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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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2
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Su X, Ma Y, Song Z, Ye M, Zhang H, Zhang P. Paediatric intracranial dural arteriovenous fistulas: clinical characteristics, treatment outcomes and prognosis. Stroke Vasc Neurol 2024:svn-2024-003122. [PMID: 38839343 DOI: 10.1136/svn-2024-003122] [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: 01/13/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Compared with dural arteriovenous fistulas (DAVFs) in adult, paediatric DAVFs are notable for distinct clinical manifestations, low cure rate and poor prognosis. However, due to the limitations of small sample sizes, the long-term prognosis and follow-up data have not been described. METHODS Clinical data from 43 consecutive paediatric DAVFs were documented and analysed between 2002 and 2022 at the author's institution. They were divided into infantile (Lasjaunias classification) and non-infantile (adult type and dural sinus malformation (DSM)) type DAVFs based on prognosis differences. RESULTS Their mean age at first symptoms was 8.4±6.0 years. 29 boys and 14 girls presented between at birth and 18 years of age. 5 of 10 patients ≤1 year of age presented with asymptomatic cardiomegaly compared with 5/33 patients >1 year of age (p=0.022). 42 (88.4%) patients received endovascular treatment alone, while 9.3% underwent radiosurgery, burr hole embolisation or surgery. 28 (65.1%) patients experienced DAVF obliteration by the end of treatment. Among them, 26 cases underwent embolisation alone, one case had embolisation in conjunction with surgery, and one case underwent burr hole embolisation. The overall complication rate among patients was 9.3%, all resulting from endovascular treatment. According to the Lasjaunias Classification, there were 18 cases of adult type, 17 cases of infantile type and 8 cases of DSM. Compared with non-infantile-type DAVFs, infantile-type DAVFs showed more times of treatment, lower cure rate and worse prognosis (p<0.001, 0.003 and 0.021, respectively). The average follow-up duration was 41.4±36.2 months (3-228 months). 8 (22.9%) patients died. CONCLUSIONS Most adult-type DAVFs and DSMs can now be effectively treated with embolisation, resulting in good outcomes and prognosis. However, there are still challenges in treating infantile-type DAVFs, and the prognosis is frequently poor.
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Affiliation(s)
- Xin Su
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
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3
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Oushy S, Orbach DB. Infantile dural arteriovenous fistula: a reconsideration. J Neurointerv Surg 2024:jnis-2023-021355. [PMID: 38453460 DOI: 10.1136/jnis-2023-021355] [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: 12/12/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Infantile-type dural arteriovenous shunts (IDAVS) are rare and heterogeneous vascular lesions, complicating their classification and management. The current tripartite classification of pediatric dural arteriovenous shunts (DAVS) into dural sinus malformation, infantile-type, and adult-type, does not stand up to scrutiny, given the variable presentations of the latter two types in children. We estimate the prevalence of IDAVS and evaluate the long term outcomes after endovascular treatment (EVT). METHODS A retrospective review of a pediatric cerebrovascular database between 2006 and 2023 was conducted. Clinical and radiographic data were analyzed to evaluate the presentation and long term outcomes of IDAVS. RESULTS IDAVS were identified in 8 (0.5%) of 1463 patients, with mean age at diagnosis of 34.7 months; male infants comprised 62.5%. The most common clinical presentations included macrocephaly (37.5%), seizures (25%), and dilated scalp veins (25%). EVT was performed in 87.5% of cases, averaging 5.8 procedures per patient. Radiographic obliteration was observed in 28.6%. Good clinical outcomes (modified Rankin Scale score of ≤2) were achieved in 85.7%. Our findings showcased discrepancies and limitations in the current classification of pediatric DAVS, prompting a re-evaluation. CONCLUSION IDAVS accounted for a small proportion of pediatric cerebrovascular pathologies, with markedly heterogeneous presentations. Stepwise selective embolization was associated with favorable outcomes, and is recommended over an aggressive approach with the goal of complete angiographic obliteration. Our proposed revised classification system bifurcates pediatric DAVS into dural sinus malformations and all other DAVS that are manifest in children, thereby enhancing diagnostic clarity and therapeutic approaches.
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Affiliation(s)
- Soliman Oushy
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Darren B Orbach
- Department of Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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4
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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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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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6
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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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7
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Kida S, Neki H, Hiramatsu H, Kamio Y, Makita I, Shiraishi Y, Kurozumi K. De novo dural arteriovenous fistula after mechanical thrombectomy for cerebral venous thrombosis: A case report. Surg Neurol Int 2022; 13:411. [PMID: 36324950 PMCID: PMC9610459 DOI: 10.25259/sni_625_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Although the relationship between dural arteriovenous fistula (dAVF) and cerebral venous thrombosis (CVT) has been reported, the etiology has not been clarified. Here, we report a case of de novo dAVF after mechanical thrombectomy for CVT and discuss the underlying mechanism. Case Description: A 61-year-old woman presented with a gradually worsening headache and was diagnosed with severe CVT. Mechanical thrombectomy was performed for the CVT because of progressive neurological deterioration despite anticoagulation therapy. Two years after the initial treatment, angiography revealed a de novo dAVF with a direct shunt of the left convexity cortical vein. Transarterial embolization with Onyx was performed and the shunt was completely obliterated. Conclusion: In this report, we describe a case of de novo dAVF with CVT that was treated with mechanical thrombectomy. Even if CVT improves with mechanical thrombectomy, we must be aware of the occurrence of de novo dAVF.
