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Jaimes C, Ferraciolli SF, Orbach DB. Cerebrovascular Anomalies in the Fetus. AJNR Am J Neuroradiol 2024:ajnr.A8377. [PMID: 38866434 DOI: 10.3174/ajnr.a8377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024]
Abstract
Four distinct vascular anomalies can be seen to affect the brain on fetal imaging: vein of Galen malformations, nongalenic arteriovenous pial fistulas, dural sinus malformations, and intracranial venous malformations. These congenital disorders affect the arteries and veins of the developing brain and are rarely seen beyond the neonatal stage. The 4 fetal cerebrovascular anomalies are associated with quite disparate natural histories and prognoses. MRI plays a pivotal role in the evaluation of fetuses with these conditions because of its ability to definitively establish the diagnosis, to detect subtle parenchymal injuries, to delineate the course of abnormal vessels in detail and to some extent the nature of vascular flow, and to identify ischemic, thrombotic, and hemorrhagic complications. Recently, an investigational transuterine embolization procedure targeted at treating fetuses with vein of Galen malformations who are at high risk for neonatal decompensation has emerged as a promising alternative to expectant management and postnatal embolization, with imaging being used to identify suitable patients for the intervention and in preprocedural planning. This manuscript reviews the essential imaging and clinical features of these 4 fetal neurovascular anomalies and underscores the practical aspects related to counseling, prognosis, and the multidisciplinary management of these entities.
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Affiliation(s)
- Camilo Jaimes
- From the Departments of Radiology (C.J., S.F.F.), Massachusetts General Hospital, Boston, Massachusetts
- Pediatric Imaging Research Center (C.J., S.F.F.), MA General Hospital, Boston, Massachusetts
- Harvard Medical School (C.J., S.F.F., D.B.O.), Boston, Massachusetts
| | - Suely Fazio Ferraciolli
- From the Departments of Radiology (C.J., S.F.F.), Massachusetts General Hospital, Boston, Massachusetts
- Pediatric Imaging Research Center (C.J., S.F.F.), MA General Hospital, Boston, Massachusetts
- Harvard Medical School (C.J., S.F.F., D.B.O.), Boston, Massachusetts
| | - Darren B Orbach
- Harvard Medical School (C.J., S.F.F., D.B.O.), Boston, Massachusetts
- Department of Interventional Neuroradiology (D.B.O.), Boston Children's Hospital, Boston, Massachusetts
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Rao TMN, Thakar S, Pandey P, Aryan S. Dural sinus malformation presenting with proptosis: report and review of a rare entity. Childs Nerv Syst 2024; 40:2599-2602. [PMID: 38644384 DOI: 10.1007/s00381-024-06410-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/13/2024] [Indexed: 04/23/2024]
Abstract
Dural sinus malformation (DSM) is a rare vascular malformation characterized by the dilatation of a dural venous sinus with or without an anomalous jugular bulb. Its presentation with venous-reflux-related secondary proptosis is anecdotal, with only six such cases reported so far. We report a 17-month-old boy who presented with a progressive proptosis of the right eye secondary to a DSM of the transverse sinus and torcula. Following endovascular embolization of the arterio-venous fistula, complete thrombosis of the venous lake and improvement in proptosis was noted at 6-month follow-up. Prognosis of this rare malformation is variable and dependent on specific angio-architectural features.
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Affiliation(s)
- Tejus M N Rao
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, ITPL Main Road, Bangalore, 560066, Karnataka, India
| | - Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, ITPL Main Road, Bangalore, 560066, Karnataka, India.
| | - Paritosh Pandey
- Department of Neurosurgery, Manipal Hospital, Bangalore, Karnataka, India
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, ITPL Main Road, Bangalore, 560066, Karnataka, India
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Kaplan JS, Dardanelli EP, Requejo F, Mackintosh C, Lipsich JE. Use of greyscale and Doppler ultrasound in initial evaluation and follow-up of neurovascular malformations in children. Pediatr Radiol 2024; 54:347-356. [PMID: 38191809 DOI: 10.1007/s00247-023-05846-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
Pediatric intracranial arteriovenous shunts are rare vascular malformations that can be diagnosed prenatally or postnatally, as an incidental finding or due to complications. We propose a review of cerebral vascular malformations in newborns and infants with special emphasis on neurosonography and Doppler ultrasound as the first diagnostic method. Sonography can thus contribute in the planning of further studies that are always necessary, and in post-therapy follow-up.
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Affiliation(s)
- Julio S Kaplan
- Department of Radiology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881 (C 1425 AAM), Buenos Aires, Argentina.
| | - Esteban P Dardanelli
- Department of Radiology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881 (C 1425 AAM), Buenos Aires, Argentina
| | - Flavio Requejo
- Department of Neuroradiology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881 (C 1425 AAM), Buenos Aires, Argentina
| | - Cecilia Mackintosh
- Department of Radiology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881 (C 1425 AAM), Buenos Aires, Argentina
| | - José E Lipsich
- Department of Radiology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881 (C 1425 AAM), Buenos Aires, Argentina
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Saliou G, Deiva K, Möhlenbruch MA, Lubicz B. Anticoagulation helps shrink giant venous lakes and arteriovenous fistulas in dural sinus malformation. J Neurointerv Surg 2024; 16:183-186. [PMID: 36804768 DOI: 10.1136/jnis-2022-019923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Dural sinus malformations (DSMs) associated with high flow arteriovenous shunts are a challenging disease in babies that can lead to severe neurological damage or death. We report our treatment strategy in seven consecutive DSMs. METHODS We performed a retrospective analysis of seven consecutive patients from four centres, treated with transarterial embolization and anticoagulants. RESULTS Mean clinical and imaging follow-up was 2.8 years (IQR1-3 1.8-5.3). At baseline, the median size of the dilated venous pouch (giant lake) was 35 mm (IQR1-3 24-41) that decreased to a normal or near normal venous collector diameter of median size 11.5 mm (IQR1-3 8.5-13.8). This was achieved after a median of two embolization sessions targeted on dural feeders (IQR1-3 1.5-2.5), leaving associated pial feeders untreated. There were no cerebral hemorrhagic complications during the anticoagulation treatment. Median percentage of shunt remaining after embolization was 30% (IQR1-3 12-30), which spontaneously decreased with anticoagulation and even after discontinuation of anticoagulation, in parallel with the reduction in diameter of the dilated sinus, up to healing (or near healing). At the last clinical assessment, the modified Rankin Scale score was 0 in four patients, 1 in one patient, and 3 in two patients. CONCLUSIONS Anticoagulants may help to potentiate transarterial embolization in DSMs in babies by decreasing venous dilatation and reducing the remaining arteriovenous shunt, particularly the pial feeders. We did not observe recurrence of arteriovenous shunts after treatment, especially during anticoagulation treatment. Further studies are needed to support our findings.
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Affiliation(s)
- Guillaume Saliou
- Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- UNIL, Lausanne, Switzerland
| | - Kumaran Deiva
- Service de Neuropédiatrie, Hôpital Bicêtre Service de Neuropédiatrie, Le Kremlin-Bicetre, France
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Boris Lubicz
- Diagnostic and Interventional Neuroradiology, Hôpital Universitaire Erasme, Bruxelles, Belgium
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Requejo F, Teplisky D, González Dutra ML, Lipsch J, Nguyen TN, Abdalkader M. Intracranial arteriovenous shunts in infants: A decade of experience from a quaternary pediatric center. Interv Neuroradiol 2023:15910199231180002. [PMID: 37331964 DOI: 10.1177/15910199231180002] [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: 06/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Intracranial arteriovenous shunts (IAVS) are rare vascular diseases in infants. They can be categorized into vein of Galen aneurysmal malformation (VGAM), pial arteriovenous fistula (PAVF), and dural arteriovenous fistula associated with dural sinus malformation (DAVF/DSM). We sought to review the clinical presentation, imaging characteristics, endovascular treatment (EVT), and outcomes of IAVS in infants presenting to a quaternary pediatric referral center over one decade. METHODS A retrospective review of a prospectively maintained database was performed of all infants diagnosed with IAVS between January 2011 and January 2021 in a quaternary pediatric referral center. For each patient, demographic data, clinical presentation, imaging findings, management strategies, and outcomes were reviewed and discussed. RESULTS Over the study period, 38 consecutive infants were diagnosed with IAVS. Patients with VGAM (23/38, 60.5%) presented with congenital heart failure (CHF) (14/23), hydrocephalus (4/23), and seizures (2/23), and three patients were asymptomatic. Eighteen patients with VGAM underwent EVT. Among those, 13 patients (72.2%) were successfully treated with an angiographic cure and three patients (3/18, 17%) died. Patients with PAVF (9/38, 23.7%) presented with CHF (5/9), intracranial hemorrhage (2/9), and seizures (2/9), and all of them were successfully treated endovascularly. Patients with Type I DAVF/DSM (4/6, 66.6%) presented with mass effect (2/4), cerebral venous hypertension (1/4), CHF (1/4), and cerebrofacial venous metameric syndrome (1/4). Patients with type II DAVF/DSM (2/6, 33.3%) presented with a thrill behind the ear. Patients with DAVF/DSM were treated endovascularly, five patients were cured, and one with type I DAVF/DSM died. CONCLUSION Intracranial arteriovenous shunts are rare but potentially life-threatening neurovascular pathologies in infants. Endovascular treatment is challenging but feasible in carefully selected patients.
