesiologists and obstetricians, with aggressive follow-up and treatment, may help limit the associated morbidity and mortality.
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Affiliation(s)
- Adam Sachs
- Columbia University College of Physicians and Surgeons, 630 W 168th St PH5, New York, NY 10032
| | - Richard Smiley
- Columbia University College of Physicians and Surgeons, 630 W 168th St PH5, New York, NY 10032.
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18
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Sheikhzadeh S, Sondermann C, Rybczynski M, Habermann CR, Brockstaedt L, Keyser B, Kaemmerer H, Mir T, Staebler A, Robinson PN, Kutsche K, Berger J, Blankenberg S, von Kodolitsch Y. Comprehensive analysis of dural ectasia in 150 patients with a causative FBN1 mutation. Clin Genet 2013; 86:238-45. [PMID: 23991918 DOI: 10.1111/cge.12264] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to perform a comprehensive study of dural ectasia (DE) related to FBN1 mutations. We performed a database analysis of two German metropolitan regions of 150 patients (68 men, 82 women; mean age 35 ± 16 years). All patients had a FBN1 mutation and underwent dural magnetic resonance imaging. Age was <16 years in 20, 16-25 in 27, 26-35 in 67, and >35 in 36 patients. Prevalence of dural ectasia was 89% with criteria of Oosterhof and Habermann, 83% with Fattori, 78% with Lundby, and 59% with Ahn. DE was less frequent in patients <16 years with Ahn and Fattori. DE related to skeletal manifestations with all criteria, to aortic Z-scores and mitral valve prolapse with criteria of Habermann and Lundby, and to age with criteria of Fattori. The Fattori-grade of DE increased with age, aortic Z-scores, and skeletal score points. There was no consistent relationship of DE with any type of FBN1 mutation. DE is frequent in patients with FBN1 mutations irrespective of age and its severity increases during life. Criteria of Oosterhof and Habermann yielded most consistent diagnostic results. DE relates to skeletal involvement, aortic Z-scores, and mitral valve prolapse.
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