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Tochigi S, Isoshima A, Ohashi H, Kawamura D, Karagiozov K, Hatano K, Ohashi S, Nagashima H, Murayama Y, Abe T. Preoperative assessment of dominant occipital sinus in patients with Chiari malformation type I: anatomical variations and implications for preventing potentially life-threatening surgical complications. J Neurosurg 2023; 138:540-549. [PMID: 35901697 DOI: 10.3171/2022.5.jns212973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The surgical treatment of Chiari malformation type I (CM-I) frequently involves dural incision at the posterior cranial fossa. In cases of persistent patent occipital sinus (OS), the sinus is usually obliterated and divided. However, there are some patients whose OS is prominent and requires crucial modification of the operative planning to avoid potentially life-threatening massive hemorrhage and disturbance of cerebral venous circulation. In the present study, the anatomical variations of the dominant OS in patients with CM-I were analyzed and the authors attempted to develop treatment recommendations for patients with CM-I with dominant OS. METHODS The study included 213 patients with CM-I who underwent MR venography (MRV) prior to surgical treatment. OS dominance was assessed using 2D time-of-flight MRV or 3D phase-contrast MRV. Particular attention was paid to the pattern of venous outflow channels. The characteristics of the patients with dominant OS and the surgical outcomes were retrospectively reviewed. RESULTS Dominant OS was identified in 7 patients (3.3%). The age in those with dominant OS was significantly younger than in those without (p = 0.0202). The incidence of concurrent scoliosis in the patients with dominant OS was significantly higher than in those without (p = 0.0366). All the dominant OSs were found to be of the oblique type. Unilateral oblique OS (OOS) with normal ipsilateral transverse sinus (TS) and hypoplastic contralateral TS was found in 2 patients (0.9%). The authors found 1 patient each (0.5%) who had unilateral OOS with hypoplastic ipsilateral TS and normal contralateral TS, unilateral OOS with bilateral hypoplastic TSs, and bilateral OOSs with bilateral normal TSs. Bilateral OOSs with bilateral hypoplastic TSs were found in 2 patients (0.9%). All these patients had syringomyelia. Instead of performing Y-shaped dural incision and duraplasty, surgical procedures were modified depending on the types of the OOSs to preserve their venous drainage routes. Although massive bleeding from the dominant OS during dural incision occurred in 1 patient, none suffered neurological deterioration. The syrinx volume decreased in all but 1 of the patients postoperatively. CONCLUSIONS Assessment of the venous drainage pattern using MRV is indispensable for safe surgical treatment in patients with CM-I. The surgical procedure should be modified based on the type of dominant OS to minimize the surgical risks.
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Affiliation(s)
- Satoru Tochigi
- 1Department of Neurosurgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba
| | - Akira Isoshima
- 2Department of Neurosurgery, Omori Red Cross Hospital, Tokyo
| | - Hiroki Ohashi
- 3Department of Neurosurgery, The Jikei University School of Medicine, Tokyo
| | - Daichi Kawamura
- 3Department of Neurosurgery, The Jikei University School of Medicine, Tokyo
| | | | - Keisuke Hatano
- 3Department of Neurosurgery, The Jikei University School of Medicine, Tokyo
| | - So Ohashi
- 4Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa
| | - Hiroyasu Nagashima
- 5Department of Neurosurgery, The Jikei University Katsushika Medical Center, Tokyo; and
| | - Yuichi Murayama
- 3Department of Neurosurgery, The Jikei University School of Medicine, Tokyo
| | - Toshiaki Abe
- 3Department of Neurosurgery, The Jikei University School of Medicine, Tokyo.,6Department of Neurosurgery, Mishima Central Hospital, Mishima, Shizuoka, Japan
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Paediatric otogenic cerebral venous sinus thrombosis: a multidisciplinary approach. The Journal of Laryngology & Otology 2021; 136:3-7. [PMID: 34698003 DOI: 10.1017/s0022215121003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Paediatric otogenic cerebral venous sinus thrombosis is a rare, heterogeneous and life-threatening condition, with possible otological, neurological and ophthalmological sequelae. Its course and outcomes can be widely variable. The publications available often consider individual aspects of paediatric otogenic cerebral venous sinus thrombosis management. The condition itself and the nature of the currently available guidance can lead to uncertainties when holistically managing patients with paediatric otogenic cerebral venous sinus thrombosis. OBJECTIVES Clear recommendations for the comprehensive assessment and management of paediatric otogenic cerebral venous sinus thrombosis are presented, along with the literature review upon which they are based. Its clinical and radiological assessment are discussed. CONCLUSION A multidisciplinary approach to assessment and management is recommended, inclusive of infectious diseases, ENT surgery, neurology, ophthalmology and haematology. On balance, anticoagulation is recommended for three months. Follow-up imaging is not recommended in the absence of clinical concern. Follow up by ENT surgery, neurology and ophthalmology departments is recommended.