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Affiliation(s)
- Flavio Requejo
- Department of Pediatric Interventional Neuroradiology, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | - Dario Teplisky
- Department of Pediatric Interventional Radiology, Vascular Anomalies Interdisciplinary Group, Hospital de Pediatría Prof. Dr Juan P Garrahan, Buenos Aires, Argentina
| | - María Laura González Dutra
- Department of Pediatric Interventional Neuroradiology, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | - José Lipsch
- Department of Radiology, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery and Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
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6
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Requejo F, Teplisky D, Dutra MLG, Mouratian DM, Kikano R, Nguyen TN, Abdalkader M. Pediatric Interventional Neuroradiology. Semin Neurol 2023; 43:408-418. [PMID: 37536373 DOI: 10.1055/s-0043-1771511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Pediatric neurovascular disorders can lead to substantial mortality and morbidity if not diagnosed early and adequately managed. Children with neurovascular diseases cannot be treated as small adults as the vascular and central nervous system anatomy, physiology, and pathologies in children differ greatly from those of adults. In addition, some neurovascular pathologies are seen exclusively in children such as aneurysmal malformation of the vein of Galen, pial fistulas, and dural fistulas in the context of dural sinus disease. In this review, we aim to present an overview of the common pediatric neurovascular diseases along with their endovascular management.
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Affiliation(s)
- Flavio Requejo
- Department of Pediatric Interventional Neuroradiology, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | - Dario Teplisky
- Department of Pediatric Interventional Radiology, Vascular Anomalies Interdisciplinary Group, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | - María Laura González Dutra
- Department of Pediatric Interventional Neuroradiology, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | | | - Raghid Kikano
- Department of Radiology, Lebanese American University-Gilbert and Rose Mary Chagoury School of Medicine, Beirut, Lebanon
- Department of Radiology, CISS de l'Abitibi-Temiscamingues, Québec, Canada
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery and Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Mohamad Abdalkader
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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Hanai S, Muroi A, Hitaka D, Murakami T, Sato M, Matsumaru Y, Ishikawa E. Remodeling of venous drainage after the treatment of dural sinus malformation with arteriovenous shunts in a neonate: a case report and literature review. Childs Nerv Syst 2023:10.1007/s00381-023-05961-w. [PMID: 37085623 DOI: 10.1007/s00381-023-05961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
Dural sinus malformations (DSMs) are rare congenital vascular diseases characterized by a giant venous pouch with or without arteriovenous shunts. We present a neonatal case of DSM that was diagnosed prenatally and treated via endovascular intervention in the early postnatal period. The patient presented with a large DSM involving the torcular Herophilion prenatal magnetic resonance imaging (MRI). Enlargement of the head circumference and respiratory failure rapidly progressed after birth. On the 5th day after birth, the neonate underwent endovascular occlusion via the umbilical artery. The arteriovenous shunt was occluded, and the reflux from the enlarged venous pouch to the dural sinus was decreased. No additional procedure other than ventriculoperitoneal shunting was required. The neonate's development slowly caught up to normal parameters. Follow-up MRI demonstrated the successful development of the venous drainage system. DSMs are characterized by an abnormally dilated dural sinus, which can block the venous return and ultimately increase intracranial pressure and cerebral ischemia. Long-term follow-up indicates that an abnormally developed dural sinus can be reconstructed by appropriate and timely treatment.
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Affiliation(s)
- Sho Hanai
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Ai Muroi
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan.
| | - Daisuke Hitaka
- Department of Pediatrics, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Takashi Murakami
- Department of Pediatrics, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
- Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
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Aksoy SH, Yurdaisik I. High riding jugular bulb: prevalence and significance in asymptomatic children. Acta Radiol 2023; 64:792-797. [PMID: 35300524 DOI: 10.1177/02841851221085674] [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: 11/15/2022]
Abstract
BACKGROUND High riding jugular bulb (HJB) is a vascular abnormality characterized by the higher-than-normal location of the jugular bulb. PURPOSE To evaluate the frequency of HJB among children who underwent cranial computed tomography (CT) mostly because of head trauma. MATERIAL AND METHODS Patient demographics such as age, sex, indication of cranial CT, diameters of the right and left JB, and presence and laterality of HJB were recorded and analyzed. Patients were grouped as with HJB and without HJB; the variables were compared between these two groups. Patients were also divided into age groups as 0-1 month, 1-12 months, 12-24 months, and >24 months and the findings. The Shapiro-Wilk test, histograms, and Q-Q, Mann-Whitney U-test, Pearson's chi-square test, and Fisher's exact test were used. RESULTS In total, CT images of 194 patients (388 JBs) were evaluated. Overall, 42.8% of children had HJB. Only three children had bilateral HJB. Of all JBs, 22.2% were high riding. Children who did not have HJB were significantly younger compared to children with HJB (P = 0.029). The median diameter of the HJB was significantly higher in children with HJB compared to children without HJB on both sides (P < 0.001). Among newborns, none had HJB. In infants, 11 (30.6%) had HJB; 35 (46.7%) and 37 (50.0%) children aged >12-24 months and >24 months had HJB, respectively. CONCLUSION A jugular bulb could be identified in all age groups, including newborns. The earliest age of HJB detection was eight months. Overall, 42% of the patients had HJB, which increased by age.
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Affiliation(s)
| | - Isil Yurdaisik
- Department of Radiology, 469683Istinye Universitesi, Istanbul, Turkey
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Varney ET, Taylor CS, Crosthwait AG, Weaver K, Nichols T. A deceptive mass on neonatal ultrasound and a fetal brain MRI-confirmed complex dural arteriovenous fistula postnatally: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22318. [PMID: 36471579 PMCID: PMC9724006 DOI: 10.3171/case22318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/06/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Dural arteriovenous fistulas (dAVFs) are direct, aberrant connections between dural arteries and cerebral veins. In neonates, delayed diagnosis results in grim outcomes. Treatment involves endovascular management because of its success and tolerability. Here, the authors present a case of a complex dAVF initially recognized with an in utero neurosonogram and fetal magnetic resonance imaging (MRI). OBSERVATIONS A 21-week fetal ultrasound of a nonspecific brain mass was confirmed with fetal MRI as a 2.7-cm T1-hyperintense posterior fossa mass. Although a large flow void in the left middle cranial fossa was present, postnatal computed tomography angiography ultimately revealed a high-flow dAVF communicating with the left transverse sinus. In the early postnatal period, the patient developed hydrocephalus. After successful partial embolization, 6-week postangiogram brain MRI indicated disease progression with the development of a venous varix causing brainstem compression. Repeat embolization resulted in complete cessation of early venous drainage. LESSONS Neonatal dAVFs are exceedingly rare and result in futile outcomes; however, detection in utero is possible. Although definitive therapy must be performed postnatally, constant monitoring and early delivery can prevent complications. Attention to fetal ultrasound is essential, and knowledge of fetal MRI in the detection of these complex lesions can significantly improve outcomes.
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Affiliation(s)
| | | | | | - Kristin Weaver
- Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi
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10
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Goldman-Yassen AE, Shifrin A, Mirsky DM, Vossough A, Licht DJ, Feygin T. Torcular Dural Sinus Malformation: Fetal and Postnatal Imaging Findings and Their Associations With Clinical Outcomes. Pediatr Neurol 2022; 135:28-37. [PMID: 35973328 DOI: 10.1016/j.pediatrneurol.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Torcular dural sinus malformations (tDSMs) are rare vascular malformations that present in fetuses and infants. Existing data on prognostic imaging features, as well as the associated morbidity and mortality, are limited and variable. We therefore reviewed cases of tDSMs diagnosed on fetal magnetic resonance imaging (MRI) at our referral center to identify pre- and postnatal MRI imaging features associated with long-term outcomes. METHODS We searched our imaging database for fetal and postnatal MRI reports of tDSM cases. The electronic medical record was then reviewed for pre- and postnatal clinical data, including follow-up imaging. Neurological outcomes were characterized using the previously reported scale based on the Bicêtre Score. Imaging features association with outcome scores were compared using the Fisher exact test. RESULTS Sixteen cases of tDMS diagnosed by fetal MRI with postnatal clinical follow-up were identified, 11 of whom underwent postnatal MRI. The majority of cases of tDSM (73%) decreased in size or resolved on postnatal follow-up study without treatment. Restricted diffusion and parenchymal hemorrhage on fetal MRI were the only imaging features identified significantly associated with unfavorable neurological outcome or death, present in two patients with poor outcomes (two of two) and only one with a normal outcome (one of 14) (P = 0.025). CONCLUSIONS Findings of tDSM on fetal MRI most often regress and/or resolve with normal or mild neurological outcomes, with the most significant predictor of poor outcome being the presence of parenchymal injury on fetal MRI. In addition, a subset will present with venolymphatic malformations.
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Affiliation(s)
- Adam E Goldman-Yassen
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
| | - Anna Shifrin
- North Shore Radiological Associates, Winchester, Massachusetts
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel J Licht
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tamara Feygin
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Ye Z, Hao J, Zhang L, Lv X. Development of bilateral subdural hematoma after endovascular embolization of a dural sinus malformation. Childs Nerv Syst 2022; 38:211-215. [PMID: 33852057 DOI: 10.1007/s00381-021-05161-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 04/09/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Dural sinus malformation is a rare congenital malformation characterized by a remarkable dilated dural sinus pouch. We described the development of bilateral subdural hematoma after endovascular embolization of a dural sinus malformation in an infant. CASE DESCRIPTION A 32-day male infant was observed to have a fever and enlarged head circumference. A dural sinus malformation with giant dural sinus pouch thrombosis was established by magnetic resonance imaging and digital subtraction angiography. The patient developed bilateral subdural hematoma after endovascular embolization of the dural fistula. His neurological outcome was normal at 3-year follow-up. CONCLUSION We report a case of development of bilateral subdural hematoma after endovascular embolization of a dural sinus malformation and had a normal neurological outcome.
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Affiliation(s)
- Zhongyin Ye
- School of Medicine& School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jiheng Hao
- Neurosurgery Department, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, China
| | - Liyong Zhang
- Neurosurgery Department, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, China
| | - Xianli Lv
- School of Medicine& School of Clinical Medicine, Tsinghua University, Beijing, China.