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Affiliation(s)
- Satoru Kida
- Department of Neurosurgery, Hamamatsu University School of Medicine,
| | - Hiroaki Neki
- Department of Neurosurgery, Hamamatsu University School of Medicine,
| | - Hisaya Hiramatsu
- Department of Neurosurgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Yoshinobu Kamio
- Department of Neurosurgery, Hamamatsu University School of Medicine,
| | - Ippei Makita
- Department of Neurosurgery, Hamamatsu University School of Medicine,
| | - Yuki Shiraishi
- Department of Neurosurgery, Hamamatsu University School of Medicine,
| | - Kazuhiko Kurozumi
- Department of Neurosurgery, Hamamatsu University School of Medicine,
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8
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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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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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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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11
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Jones J, Christie J, Woodbury S, Mizia K. Fetal dural sinus malformation: A case report and discussion of the literature. Australas J Ultrasound Med 2021; 24:249-252. [PMID: 34888135 DOI: 10.1002/ajum.12285] [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: 04/27/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction Fetal dural sinus malformation is a rare but important finding during pregnancy as it has the potential for significant complications. Methods Here we present a case of fetal dural sinus malformation and review the current literature relevant to this condition. Results We present the case of a 33-year-old woman who had fetal dural sinus malformation containing thrombus diagnosed at morphology ultrasound and confirmed on fetal magnetic resonance imaging (MRI). Serial ultrasounds demonstrated the sinus to reduce significantly in size over the course of the pregnancy. The woman delivered a healthy, term baby and there was no evidence of any neurological compromise in the early neonatal period. Discussion This case is in keeping with a recent systematic review, which identified 78 previous cases of fetal dural sinus thrombosis and reported good outcomes in most cases. Conclusion It therefore appears reasonable, in most cases of isolated dural sinus malformation, to monitor the progress of the lesion and continue managing the pregnancy as usual.
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Affiliation(s)
- Jacqueline Jones
- Obstetrics and Gynaecology Royal North Shore Hospital Sydney New South Wales Australia
| | - James Christie
- Radiology Department The Children's Hospital at Westmead Sydney New South Wales Australia.,Radiology Department North Shore Private Hospital Sydney New South Wales Australia
| | - Sarah Woodbury
- Obstetrics and Gynaecology North Shore Private Hospital Sydney New South Wales Australia
| | - Karen Mizia
- Obstetrics and Gynaecology Royal North Shore Hospital Sydney New South Wales Australia.,Maternal Fetal Medicine Unit Royal North Shore Hospital Sydney New South Wales Australia.,Sydney University Sydney New South Wales Australia
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12
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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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13
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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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14
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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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15
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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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16
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Rare occurrence of dural arteriovenous fistula in a child: Multi-modality imaging and literature review. Radiol Case Rep 2021; 16:879-883. [PMID: 33552345 PMCID: PMC7850937 DOI: 10.1016/j.radcr.2021.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
A dural arteriovenous fistula (AVF) is a rare condition in a child and is not evident clinically. It is a type of an acquired cerebral vascular malformation that usually occurs after a thrombotic event of the cerebral venous sinuses. Dural AVF is not suspected clinically and is revealed through imaging done for evaluation of cranial symptoms. Therefore, it is essential to revisit the pathophysiology and the clinical situations leading to intracranial dural AVF. Equally crucial is identifying the imaging findings on computed tomography, or magnetic resonance imaging brain scans done as a preliminary work-up in these patients. However, for optimal management decision and prognostication of dural AVF, a digital subtraction angiography is essential. As the entire burden of establishing the diagnosis rests on the radiologists, we would like to present this rare case report highlighting both the clinical and imaging aspects and the management options available for dural AVFs.
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17
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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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18
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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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19
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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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20
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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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21
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Venous pathologies in paediatric neuroradiology: from foetal to adolescent life. Neuroradiology 2019; 62:15-37. [PMID: 31707531 DOI: 10.1007/s00234-019-02294-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
The interpretation of cerebral venous pathologies in paediatric practice is challenging as there are several normal anatomical variants, and the pathologies are diverse, involving the venous system through direct and indirect mechanisms. This paper aims to provide a comprehensive review of these entities, as their awareness can avoid potential diagnostic pitfalls. We also propose a practical classification system of paediatric cerebral venous pathologies, which will enable more accurate reporting of the neuroimaging findings, as relevant to the underlying pathogenesis of these conditions. The proposed classification system comprises of the following main groups: arterio-venous shunting-related disorders, primary venous malformations and veno-occlusive disorders. A multimodal imaging approach has been included in the relevant subsections, with a brief overview of the modality-specific pitfalls that can also limit interpretation of the neuroimaging. The article also summarises the current literature and international practices in terms of management options and outcomes in specific disease entities.