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Juhász J, Hensler J, Jansen O. MRI-findings in idiopathic intracranial hypertension (Pseudotumor cerebri). ROFO-FORTSCHR RONTG 2021; 193:1269-1276. [PMID: 33979869 DOI: 10.1055/a-1447-0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pseudotumor cerebri, also known as idiopathic intracranial hypertension, is a disorder of increased intracranial pressure of unknown etiology. Main symptom is headache which has a characteristic similar to other headache diseases, therefore the idiopathic intracranial hypertension often remains undetected. The incidence is 1/100 000 with the number of unreported cases being much higher. This article highlights the essential role of MRI in the differential diagnosis. METHODS A literature search was carried out on idiopathic intracranial hypertension and Pseudotumor cerebri in English and German. Original and Review articles as well as case reports were taken into account. Since the main focus of the article is MRI diagnostics, some images were selected to illustrate the characteristic MRI morphological features. RESULTS AND CONCLUSION The diagnosis of idiopathic intracranial hypertension is based on an exclusion procedure. Most common syndromes are headache, transient visual obscurations, pulsatile tinnitus and nausea. In the presence of an underlying cause for the increased intracranial pressure one speaks of a secondary intracranial hypertension. The diagnostics include a detailed medical history, neurological and ophthalmic examination, lumbar puncture, and neuroradiological imaging procedures. MRI, in particular, has become increasingly important in recent years, since signs for changes in cerebrospinal fluid pressure are now detectable and well-defined. The therapeutic approaches are symptom-oriented and aim to lower the pressure. With a precise diagnosis and timely start of therapy, idiopathic intracranial hypertension has a good prognosis, especially with regard to the preservation of eyesight. KEY POINTS · The idiopathic intracranial hypertension is an important differential diagnosis for unspecific headache and impaired vision. · Overweight women in childbearing age are particularly affected. · The most important component in diagnostics is MRI. CITATION FORMAT · Juhász J, Hensler J, Jansen O. MRT-Befunde bei der idiopathischen intrakraniellen Hypertension (Pseudotumor cerebri). Fortschr Röntgenstr 2021; DOI: 10.1055/a-1447-0264.
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Affiliation(s)
- Julia Juhász
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
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Bai C, Wang Z, Stone C, Zhou D, Ding J, Ding Y, Ji X, Meng R. Pathogenesis and Management in Cerebrovenous Outflow Disorders. Aging Dis 2021; 12:203-222. [PMID: 33532137 PMCID: PMC7801276 DOI: 10.14336/ad.2020.0404] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/04/2020] [Indexed: 11/04/2022] Open
Abstract
In keeping with its status as one of the major causes of disability and mortality worldwide, brain damage induced by cerebral arterial disease has been the subject of several decades of scientific investigation, which has resulted in a vastly improved understanding of its pathogenesis. Brain injury mediated by venous etiologies, however, such as cerebral, jugular, and vertebral venous outflow disturbance, have been largely ignored by clinicians. Unfortunately, this inattention is not proportional to the severity of cerebral venous diseases, as the impact they exact on the quality of life of affected patients may be no less than that of arterial diseases. This is evident in disease sequelae such as cerebral venous thrombosis (CVT)-mediated visual impairment, epilepsy, and intracranial hypertension; and the long-term unbearable head noise, tinnitus, headache, dizziness, sleeping disorder, and even severe intracranial hypertension induced by non-thrombotic cerebral venous sinus (CVS) stenosis and/or internal jugular venous (IJV) stenosis. In addition, the vertebral venous system (VVS), a large volume, valveless vascular network that stretches from the brain to the pelvis, provides a conduit for diffuse transmission of tumors, infections, or emboli, with potentially devastating clinical consequences. Moreover, the lack of specific features and focal neurologic signs seen with arterial etiologies render cerebral venous disease prone to both to misdiagnoses and missed diagnoses. It is therefore imperative that awareness be raised, and that as comprehensive an understanding as possible of these issues be cultivated. In this review, we attempt to facilitate these goals by systematically summarizing recent advances in the diagnosis and treatment of these entities, including CVT, CVS stenosis, and IJV stenosis, with the aim of providing a valid, practical reference for clinicians.