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Litang Road 168, Changping, Beijing, 102218, China.
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12
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Demartini Z, Maeda AK, Koppe GL, Guimarães RMDR, Maranha Gatto LA, Cardoso-Demartini AA. Torcular Dural Sinus Malformation. Pediatr Neurosurg 2022; 57:141-143. [PMID: 35026762 DOI: 10.1159/000521935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, Brazil.,Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Gelson Luis Koppe
- Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Ricardo Munhoz da Rocha Guimarães
- Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Luana A Maranha Gatto
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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13
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Miller RM, Zarka A, Ahmad SF. The Case of the Rare Malformation and Rare Variant: An Infant with a Self-Embolized Torcular Dural Sinus Malformation and a Concomitant Prothrombin Variant. Child Neurol Open 2022; 9:2329048X221140784. [PMID: 36465491 PMCID: PMC9716620 DOI: 10.1177/2329048x221140784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 03/22/2024] Open
Abstract
Torcular dural sinus malformations (tDSMs) can occur in the brain during prenatal development. These rare vascular malformations occur in less than 1% of the population but can lead to a poor prognosis secondary to congestive heart failure and hydrocephalus. Many tDSM cases require surgical embolization or coiling to return normal cerebral blood flow and prevent mortality and morbidity. We describe the first case of spontaneous self-embolization of a large torcular dural sinus malformation, possibly due to hypercoagulability from a comorbid prothrombin gene variant. Despite a grim prognosis at birth, the child is alive and thriving at age 3, with only mild speech delay.
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Affiliation(s)
- Roxanne M Miller
- The Office of Research and Innovation, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
- Department of Radiology, The Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Anthony Zarka
- Department of Radiology, The Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Samiya F Ahmad
- Department of Radiology, The Children's Hospital of San Antonio, San Antonio, TX, USA
- Departments of Radiology and Neurology, Baylor College of Medicine, San Antonio, TX, USA
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14
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Smajda SJ, Söderman M, Dorfmüller G, Dorison N, Nghe MC, Rodesch GL. OUP accepted manuscript. Brain Commun 2022; 4:fcac043. [PMID: 35243346 PMCID: PMC8889109 DOI: 10.1093/braincomms/fcac043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/14/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Paediatric intracranial dural arteriovenous shunts have clinical presentations and evolutions, with angiographic characteristics that differ from those described in adults. We report our experience concerning their therapeutic management, emphasizing the relevance of early diagnosis and appropriate treatment for satisfactory neurocognitive development. Using a prospective database, we reviewed the clinical and radiological data of all children with dural arteriovenous shunts managed between 2002 and 2020. Dural shunts were categorized into three types: dural sinus malformations with arteriovenous shunts; infantile dural arteriovenous shunts; and adult-type dural arteriovenous shunts. Therapeutic strategies and outcomes were analysed depending on lesional subtypes. Modified Rankin Scale for the paediatric population was assessed pre-treatment and at last follow-up. Twenty-eight patients [16 girls (57.1%); 12 boys (42.9%)] were included: 17 dural sinus malformation [10 boys (58.8%); seven girls (41.2%)], three infantile shunts [three girls (100%)], eight adult-type shunts [four girls (50%)]; four boys (50%)], with a mean age of 19.2 ± 36.6 months at presentation. Twelve (42.9%) had a modified Rankin Scale score of 0–2, four (14.3%) had a score of 3, three (10.7%) had a score of 4 and eight (28.6%) had a score of 5. Embolization was performed in 22 children [78.6%; 12 girls (54.5%); 10 boys (45.5%)]. Fifteen patients could be cured (68.2%): 11 dural sinus malformations (73.3%), four adult-type lesions (100%) but no infantile shunt. Mean post-treatment follow-up was 39.5 months (max. 139 months): 14 patients (63.6%) presented a modified Rankin Scale score of 0–2 and eight (36.4%) had a score ≥3. In the dural sinus malformation group, the modified Rankin Scale score was improved in 11 patients (73.3%) and unchanged in three (20%). Only one patient with infantile subtype (33.3%) improved clinically. In the adult-subtype group, all children (100%) improved. Of six untreated patients [four girls (66.7%); two boys (33.3%)], four with adult-subtype shunts showed uneventful evolutions, one with dural sinus malformation died, and therapeutic abortion was conducted in an antenatally diagnosed dural sinus malformation. Paediatric dural fistulas comprise different subtypes with variable clinical courses. Proper diagnosis is mandatory for optimal therapeutic strategies within appropriate therapeutic windows.
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Affiliation(s)
- Stanislas J. Smajda
- Correspondence to: Stanislas Smajda, MD Department of Interventional Neuroradiology 29 Rue Manin, 75019 Paris, France E-mail:
| | - Michael Söderman
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Georg Dorfmüller
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Nathalie Dorison
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Marie-Claire Nghe
- Department of Anesthesiology and Intensive Care, Rothschild Foundation Hospital, Paris, France
| | - Georges L. Rodesch
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
- Department of Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
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15
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Kaushik KS, Acharya UV, Ananthasivan R, Girishekar B, Kalidindi P, Patil PG. Fetal imaging of a rare case of dural sinus malformation: a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Dural sinus malformations (DSM) are rare congenital anomalies, accounting for less than 2% of all intracranial vascular malformations. Fetal MRI plays an important role in the confirmation of the diagnosis, prognostication, and planning of treatment strategies. Here, we present a rare case of dural sinus malformation without thrombosis, diagnosed by prenatal ultrasound and fetal MRI. In addition to this, fetal intracranial 3D gradient recalled echo Dixon-based MRA was done which, to the best of our knowledge, is a first.
Case presentation
A 24-year-old multigravida with no known comorbidities underwent a routine second trimester anomaly scan in which an unusual posterior interhemispheric cyst was diagnosed. Further evaluation with fetal MRI revealed dilated posterior sinuses and torcula, normal internal jugular vein, and maintained flow voids with no mass effect. Fetal Dixon-based MRA and correlated Doppler revealed supply to the lesion by bilateral occipital arteries and posterior cerebral arteries. With these imaging features, a midline dural sinus malformation was diagnosed.
Conclusion
Dural sinus malformations should be considered in the differential diagnosis of unusual posterior fossa cystic lesions detected on antenatal ultrasound coupled with a colour Doppler examination. Prompt fetal MRI is essential to establish the diagnosis, identify intracranial complications and decide the postnatal treatment strategy, thereby possibly improving the postnatal outcome.
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16
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Luther EM, Jamshidi A, King H, Starke R. Staged embolisation of a giant torcular dural sinus malformation in a neonate. BMJ Case Rep 2021; 14:e244216. [PMID: 34764109 PMCID: PMC8586880 DOI: 10.1136/bcr-2021-244216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/04/2022] Open
Abstract
Torcular dural sinus malformations (tDSMs) represent a rare subset of paediatric cerebrovascular malformations and are often diagnosed antenatally via ultrasound. The management of these in utero lesions remains controversial as previous studies suggested elective termination of the pregnancy because of their presumably high mortality and severe long-term morbidity. However, more recent evaluations have suggested that the overall prognosis for infants harbouring these lesions may be much better than previously believed. As such, we present the case of a neonate with a giant tDSM, diagnosed in utero, who was treated postnatally via staged transarterial and transvenous embolisation to alleviate worsening obstructive hydrocephalus and brainstem compression. We provide details regarding the surgical approach and long-term neurological outcomes for this patient. To the best of our knowledge, this is one of the largest reported tDSM presented in the literature.
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Affiliation(s)
- Evan M Luther
- Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Aria Jamshidi
- Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Hunter King
- Neurological Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert Starke
- Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
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17
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Ku JC, Hanak B, Muthusami P, Narvacan K, Girgis H, terBrugge K, Krings T, Rutka JT, Dirks P. Improving long-term outcomes in pediatric torcular dural sinus malformations with embolization and anticoagulation: a retrospective review of The Hospital for Sick Children experience. J Neurosurg Pediatr 2021; 28:469-475. [PMID: 34330098 DOI: 10.3171/2021.3.peds20921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Torcular dural sinus malformations (tDSMs) are rare pediatric cerebrovascular malformations characterized by giant venous lakes localized to the midline confluence of sinuses. Historical clinical outcomes of patients with these lesions were poor, though better prognoses have been reported in the more recent literature. Long-term outcomes in children with tDSMs are uncertain and require further characterization. The goal of this study was to review a cohort of tDSM patients with an emphasis on long-term outcomes and to describe the treatment strategy. METHODS This study is a single-center retrospective review of a prospectively maintained data bank including patients referred to and cared for at The Hospital for Sick Children for tDSM from January 1996 to March 2019. Each patient's clinical, radiological, and demographic information, as well as their mother's demographic information, was collected for review. RESULTS Ten patients with tDSM, with a mean follow-up of 58 months, were included in the study. Diagnoses were made antenatally in 8 patients, and among those cases, 4 families opted for either elective termination (n = 1) or no further care following delivery (n = 3). Of the 6 patients treated, 5 had a favorable long-term neurological outcome, and follow-up imaging demonstrated a decrease or stability in the size of the tDSM over time. Staged embolization was performed in 3 patients, and anticoagulation was utilized in 5 treated patients. CONCLUSIONS The authors add to a growing body of literature indicating that clinical outcomes in tDSM may not be as poor as initially perceived. Greater awareness of the lesion's natural history and pathophysiology, advancing endovascular techniques, and individualized anticoagulation regimens may lead to continued improvement in outcomes.
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Affiliation(s)
- Jerry C Ku
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Brian Hanak
- 3Department of Neurosurgery, Loma Linda University Health, Loma Linda, California
| | - Prakash Muthusami
- 4Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto
| | - Karl Narvacan
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Hidy Girgis
- 5Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa
| | - Karel terBrugge
- 4Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto
- 6Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - Timo Krings
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto
- 4Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto
- 6Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - James T Rutka
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Peter Dirks
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
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18
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Fesslova V, Colli AM, Boito S, Fabietti I, Triulzi F, Persico N. Dural Sinus Arteriovenous Malformation in the Fetus. Case Report and Discussion of the Literature. Diagnostics (Basel) 2021; 11:diagnostics11091651. [PMID: 34573993 PMCID: PMC8464898 DOI: 10.3390/diagnostics11091651] [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: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 11/16/2022] Open
Abstract
Sonographic findings of cerebral arteriovenous malformations in the fetus are uncommon and usually regard aneurysm of the Galen vein. Outcome of arteriovenous malformations is usually severe. We report a case of a fetus at 21 weeks' gestation with a rarer arteriovenous malformation, referred to us for echocardiography on account of a suspicious cardiomegaly at obstetrical scan. Upon examination, we found cardiomegaly, together with an associated moderate tricuspid regurgitation, however, there were no clear features of tricuspid dysplasia. Considering an unusually dilated superior vena cava, we found via color Doppler imaging a systodiastolic flow at Color Doppler progressing. Subsequent MRI of the central nervous system determined the localization in the sinus dura mater. Due to an already evident hemodynamic impact, the parents opted for the termination of the pregnancy. Autopsy confirmed a voluminous arteriovenous malformation of the transverse sinus of the dura mater, severe cardiomegaly, mainly of the ventricles, and hypoplasia of the lungs.
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Affiliation(s)
- Vlasta Fesslova
- Center of Fetal Cardiology, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Correspondence: or
| | - Anna Maria Colli
- U.O. Cardiologia, Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, 20121 Milan, Italy;
| | - Simona Boito
- Fetal Medicine and Surgery Service, Department of Clinical Sciences and Community Health, University of Milan, 20121 Milan, Italy; (S.B.); (I.F.); (N.P.)
| | - Isabella Fabietti
- Fetal Medicine and Surgery Service, Department of Clinical Sciences and Community Health, University of Milan, 20121 Milan, Italy; (S.B.); (I.F.); (N.P.)
| | - Fabio Triulzi
- Department of Radiology, Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, 20121 Milan, Italy;
| | - Nicola Persico
- Fetal Medicine and Surgery Service, Department of Clinical Sciences and Community Health, University of Milan, 20121 Milan, Italy; (S.B.); (I.F.); (N.P.)
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19
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Song Y, Kwon B, Al-Abdulwahhab AH, Nam YK, Ahn Y, Jeong SY, Seo EJ, Lee JK, Suh DC. Rare Neurovascular Diseases in Korea: Classification and Related Genetic Variants. Korean J Radiol 2021; 22:1379-1396. [PMID: 34047503 PMCID: PMC8316781 DOI: 10.3348/kjr.2020.1171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/07/2020] [Accepted: 01/23/2021] [Indexed: 01/19/2023] Open
Abstract
Rare neurovascular diseases (RNVDs) have not been well-recognized in Korea. They involve the central nervous system and greatly affect the patients' lives. However, these diseases are difficult to diagnose and treat due to their rarity and incurability. We established a list of RNVDs by referring to the previous literature and databases worldwide to better understand the diseases and their current management status. We categorized 68 RNVDs based on their pathophysiology and clinical manifestations and estimated the prevalence of each disease in Korea. Recent advances in genetic, molecular, and developmental research have enabled further understanding of these RNVDs. Herein, we review each disease, while considering its classification based on updated pathologic mechanisms, and discuss the management status of RNVD in Korea.
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Affiliation(s)
- Yunsun Song
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boseong Kwon
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Abdulrahman Hamed Al-Abdulwahhab
- Department of Diagnostic and Interventional Radiology, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
| | - Yeo Kyoung Nam
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yura Ahn
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeong Jeong
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eul Ju Seo
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Keuk Lee
- Asan Institute of Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Chul Suh
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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20
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Giant dural arteriovenous fistula in a pediatric patient: positive outcome following surgical treatment. Childs Nerv Syst 2021; 37:2063-2068. [PMID: 33108519 DOI: 10.1007/s00381-020-04923-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Our purpose is to present an atypical case of a 4-month-old patient with a giant dural arteriovenous fistula (DAVF). METHODS Presentation of a case report and review of the literature. RESULTS The DAVF arterial supply was through the middle meningeal artery bilaterally and the anterior and middle cerebral arteries on the right hemisphere. The venous drainage was through the posterior two-thirds of the superior sagittal sinus. The endovascular team performed an embolization to reduce the flow of the lesion, and finally, the surgical team completed the excision of the residual venous sac, without causing any significant neurological deficit. We used a double surgical approach done with two surgical teams in order to optimize the hemostasis control and reduce morbidity and mortality. CONCLUSION Midline DAVF usually has devastating consequences in children. Endovascular treatment is the first choice since it has lower mortality. Nevertheless, it requires multiple interventions, and the cure of the disease may not be achieved. We believe that joint endovascular and surgical treatment, supported by a reliable multidisciplinary medical team, is a good option for this type of lesions.
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21
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Moazeni Y, Abdalla RN, Cantrell DR, Hurley MC, Ansari SA, DiPatri AJ, Shaibani A. Direct percutaneous transcarotid approach for embolization of dural sinus malformation in a premature neonate: A case report. Interv Neuroradiol 2021; 27:667-671. [PMID: 33745364 DOI: 10.1177/15910199211005319] [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: 11/17/2022] Open
Abstract
CONCLUSIONS Direct percutaneous TCAA can be a feasible access for intracranial interventions in neonates with LBW and unavailable UA access.
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Affiliation(s)
- Yasaman Moazeni
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ramez N Abdalla
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Donald R Cantrell
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael C Hurley
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sameer A Ansari
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arthur J DiPatri
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ali Shaibani
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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22
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Sacco A, Pannu D, Ushakov F, Dyet L, Pandya P. Fetal dural sinus thrombosis: A systematic review. Prenat Diagn 2020; 41:248-257. [PMID: 33219698 DOI: 10.1002/pd.5869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Fetal dural sinus thrombosis (DST) is a rare condition. Although numerous case reports exist, the findings appear heterogenous and providing accurate patient counselling remains challenging. METHODS A systematic literature review was conducted in accordance with PRISMA guidance. RESULTS Thirty-one studies including 78 patients were included in this review. No association with maternal or neonatal coagulopathy, infection or trauma was found. The average gestational age at diagnosis was 25 weeks (range 17-34 weeks). Approximately half of foetuses affected were female (48.7%); one quarter were male (25.6%) and one quarter had no sex stated (25.6%). Termination of pregnancy was chosen in 25.6% of cases (20/78). In continuing pregnancies,10.3% (6/58) experienced a perinatal death. Antenatally, the majority of lesions either decreased in size (38.5%) or completely resolved (32.7%). The neonatal or childhood outcome was normal in 88.0% of survivors (44/50). The average age at follow up was 16.4 months, ranging from birth to 6 years. CONCLUSION This review found that 10% of DST cases experience in-utero or neonatal death. In survivors, the majority of cases reduce in size or completely resolve in pregnancy and 85% are reported to have a good outcome. However, further evidence is needed regarding long-term neurocognitive sequelae.
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Affiliation(s)
- Adalina Sacco
- Institute for Women's Health, University College London, London, UK.,Fetal Medicine Unit, University College London Hospitals, London, UK
| | - Deepika Pannu
- Fetal Medicine Unit, University College London Hospitals, London, UK
| | - Fred Ushakov
- Fetal Medicine Unit, University College London Hospitals, London, UK
| | - Leigh Dyet
- Department of Neonatology, University College London Hospitals, London, UK
| | - Pranav Pandya
- Institute for Women's Health, University College London, London, UK.,Fetal Medicine Unit, University College London Hospitals, London, UK
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23
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Nesbit GM. Neurovascular disease and syndromes: Diagnosis and therapy in children. HANDBOOK OF CLINICAL NEUROLOGY 2020; 176:305-323. [PMID: 33272401 DOI: 10.1016/b978-0-444-64034-5.00015-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pediatric neurovascular disease runs the chronologic spectrum with dramatic changes in the presentation, evaluation, and treatment from the prenatal, perinatal, and infant periods through childhood and adolescence. These diseases are often dynamic throughout this period and the dynamic continues throughout life. There are four major categories: high-flow arteriovenous shunting lesions, arterial aneurysms, low-flow vascular lesions, and vascular occlusive disease. The high-flow lesions can be subdivided into a vein of Galen malformation, non-Galenic arteriovenous fistula, dural sinus malformations and fistula, and arteriovenous malformation. Low-flow vascular lesions include cerebral cavernous malformation, developmental venous anomaly, and capillary telangiectasia. The cerebrovascular occlusive disease can be divided between arterial occlusive disease and cerebral venous sinus thrombosis. The presentation of each of these entities can be very similar, especially in younger children; however, imaging and laboratory analysis can establish the diagnosis leading to the most appropriate therapy. A multidisciplinary team, dedicated to treating pediatric cerebrovascular disease, is important in delivering the best outcomes in these complex diseases. Given the relative rarity of pediatric presentation of cerebrovascular disease, many apply adult concepts to children. A better understanding of the diseases and their difference from adults makes a critical difference in selecting the correct approach.
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Affiliation(s)
- Gary M Nesbit
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, United States.