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Affiliation(s)
- Chaobo Bai
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongao Wang
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Christopher Stone
- 4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Da Zhou
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiayue Ding
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- 3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xunming Ji
- 2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,5Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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Lin BS, Chen CW, Zhou SK, Tseng YH, Wang SC, Huang YK. Evaluation of static ulcer on lower extremities using wireless wearable near-infrared spectroscopy device: Effect of deep venous thrombosis on TRiggered Angiography Non-Contrast-Enhanced sequence magnetic resonance imaging. Phlebology 2020; 35:814-823. [PMID: 32700650 DOI: 10.1177/0268355520935739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Venous leg ulcers, or static leg ulcers, are chronic wounds associated with ambulatory venous hypertension of the lower extremities as a consequence of venous valve reflux, reduce venous capacitance, poor calf venous pump, heart failure, or in conjunction with venous obstruction. A static ulcer with venous thrombosis in a pelvic or thigh vein responds favorably to anticoagulation agents. However, anticoagulation is less effective and even harmful when ambulatory venous hypertension has another cause such as venous reflux, poorly heart function, and poor calf venous pump. METHOD TRiggered Angiography Non-Contrast-Enhanced (TRANCE) magnetic resonance imaging (MRI) exploits differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction, providing detailed radiation-free venograms without the use of contrast agents. The method is a new tool for evaluating the presence of thrombosis in the venous systems. TRANCE-MRI was employed to document the existence of venous thrombosis within the eight patients in this study. Subsequently, we used a wireless wearable near-infrared spectroscopy device to compare deep vein thrombosis-associated and non-deep vein thrombosis-associated static ulcers. The sampling depths were 5 and 10 mm, representing the dermis and subcutaneous tissue, respectively. RESULT There are four patients with venous leg ulcers proven with venous thrombosis by TRANCE-MRI and are classified as deep vein thrombosis group. Compared with the non-deep vein thrombosis group, the deep vein thrombosis group had less deoxyhemoglobin, less total hemoglobin, and a significantly lower H2O signal in the 5-mm sampling depth (dermis level). And eight health participants were included as control group. Wounded patients (including deep vein thrombosis and non-deep vein thrombosis patients) have higher H2O concentration on the 5-mm depth sampling than control group. In the 10-mm sampling depth (subcutaneous level), the deoxyhemoglobin and tissue oxygen saturation of the deep vein thrombosis group were lower than those of the non-deep vein thrombosis group, and the H2O concentration was higher than non-deep vein thrombosis group. Patients with static foot ulcers and deep vein thrombosis had similar oxyhemoglobin, deoxyhemoglobin, total hemoglobin, and tissue oxygen saturation than did those without deep vein thrombosis in 5-mm depth sampling (dermis level). Notably, the H2O signal of patients with non-deep vein thrombosis-associated static ulcers was higher for the 5-mm sampling depth. CONCLUSION In patients with static ulcers and deep vein thrombosis, the H2O level may be higher in the 10-mm sampling depth, indicating that those patients had more subcutaneous water. In patients with non-deep vein thrombosis static foot ulcer, the near-infrared spectroscopy (NIRS) indicated worse fluid retention in the dermis level. The H2O value in the NIRS may be different owing to underline the cause of the venous leg ulcers.
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Affiliation(s)
- Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, and Wound Center, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan.,Institute of Medicine, Chung Shan Medical University, Taichung
| | - Shao-Kui Zhou
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, and Wound Center, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
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Ghoneim A, Straiton J, Pollard C, Macdonald K, Jampana R. Imaging of cerebral venous thrombosis. Clin Radiol 2020; 75:254-264. [DOI: 10.1016/j.crad.2019.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/11/2019] [Indexed: 11/17/2022]
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Sakamoto D, Fukuya S, Harada A, Utsunomiya H. Two pediatric cases of epidural hematoma in the posterior fossa with extension along the sigmoid sinus groove: MR evaluation. Acta Radiol Open 2020; 9:2058460120902894. [PMID: 32071767 PMCID: PMC6997969 DOI: 10.1177/2058460120902894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/04/2020] [Indexed: 11/16/2022] Open
Abstract
To discuss the computed tomography (CT) and magnetic resonance (MR) findings of
posterior fossa epidural hematoma (PFEDH) mimicking sinus thrombosis, we present
two pediatric cases with the PFEDH extending along the sigmoid sinus groove
evaluated by MR imaging (MRI) and MR venography (MRV). T2-weighted coronal MRI
can diagnose both patency of the sigmoid sinus and epidural hematoma extending
along the sinus groove. Phase-contrast MRV (PC-MRV) is also useful to evaluate
the flow state in the dural sinuses but it should be diagnosed carefully whether
low visualization of the dural sinus means only functional flow impairment or
organized occlusion due to thrombus. To avoid an unnecessary anticoagulant
therapy that may worsen epidural hematoma, it is important to recognize the
pitfall that PFEDH extending along the sinus groove is easy to misdiagnose for a
dural sinus thrombosis.
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Affiliation(s)
- Daisuke Sakamoto
- Department of Neurosurgery, Hyogo College of Medicine, Hyogo, Japan
- Department of Pediatric Neurosurgery, Takatsuki General Hospital, Osaka, Japan
| | - Shogo Fukuya
- Department of Pediatric Neurosurgery, Takatsuki General Hospital, Osaka, Japan
- Department of Neurosurgery, Hanwa Memorial Hospital, Osaka, Japan
| | - Atsuko Harada
- Department of Pediatric Neurosurgery, Takatsuki General Hospital, Osaka, Japan
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