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24
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Smajda S, Söderman M, Dorfmüller G, Dorison N, Nghe MC, Rodesch G. Endovascular management of torcular dural sinus malformations in children: the role of straight sinus occlusion. J Neurointerv Surg 2020; 13:278-283. [PMID: 33199540 DOI: 10.1136/neurintsurg-2020-016888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Torcular dural sinus malformations (tDSMs) with arteriovenous shunts are rare congenital intracranial vascular malformations that carry a high rate of neurologic impairment and death in the neonatal, infant and young pediatric population. Their impact on brain venous drainage, especially the deep venous system, is one of the key factors in the clinical prognosis and natural history of the disease. We describe our therapeutic strategy for tDSMs, disconnecting the reflux into the deep venous system by performing an endovascular straight sinus occlusion. METHODS Among all children with dural sinus malformations seen between 2002 and 2020, we retrospectively reviewed those with tDSM in whom straight sinus occlusion had been performed. RESULTS Our databank included nine patients with tDSM that were embolized. Mean age at the clinical onset was 8.9±9.6 months (min-max=0-31). Five patients presented a significant reflux in the straight sinus on digital subtraction angiography. Those patients were initially clinically worse (mean modified Rankin Scale (mRS) 3.8) than those who did not present with reflux (mean mRS 2.25), this reflux being responsible for intraventricular hemorrhage in three patients. The reflux was suppressed by transarterial embolization in one patient and by transvenous straight sinus occlusion in four patients. Staged endovascular treatment resulted in a complete cure in six patients without complications, and clinical improvement in all patients. CONCLUSION Straight sinus occlusion is a feasible technique that needs to be considered in the treatment strategy for tDSM with deep venous reflux in order to avoid or minimize brain damage.
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Affiliation(s)
- Stanislas Smajda
- Interventional Neuroradiology, The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Michael Söderman
- Neuroradiology, Karolinska Universitetssjukhuset, Stockholm, Sweden.,Karolinska Institutet Department of Clinical Neuroscience, Stockholm, Sweden
| | - Georg Dorfmüller
- Department of Pediatric Neurosurgery, The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Nathalie Dorison
- Department of Pediatric Neurosurgery, The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Marie-Claire Nghe
- Department of Anesthesiology and Intensive Care, The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Georges Rodesch
- Diagnostic and Interventional Neuroradiology Department, Hôpital Foch, Suresnes, France
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25
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Brinjikji W, Cloft HJ, Flemming K, Lanzino G. Evolution of Developmental Venous Anomalies in the Setting of a Torcular Dural Arteriovenous Fistula and Cerebrofacial Venous Metameric Syndrome. World Neurosurg 2020; 143:46-50. [PMID: 32540292 DOI: 10.1016/j.wneu.2020.06.035] [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] [Received: 05/14/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND We describe evolution of a developmental venous anomaly (DVA) over time in a patient with a complex intracranial vascular malformation. CASE DESCRIPTION A 26-year-old male patient initially presented with a scalp vascular malformation and was later diagnosed to have a torcular dural arteriovenous fistula resembling a dural sinus malformation. The dural fistula increased in size over 4 years. The dural fistula also was associated with multiple complex developmental venous anomalies draining the bilateral cerebral hemispheres and cerebellum. The DVA was only faintly demonstrated on the baseline magnetic resonance imaging but appeared to increase in size and extent over time as the dural arteriovenous fistula developed more aggressive angioarchitecture features. In addition to the evolution manifestation of the DVAs, the patient developed multiple de novo cavernous malformations in the venous radicles of the DVA. Increased venous hypertension in the superficial venous system from the dural fistula likely resulted in growth of the DVAs, as they served as the primary means of venous drainage for the bilateral cerebral hemispheres. The patient also had reopening of the persistent falcine sinus, which was not present at baseline. CONCLUSIONS This would be the first reported case of growth or evolution of a DVA in association with a dural arteriovenous fistula in an adult patient and highlights the dynamic nature of both the medullary venous and dural venous sinuses of the cerebral venous system, even into adulthood.
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Affiliation(s)
- Waleed Brinjikji
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Harry J Cloft
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelly Flemming
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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26
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Liby P, Lomachinsky V, Petrak B, Kyncl M, Montarroyos UR, Tichy M. Torcular dural sinus malformations: a grading system proposal. Childs Nerv Syst 2020; 36:2707-2716. [PMID: 32198580 DOI: 10.1007/s00381-020-04569-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Torcular dural sinus malformations (tDSMs) are congenital complex vascular anomalies often referred as a single unit. Nevertheless, they possess distinct anatomical features, clinical diversity, and markedly different outcomes. OBJECTIVE On the basis of our institutional experience and analysis of published data, we propose a grading system. METHODS We have identified 44 papers to which we added our four institutional cases for a total of 126 patients. Eight predictor variables were studied. In order to assess their individual impact on mortality and possible correlations, a logistic regression model was constructed through a stepwise forward process. RESULTS Overall mortality was 22.1%. Mortality was higher in tDSM patients diagnosed postnatally, 40.7% versus a 15.6% in prenatally found cases (p = 0.007). We divided the patients into four grades. Grade I comprised patients with no feeder evidence and possessed the best outcomes (mortality of 7.55%). Mortality rose for grades II and III defined respectively by scarce and multiple feeders. Brain damage was the defining feature of grade IV. A mortality of 75% could be observed within this grade. Grade IV was further divided into grades IVa (antenatal) and IVb (postnatal cases). Furthermore, our logistic regression model found that brain damage (OR 11.3, p < 0.001, 95% CI 2.97-42.91) and patent feeders (OR 4, p = 0.03, 95% CI 1.15-13.86) were major determinants of poor outcome (area under ROC curve of 81.44%). CONCLUSION The grading system (tDSM-GS) streamlines classification into four different grades facilitating both diagnosis, clinical decision-making, and proper prognostication.
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Affiliation(s)
- P Liby
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, Prague 5, 150 06, Prague, Czech Republic.
| | - V Lomachinsky
- Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil
| | - B Petrak
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - M Kyncl
- Department of Radiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - U R Montarroyos
- Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil
| | - M Tichy
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, Prague 5, 150 06, Prague, Czech Republic
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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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Brinjikji W, Mark IT, Silvera VM, Guerin JB. Cervicofacial Venous Malformations Are Associated with Intracranial Developmental Venous Anomalies and Dural Venous Sinus Abnormalities. AJNR Am J Neuroradiol 2020; 41:1209-1214. [PMID: 32586966 DOI: 10.3174/ajnr.a6617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Prior studies have suggested an association between the presence of cervicofacial venous malformations and intracranial developmental venous anomalies. We reviewed our institutional cohort of patients with cervicofacial venous malformations and examined the spectrum of intracranial venous anomalies, including developmental venous anomalies, cavernous malformations, and dural venous sinus abnormalities. MATERIALS AND METHODS Consecutive patients who presented to our institution with cervicofacial venous malformations and underwent postcontrast MR imaging were studied. Three neuroradiologists reviewed brain MRIs for the presence of developmental venous anomalies, dural venous sinus ectasia, and cavernous malformations. The prevalence of developmental venous anomalies in this patient population was compared with an age- and sex-matched control group without venous malformations at a ratio of 1:2. Categoric variables were compared with χ2 tests. RESULTS Sixty-three patients with venous malformations met the inclusion criteria with a mean age of 38.3 ± 24.0 years. The overall presence of developmental venous anomalies in patients with venous malformations was 36.5% (23/63) compared with 7.9% (10/126) in controls (P < .001). The prevalence of dural venous sinus ectasia was 9.5% (6/63) compared with 0% for controls (P = .002). One patient with a venous malformation had a cavernous malformation compared with 1 patient in the control group (P = .62). In 73.9% of patients (17/23), developmental venous anomalies were along the same metamere; and in 82.6% of patients, developmental venous anomalies were ipsilateral to the venous malformations. CONCLUSIONS Our case-control study demonstrated a significant association between cervicofacial venous malformations and cerebral developmental venous anomalies as well as between cervicofacial venous malformations and dural venous sinus abnormalities. Our findings suggest that venous malformations may be the result of a segmental in utero insult to cells involved in cerebrofacial venous development.
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Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B., I.T.M., V.M.S., J.B.G.) .,Neurosurgery (W.B.), Mayo Clinic, Rochester, Minnesota
| | - I T Mark
- From the Departments of Radiology (W.B., I.T.M., V.M.S., J.B.G.)
| | - V M Silvera
- From the Departments of Radiology (W.B., I.T.M., V.M.S., J.B.G.)
| | - J B Guerin
- From the Departments of Radiology (W.B., I.T.M., V.M.S., J.B.G.)
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Lv X, Jiang C, Wang J. Pediatric intracranial arteriovenous shunts: Advances in diagnosis and treatment. Eur J Paediatr Neurol 2020; 25:29-39. [PMID: 31996298 DOI: 10.1016/j.ejpn.2019.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/24/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
Abstract
Pediatric intracranial arteriovenous shunts (IAVSs) comprise a wide range of lesions, including pial arteriovenous malformation (AVM) and arteriovenous fistula (AVF), dural arteriovenous fistula (DAVF) and vein of Galen aneurysmal malformation (VGAM). We provide an overview of pediatric IAVSs, encompassing both diagnosis and endovascular treatment. We include references from pertinent literature and representative cases from our hospital. Pediatric IAVS are frequently associated two broader conditions, such as capillary malformation-arteriovenous malformation (CM-AVM) and hereditary hemorrhagic telangiectasia (HHT). These conditions and the associated genetic mutations have only recently been described. Their impact on the brain will be different in the prenatal period, in neonates, in infants, and in children, with variable symptoms according to each age group and the current strategies of endovascular treatment in the management of these vascular lesions will be discussed. This review could improve the understanding of pediatric IAVSs and their diagnosis and treatment.
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Affiliation(s)
- Xianli Lv
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Chuhan Jiang
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Wang
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Torcular dural sinus malformations: a single-center case series and a review of literature. Childs Nerv Syst 2020; 36:333-341. [PMID: 31267184 DOI: 10.1007/s00381-019-04280-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Torcular dural sinus malformations (tDSMs) are rare vascular pathologies with various anatomoclinical pictures and prognosis. We analyzed our case series and corroborated the complexity of this rare unit by a review of literature. CASE SERIES From 2003 to 2018, we treated four tDSMs patients. The evolution of three postnatally diagnosed cases of similar angioarchitecture contrasted with a fourth antenatally diagnosed case with significant torcular thrombosis. All patients were examined by computed tomography, magnetic resonance imaging, CT angiography, and MRI angiography. Three patients underwent digital subtraction angiography with embolization of feeders. Unusual pathological images were depicted. CONCLUSIONS Early diagnosis along with embolization of feeders and lake could improve the outcome for tDSM patients with dural arteriovenous shunts. Ventriculoperitoneal shunt implantation before endovascular treatment led to significant worsening of both clinical presentation and MRI picture. For patients who persist with hydrocephalus despite the endovascular approach, we suggest endoscopic third ventriculostomy as a first-line treatment option. Antenatally diagnosed patients with thrombosed lakes constitute a prognostically better group of patients. Spontaneous thrombosis and remodelation of the lake can, however, still leave neurological sequelae, as observed in our patient.
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Dural sinus malformation with giant pouch (DSMGP): symptoms and treatment. Childs Nerv Syst 2020; 36:343-348. [PMID: 31396697 DOI: 10.1007/s00381-019-04338-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study is to describe the clinical manifestations and treatment options of patients having dural sinus malformation with giant pouch (DSMGP) in a tertiary pediatric center. INTRODUCTION Dural sinus malformation with giant pouch (DSMGP) is a rare vascular malformation affecting fetuses, newborns, and infants. It is characterized by a dilated dural sinus frequently thrombosed with arteriovenous fistula (AVF) in its wall. There is a few information about symptoms, best treatment, and prognosis of the disease. MATERIAL AND METHODS Medical charts of cases of DSMGP were retrospectively analyzed from January 2010 to January 2019. Our hospital is a pediatric tertiary center. An adult patient managed by the authors in another institution was added to the series. RESULTS Eight pediatric patients from 0 to 9 months were managed, four were males. The adult patient was a 40-year-old male. Symptoms were mass effect in 4 pediatric cases. Exophthalmos was present in the pediatric case and adult case. Both cases had venolymphatic malformation of the orbit. Congestive heart failure (CHF), epistaxis and facial vein engorgement, and intracranial hemorrhage (ICH) were the symptoms in other 3 cases. A child has spontaneous resolution of the disease. DISCUSSION Transverse sinus and superior sagittal sinus are affected more commonly. Patients with totally thrombosed pouch had mass effect symptoms. These cases were managed by surgical excision. When AVFs are present, clinical manifestations were secondary to cerebral venous hypertension or cardiac overload. If cavernous sinus drained the shunt (capture), epistaxis and facial veins engorgement could be present. AVFs are amenable to embolization, achieving the control of venous hypertension in most cases. Cavernous malformation could be present and must be controlled because its enlargement could be a sign of uncontrolled venous hypertension. On the other hand, DSMGP can be accompanied by venolymphatic malformation conforming a cerebral venous metameric syndrome.
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Jugular Bulb Dysmaturation in Torcular Dural Sinus Malformation: Clinical Images and Review of Literature. World Neurosurg 2019; 127:434-435. [DOI: 10.1016/j.wneu.2019.04.129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
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Puccinelli F, Tran Dong MNTK, Iacobucci M, Mazoit JX, Durand P, Tissieres P, Saliou G. Embolization of cerebral arteriovenous shunts in infants weighing less than 5 kg. J Neurosurg Pediatr 2019; 23:597-605. [PMID: 30797209 DOI: 10.3171/2018.11.peds1865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 11/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endovascular treatment in children, especially neonates, can be more challenging than analogous procedures in adults. This study aimed to describe the clinical and radiological findings, type and timing of endovascular treatment, and early outcomes in children who present with neurovascular malformations, who are treated with embolization, and who weigh less than 5 kg. METHODS The authors carried out a retrospective review of all consecutively treated children weighing less than 5 kg with neurovascular arteriovenous malformations (AVMs) at a single institution over a 10-year period. RESULTS Fifty-two patients were included in the study. Thirty-eight had a vein of Galen aneurysmal malformation, 3 a pial AVM, 6 a pial arteriovenous fistula, and 5 a dural sinus malformation. The endovascular treatment goals were control of cardiac failure or hydrocephalus in cases of nonhemorrhagic malformations or to prevent new bleeding in cases of previous hemorrhage. A hemorrhagic complication occurred in 12 procedures and an ischemic complication in 2. Both complication types were correlated with the age of the infant (age cutoff at 3 months) (p = of 0.015 and 0.049, respectively). No correlation was found with the weight of the infant or the duration of the procedure. CONCLUSIONS The embolization of AVMs in these patients prevented adverse cardiac effects, hydrovenous disorders, and rebleeding. The risk of major cerebral complications seems mainly correlated with age, with a threshold at 3 months. A multidisciplinary team involved in the treatment of these children may help to improve treatment success and management.
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Affiliation(s)
- Francesco Puccinelli
- 1Neuroradiologie Interventionnelle, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | - Jean-Xavier Mazoit
- 4Anesthésie Pédiatrique, Hôpital Bicêtre; Laboratoire d'Anesthésie UMR788 "Neuroprotection, Régénération des Axones et de la Myéline," Université Paris-Sud, Faculté de Médecine du Kremlin-Bicêtre; and
| | - Philippe Durand
- 5Réanimation Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Pierre Tissieres
- 5Réanimation Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Guillaume Saliou
- 1Neuroradiologie Interventionnelle, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- 3Service de Neuroradiologie, Hôpital Bicêtre
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Maneenil G, Thatrimontrichai A, Janjindamai W, Dissaneevate S, Tanaanantarak P. Spontaneous regression of neonatal dural sinus malformation. Pediatr Int 2019; 61:96-97. [PMID: 30734434 DOI: 10.1111/ped.13742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/15/2018] [Accepted: 10/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Gunlawadee Maneenil
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Anucha Thatrimontrichai
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Waricha Janjindamai
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Supaporn Dissaneevate
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pattama Tanaanantarak
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Koutsouras GW, Rahmani R, Schmidt T, Silberstein H, Bhalla T. Coil and Onyx embolization of a torcular herophili dural arteriovenous fistula in a full-term neonate with advanced heart failure using a transumbilical approach. J Neurosurg Pediatr 2019; 23:80-85. [PMID: 30485222 DOI: 10.3171/2018.6.peds1819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/22/2018] [Indexed: 11/06/2022]
Abstract
Neonatal dural arteriovenous fistulas (DAVFs) are rare, but if left untreated will advance to life-threatening neurological and cardiovascular compromise. Endovascular treatment is the preferred treatment modality for DAVFs. The goal of endovascular therapy is to obliterate feeding vasculature and prevent secondary complications. Endovascular access can be difficult to obtain in a neonate. The authors present the case of a full-term, normal birth weight neonate with severe congestive heart failure secondary to a congenital DAVF of the torcular herophili that was successfully treated with transumbilical arterial coil embolization and a liquid embolic agent.
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Affiliation(s)
- George W Koutsouras
- 1Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury; and
| | - Redi Rahmani
- 2Department of Neurological Surgery, University of Rochester, New York
| | - Tyler Schmidt
- 2Department of Neurological Surgery, University of Rochester, New York
| | | | - Tarun Bhalla
- 2Department of Neurological Surgery, University of Rochester, New York
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Terada A, Komiyama M, Ishiguro T, Niimi Y, Oishi H. Nationwide survey of pediatric intracranial arteriovenous shunts in Japan: Japanese Pediatric Arteriovenous Shunts Study (JPAS). J Neurosurg Pediatr 2018; 22:550-558. [PMID: 30052118 DOI: 10.3171/2018.5.peds18123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/10/2018] [Indexed: 11/06/2022]
Abstract
The authors performed a nationwide study in Japan to evaluate the annual detected rate of pediatric intracranial arteriovenous (AV) shunts such as brain AV malformations (BAVMs), pial AV fistulas (PAVFs), vein of Galen aneurysmal malformations (VGAMs), and dural AV fistulas (DAVFs). These rates were revealed for the first time and showed that VGAM, DAVF, and PAVF were relatively common but that BAVMs were extremely rare in neonates and infants.
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Affiliation(s)
- Aiko Terada
- Departments of1Neurosurgery and
- 2Neurointervention, Osaka City General Hospital, Osaka
| | | | | | - Yasunari Niimi
- 3Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo; and
| | - Hidenori Oishi
- Departments of4Neuroendovascular Therapy and
- 5Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
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Goyal P, Mangla R, Gupta S, Malhotra A, Almast J, Sapire J, Kolar B. Pediatric Congenital Cerebrovascular Anomalies. J Neuroimaging 2018; 29:165-181. [DOI: 10.1111/jon.12575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pradeep Goyal
- Department of Radiology; St. Vincent's Medical Center; Bridgeport CT
| | - Rajiv Mangla
- Department of Radiology; SUNY Upstate Medical University; Syracuse NY
| | - Sonali Gupta
- Department of Medicine; St. Vincent's Medical Center; Bridgeport CT
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging; Yale School of Medicine; New Haven CT
| | - Jeevak Almast
- Department of Radiology; University of Rochester Medical Center; Rochester NY
| | - Joshua Sapire
- Department of Radiology; St. Vincent's Medical Center; Bridgeport CT
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Cho HJ, Jung EJ, Byun JM, Jeong DH, Lee KB, Sung MS, Kim YN. Thrombosed Fetal Dural Sinus Malformation: Correlation Between Prenatal Ultrasound and Autopsy Findings. Fetal Pediatr Pathol 2018; 37:287-295. [PMID: 30265815 DOI: 10.1080/15513815.2018.1478473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Dural sinus malformations, which are characterized by massively dilated dural sinuses, are one of the etiologies of an intracranial fetal cystic mass. Thrombi within these dural sinus malformations can develop while in-utero, and can be visualized by ultrasound in fetal life. Definitive postnatal diagnosis requires an autopsy. CASE REPORT We report two thrombosed fetal dural sinus malformations which are prenatally suspected during the second trimester with ultrasonography and postnatally confirmed with autopsy. CONCLUSION Prenatal ultrasound images and fetal autopsy findings can be useful to establish the prenatal diagnosis of thrombosed dural sinus malformation.
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Affiliation(s)
- Hwa Jin Cho
- a Pathology , Inje University Busan Paik Hospital , Busan , Korea
| | - Eun Jung Jung
- b Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital , Busan , Korea
| | - Jung Mi Byun
- b Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital , Busan , Korea.,c Paik Institute for Clinical Research, Busan Paik Hospital , Busan , Korea
| | - Dae Hoon Jeong
- b Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital , Busan , Korea.,c Paik Institute for Clinical Research, Busan Paik Hospital , Busan , Korea
| | - Kyung Bok Lee
- b Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital , Busan , Korea.,c Paik Institute for Clinical Research, Busan Paik Hospital , Busan , Korea
| | - Moon Su Sung
- b Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital , Busan , Korea.,c Paik Institute for Clinical Research, Busan Paik Hospital , Busan , Korea
| | - Young Nam Kim
- b Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital , Busan , Korea.,c Paik Institute for Clinical Research, Busan Paik Hospital , Busan , Korea
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Xia W, Hu D, Xiao P, Yang W, Chen X. Dural Sinus Malformation Imaging in the Fetus: Based on 4 Cases and Literature Review. J Stroke Cerebrovasc Dis 2018; 27:1068-1076. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/27/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022] Open
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Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus. Neuroradiology 2018; 60:325-333. [PMID: 29356857 DOI: 10.1007/s00234-018-1980-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The primitive tentorial, occipital, and falcine sinuses are thought to attain the adult pattern or regress between the fetal stage and adulthood. The anatomy of these three primitive dural sinuses has seldom been studied in the infant population, and it remains unclear when these dural sinuses reach the adult condition. Using computed tomography digital subtraction venography (CT-DSV), we analyzed the anatomy of these embryonic dural sinuses in infants. METHODS We included 13 infants who underwent CT-DSV prior to neurosurgery and 35 cases with unruptured cerebral aneurysms as normal adult controls. Three embryonic dural sinuses, i.e., the primitive tentorial, occipital, and falcine sinuses, were retrospectively analyzed in CT-DSV images of infants and adults. We also analyzed the drainage patterns of the superficial middle cerebral vein (SMCV), determined by the connection between the primitive tentorial sinus and the cavernous sinus. RESULTS The primitive tentorial, occipital, and falcine sinuses were present in 15.4%, 46.2%, and none of the infants, respectively, and in 10.0, 8.6, and 2.9% of the adults, respectively. The difference in SMCV draining pattern between infants and adults was insignificant. The incidence of the occipital sinus was significantly higher in infants than in adults. CONCLUSIONS The connection between the primitive tentorial sinus and the cavernous sinus appears to be established before birth. The occipital sinus is formed at the embryonic stage and mostly regresses after infancy. The falcine sinus is usually obliterated prenatally. Our findings form the basis for interventions by pediatric interventional neuroradiologists and neurosurgeons.
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Yang E, Storey A, Olson HE, Soul J, Estroff JA, Trenor CC, Cooper BK, Smith ER, Orbach DB. Imaging features and prognostic factors in fetal and postnatal torcular dural sinus malformations, part II: synthesis of the literature and patient management. J Neurointerv Surg 2017; 10:471-475. [PMID: 28965104 DOI: 10.1136/neurintsurg-2017-013343] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Torcular dural sinus malformations (tDSMs) are described as slow flow dural arteriovenous fistulae with frequently poor outcomes in the neuroangiographic literature, but other etiologies have been proposed in the obstetric literature, where outcomes have been more favorable. OBJECTIVE To review tDSMs reported in the literature of multiple specialties for features that support a common etiology, and to identify key prognostic factors, with an emphasis on tDSM trajectory highlighted in part I. METHODS Analysis of imaging features and clinical outcome for 77 prenatal and 22 postnatal tDSMs reported in 37 papers from the literature. RESULTS In addition to large venous lakes, 36% of prenatal and 96% of postnatal tDSMs had evidence of arterialization, where specifically assessed. For fetal cases, where there was an observable natural history, 97% underwent a spontaneous decrease-13% after an initial increase and only 1 case with subsequent enlargement after a decrease. Prenatal cases had 83% survival (62% with a favorable outcome) whereas postnatal cases had 59% survival (29% favorable). In addition to a postnatal diagnosis, unfavorable features included ventriculomegaly, parenchymal injury, arterialization, and need for intervention. Favorable features included decreasing tDSM size, presence of clot, and increasing clot percentage. CONCLUSIONS Neonatal and fetal tDSMs have overlapping imaging appearances, suggesting a common etiology, where neonatal tDSMs represent those rare fetal tDSMs that do not undergo spontaneous regression and have a propensity for worse outcomes. Decrease in tDSM size is a critical observation when managing a tDSM because it is generally irreversible and associated with a favorable outcome.
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Affiliation(s)
- Edward Yang
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Armide Storey
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Heather E Olson
- Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Janet Soul
- Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Judy A Estroff
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cameron C Trenor
- Stroke and Cerebrovascular Center and Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Benjamin K Cooper
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Edward R Smith
- Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Darren B Orbach
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, Massachusetts, USA
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Yang E, Storey A, Olson HE, Soul J, Estroff JA, Trenor CC, Cooper BK, Smith ER, Orbach DB. Imaging features and prognostic factors in fetal and postnatal torcular dural sinus malformations, part I: review of experience at Boston Children's Hospital. J Neurointerv Surg 2017; 10:467-470. [PMID: 28965107 DOI: 10.1136/neurintsurg-2017-013344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Even for the most common dural sinus malformation (DSM), the torcular DSM (tDSM), generalizable statements about etiology and prognosis are difficult because neurosurgeons/neuroradiologists and obstetrical imagers have focused on different patient age groups, have reported different outcomes, and have offered differing pathophysiologic explanations. OBJECTIVE To examine the imaging features and outcomes of a local cohort of tDSMs across fetal-neonatal life for commonalities. METHODS Review of imaging and clinical outcome for a local cohort of 12 tDSM patients (9 fetal, 3 postnatal). RESULTS All 12 tDSMs had similar imaging characteristics, including enlargement of the torcular and intraluminal thrombus early on, later evolving to peripheral scar tissue after treatment or spontaneous regression. Spontaneous decrease in size of the tDSM was observed in 6 prenatal and 1 postnatal case, and this decrease appeared to be irreversible once it occurred. One of 9 prenatal tDSMs was demonstrated to have arteriovenous fistulae in utero, while 2 of 3 postnatal diagnoses had arteriovenous fisutlae. All 6 prenatal tDSM diagnoses followed to term and all 3 postnatal diagnoses had a grossly normal neurologic outcome after a median of 12 months of age. CONCLUSIONS Prenatal and postnatal tDSMs have overlapping imaging features suggesting a common etiology, and involution of a tDSM is a key imaging biomarker for a favorable outcome. While there is reason for concern with postnatally diagnosed tDSMs, good outcomes may still be achieved across the fetal-neonatal age spectrum of presentations. These findings are generalized in part II of this article.
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Affiliation(s)
- Edward Yang
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Armide Storey
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Heather E Olson
- Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Janet Soul
- Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Judy A Estroff
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cameron C Trenor
- Stroke and Cerebrovascular Center and Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Benjamin K Cooper
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Edward R Smith
- Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Darren B Orbach
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, Massachusetts, USA
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Mizutani K, Miwa T, Akiyama T, Kanazawa T, Nagashima H, Miyakoshi K, Niimi Y, Yoshida K. Postnatal delayed exacerbation of dural sinus malformation associated with brainstem cavernous malformations: A case report. Interv Neuroradiol 2017; 23:510-515. [PMID: 28728536 DOI: 10.1177/1591019917720806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dural sinus malformation (DSM) is a rare paediatric vascular malformation characterised by abnormal dilation of the posterior dural sinus. Owing to its rarity, the pathophysiology of DSM has not been fully elucidated. We report a case of prenatally diagnosed DSM with an unusual clinical course. We detected DSM in a male foetus in the 26th week of gestation by using foetal ultrasonography. Although the DSM regressed during the foetal stage and the arteriovenous shunt was insignificant in the neonate, the shunt rapidly developed four months after birth. The neonate also had postnatal de novo brainstem cavernous malformation (CM), which also developed rapidly, supposedly due to the aggravated venous hypertension resulting from the DSM. We successfully treated the aggravated shunts by endovascular transarterial and transvenous embolisation six times over two years and, subsequently, the clinical condition and the size of the brainstem CM became stable. The DSM and CM seemed to have a metameric origin. Such aberrant cases could help to further the understanding of DSM.
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Affiliation(s)
- Katsuhiro Mizutani
- 1 Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Tomoru Miwa
- 1 Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Takenori Akiyama
- 1 Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Tokunori Kanazawa
- 1 Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Hideaki Nagashima
- 1 Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Kei Miyakoshi
- 2 Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunari Niimi
- 3 Department of Neuroendovascular Therapy, St Luka's International Hospital, Tokyo, Japan
| | - Kazunari Yoshida
- 1 Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
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Yu J, Lv X, Li Y, Wu Z. Therapeutic progress in pediatric intracranial dural arteriovenous shunts: A review. Interv Neuroradiol 2016; 22:548-56. [PMID: 27306522 PMCID: PMC5072209 DOI: 10.1177/1591019916653254] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023] Open
Abstract
Pediatric dural arteriovenous shunts (dAVSs) are a rare form of vascular disease: Fewer than 100 cases are reported in PubMed and the understanding of pediatric dAVS is limited. For this study, we searched in PubMed, reviewed and summarized the literature related to pediatric dAVSs. Our review revealed that pediatric dAVSs have an unfavorable natural history: If left untreated, the majority of pediatric dAVSs deteriorate. In a widely accepted classification scheme developed by Lasjaunias et al., pediatric dAVSs are divided into three types: Dural sinus malformation (DMS) with dAVS, infantile dAVS (IDAVS) and adult-type dAVS (ADAVS). In general, the clinical manifestations of dAVS can be summarized as having symptoms due to high-flow arteriovenous shunts, symptoms from retrograde venous drainage, symptoms from cavernous sinus involvement and hydrocephalus, among other signs and symptoms. The pediatric dAVSs may be identified with several imaging techniques; however, the gold standard is digital subtraction angiography (DSA), which indicates unique anatomical details and hemodynamic features. Effectively treating pediatric dAVS is difficult and the prognosis is often unsatisfactory. Transarterial embolization with liquid embolic agents and coils is the treatment of choice for the safe stabilization and/or improvement of the symptoms of pediatric dAVS. In some cases, transumbilical arterial and transvenous approaches have been effective, and surgical resection is also an effective alternative in some cases. Nevertheless, pediatric dAVS can have an unsatisfactory prognosis, even when timely and appropriate treatment is administered; however, with the development of embolization materials and techniques, the potential for improved treatments and prognoses is increasing.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China Beijing Tiantan Hospital, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China Beijing Tiantan Hospital, Beijing, China
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China Beijing Tiantan Hospital, Beijing, China
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Management of midline dural sinus malformations and review of the literature. Childs Nerv Syst 2016; 32:1449-61. [PMID: 27207610 DOI: 10.1007/s00381-016-3115-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Dural sinus malformations (DSMs) are rare pediatric vascular lesions that have variable presentations and outcomes. We present three cases of midline DSMs and discuss the treatment strategy employed for each lesion. A review of the literature was completed to summarize current literature and treatment practices. METHODS A retrospective review of the electronic medical record and all available imaging studies was performed for each of our patients. RESULTS Patient 1 had a prenatally diagnosed DSM which decreased in size despite no intervention. She was born without complication and continues to do well at 15 months of age. Patient 2 presented 2 weeks after birth with cardiac failure, intracranial hemorrhage, and seizures and imaging showed a large midline DSM with multiple high-flow shunts. She required multiple endovascular embolizations with complete occlusion of the lesion. At her 3-year follow-up, she was neurologically normal. The third patient was diagnosed prenatally with an enlarging DSM. Multiple endovascular embolizations, surgical decompression, cranial expansion, and CSF diversion were required for treatment. At her 2.5-year follow-up, she was meeting developmental milestones, with some motor delay. CONCLUSION Early diagnosis and treatment, if necessary, of DSMs are critical to prevent cardiac failure or parenchymal injury from chronic venous hypertension. Management should be decided on individual case basis depending on the angioarchitecture and progression of the lesion and can involve observation, endovascular embolization, surgical interventions, or a combination of treatments. A personalized approach to treating these variable lesions can be associated with good outcomes.
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Honarmand AR, Hurley MC, Ansari SA, Alden TD, Kuhn R, Syed FH, Shaibani A. Familial incidence of the congenital torcular dural arteriovenous shunt: Case report and review of the literature. Clin Neurol Neurosurg 2016; 144:129-32. [PMID: 27049968 DOI: 10.1016/j.clineuro.2016.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 11/24/2022]
Abstract
Congenital dural sinus malformations are rare but can be major causes of mortality and morbidity in the pediatric population if not detected and managed urgently. Lesions involving large draining sinus structures such as superior sagittal sinus and torcular herophili can result in significant intracranial circulation impairment mostly due to venous drainage disturbance. Early detection plays a pivotal role in the outcome of the patients. Rarely familial incidence of some types of arteriovenous malformations in isolation from other congenital hereditary disorders has been reported. Knowledge of the familial association of congenital dural sinus malformations may raise the awareness for considering the possibility of occurrence of these lesions in the relatives of index cases. Herein, we describe the occurrence of giant torcular dural shunt in two pediatric cousins treated with endovascular embolization.
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Affiliation(s)
- Amir R Honarmand
- Departments of Radiology Northwestern University, Feinberg of School of Medicine, Chicago, IL, USA.
| | - Michael C Hurley
- Departments of Radiology Northwestern University, Feinberg of School of Medicine, Chicago, IL, USA; Neurological Surgery, Northwestern University, Feinberg of School of Medicine, Chicago, IL, USA
| | - Sameer A Ansari
- Departments of Radiology Northwestern University, Feinberg of School of Medicine, Chicago, IL, USA; Neurological Surgery, Northwestern University, Feinberg of School of Medicine, Chicago, IL, USA; Neurology, Northwestern University, Feinberg of School of Medicine, Chicago, IL, USA
| | - Tord D Alden
- Neurological Surgery, Northwestern University, Feinberg of School of Medicine, Chicago, IL, USA; Neurosurgery, Divisions, Ann & Robert H. Lurie Children's, Hospital of Chicago. Chicago, IL, USA
| | - Ryan Kuhn
- Neuro-interventional Surgery, Divisions, Ann & Robert H. Lurie Children's, Hospital of Chicago. Chicago, IL, USA
| | - Furqan H Syed
- Departments of Radiology Northwestern University, Feinberg of School of Medicine, Chicago, IL, USA
| | - Ali Shaibani
- Departments of Radiology Northwestern University, Feinberg of School of Medicine, Chicago, IL, USA; Neurological Surgery, Northwestern University, Feinberg of School of Medicine, Chicago, IL, USA; Neuro-interventional Surgery, Divisions, Ann & Robert H. Lurie Children's, Hospital of Chicago. Chicago, IL, USA
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Lolli V, Molinari F, Pruvo JP, Soto Ares G. Radiological and clinical features of cerebral sinovenous thrombosis in newborns and older children. J Neuroradiol 2016; 43:280-9. [PMID: 26970861 DOI: 10.1016/j.neurad.2015.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/08/2015] [Accepted: 12/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral sinovenous thrombosis (CSVT) represents an increasingly recognized cause of pediatric stroke. Our purpose was to assess gender and age differences in the etiology, clinical presentation, and imaging features of CSVT in neonates and older children. METHODS Subjects aged newborn to 18 years diagnosed with CSVT at the Lille university hospital between 2011 and 2014 were included. RESULTS Eleven neonates and 16 non-neonates constituted the study population. The incidence of CSVT was significantly higher in male newborns. Clinical presentation did not vary significantly between the groups. Risk factors were age-dependent, with acute systemic illnesses significantly predominating in neonates (54%), whereas local infections, prothrombotic conditions, and trauma were more common in older children (36, 27, and 27% respectively). No predisposing factor could be identified in 36% of the neonates as compared to less than 5% of the non-neonates. Thrombosis of the deep venous structures was documented in 73% of the neonates whereas involvement of the superficial sinuses was significantly more frequent in the non-neonates group. Venous infarctions and extraparenchymal hemorrhages were significantly more frequent in the neonates group. CONCLUSION Male patients are at higher risk for CSVT than females. In neonates, involvement of the deep venous structures is significantly more common. Brain parenchymal and extraparenchymal changes occur more frequently in this age group than in older children.
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Affiliation(s)
- Valentina Lolli
- Radiology department, Erasmus university hospital, 808, route de Lennik, 1070 Brussels, Belgium.
| | | | - Jean-Pierre Pruvo
- Neuroradiology department, Roger-Salengro hospital, 59037 Lille, France
| | - Gustavo Soto Ares
- Neuroradiology department, Roger-Salengro hospital, 59037 Lille, France
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Ochiai D, Miyakoshi K, Miwa T, Fukutake M, Kasuga Y, Matsumoto T, Tanaka M. Prenatal diagnosis of thrombosed dural sinus malformation with periorbital hemangioma: a case report. Eur J Obstet Gynecol Reprod Biol 2016; 198:157-159. [DOI: 10.1016/j.ejogrb.2015.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 08/29/2015] [Accepted: 09/17/2015] [Indexed: 12/01/2022]
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50
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Burch EA, Orbach DB. Pediatric central nervous system vascular malformations. Pediatr Radiol 2015; 45 Suppl 3:S463-72. [PMID: 26346152 DOI: 10.1007/s00247-015-3356-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/10/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
Pediatric central nervous system (CNS) vascular anomalies include lesions found only in the pediatric population and also the full gamut of vascular lesions found in adults. Pediatric-specific lesions discussed here include infantile hemangioma, vein of Galen malformation and dural sinus malformation. Some CNS vascular lesions that occur in adults, such as arteriovenous malformation, have somewhat distinct manifestations in children, and those are also discussed. Additionally, children with CNS vascular malformations often have associated broader vascular conditions, e.g., PHACES (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, eye anomalies and sternal anomalies), hereditary hemorrhagic telangiectasia, and capillary malformation-arteriovenous malformation syndrome (related to the RASA1 mutation). The treatment of pediatric CNS vascular malformations has greatly benefited from advances in endovascular therapy, including technical advances in adult interventional neuroradiology. Dramatic advances in therapy are expected to stem from increased understanding of the genetics and vascular biology that underlie pediatric CNS vascular malformations.
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Affiliation(s)
- Ezra A Burch
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
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