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22
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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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23
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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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24
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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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25
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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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26
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Batista UC, Abud TG, Baccin CE, Tosello RT, Diniz AA, Pereira BJA, Piske RL. Dural sinus malformation presenting with seizure and treated by combined arterial and venous embolization. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 75:677-679. [PMID: 28977152 DOI: 10.1590/0004-282x20170117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/31/2017] [Indexed: 11/21/2022]
Affiliation(s)
- Ulysses C Batista
- Hospital Beneficência Portuguesa de São Paulo, Centro de Neuroangiografia (CNA), São Paulo SP, Brasil.,Hospital Alvorada, Neuroradiologia Intervencionista, São Paulo SP, Brasil
| | - Thiago Giansante Abud
- Hospital Beneficência Portuguesa de São Paulo, Centro de Neuroangiografia (CNA), São Paulo SP, Brasil.,Hospital Alvorada, Neuroradiologia Intervencionista, São Paulo SP, Brasil.,Hospital Albert Einstein, Neuroradiologia Intervencionista, São Paulo SP, Brasil
| | - Carlos Eduardo Baccin
- Hospital Beneficência Portuguesa de São Paulo, Centro de Neuroangiografia (CNA), São Paulo SP, Brasil.,Hospital Alvorada, Neuroradiologia Intervencionista, São Paulo SP, Brasil.,Hospital Albert Einstein, Neuroradiologia Intervencionista, São Paulo SP, Brasil
| | - Renato Tavares Tosello
- Hospital Beneficência Portuguesa de São Paulo, Centro de Neuroangiografia (CNA), São Paulo SP, Brasil.,Hospital Alvorada, Neuroradiologia Intervencionista, São Paulo SP, Brasil
| | - Aron Athayde Diniz
- Hospital Beneficência Portuguesa de São Paulo, Centro de Neuroangiografia (CNA), São Paulo SP, Brasil.,Hospital Alvorada, Neuroradiologia Intervencionista, São Paulo SP, Brasil
| | | | - Ronie Leo Piske
- Hospital Beneficência Portuguesa de São Paulo, Centro de Neuroangiografia (CNA), São Paulo SP, Brasil.,Hospital Alvorada, Neuroradiologia Intervencionista, São Paulo SP, Brasil.,Hospital Albert Einstein, Neuroradiologia Intervencionista, São Paulo SP, Brasil
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27
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Tan AP, Svrckova P, Cowan F, Chong WK, Mankad K. Intracranial hemorrhage in neonates: A review of etiologies, patterns and predicted clinical outcomes. Eur J Paediatr Neurol 2018; 22:690-717. [PMID: 29731328 DOI: 10.1016/j.ejpn.2018.04.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 03/31/2018] [Accepted: 04/18/2018] [Indexed: 12/29/2022]
Abstract
Intracranial hemorrhage (ICH) in neonates often results in devastating neurodevelopmental outcomes as the neonatal period is a critical window for brain development. The neurodevelopmental outcomes in neonates with ICH are determined by the maturity of the brain, the location and extent of the hemorrhage, the specific underlying etiology and the presence of other concomitant disorders. Neonatal ICH may result from various inherited and acquired disorders. We classify the etiologies of neonatal ICH into eight main categories: (1) Hemorrhagic stroke including large focal hematoma, (2) Prematurity-related hemorrhage, (3) Bleeding diathesis, (4) Genetic causes, (5) Infection, (6) Trauma-related hemorrhage, (7) Tumor-related hemorrhage and (8) Vascular malformations. Illustrative cases showing various imaging patterns that can be helpful to predict clinical outcomes will be highlighted. Potential mimics of ICH in the neonatal period are also reviewed.
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Affiliation(s)
- Ai Peng Tan
- Department of Diagnostic Imaging, National University Health System, 1E Kent Ridge Rd 119228, Singapore.
| | - Patricia Svrckova
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK.
| | - Frances Cowan
- Dept. of Neonatology, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College, London, SW10 9NH, UK.
| | - Wui Khean Chong
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK.
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK.
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28
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29
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Shuman MJ, Hutchins KD. Authors' Response. J Forensic Sci 2017; 62:1679-1681. [PMID: 29152800 DOI: 10.1111/1556-4029.13630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mark J Shuman
- Miami-Dade County Medical Examiner Department, 1 Bob Hope Road, Miami, FL, 33136
| | - Kenneth D Hutchins
- Miami-Dade County Medical Examiner Department, 1 Bob Hope Road, Miami, FL, 33136
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30
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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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Hetts SW, Moftakhar P, Maluste N, Fullerton HJ, Cooke DL, Amans MR, Dowd CF, Higashida RT, Halbach VV. Pediatric intracranial dural arteriovenous fistulas: age-related differences in clinical features, angioarchitecture, and treatment outcomes. J Neurosurg Pediatr 2016; 18:602-610. [PMID: 27540826 DOI: 10.3171/2016.5.peds15740] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial dural arteriovenous fistulas (DAVFs) are rare in children. This study sought to better characterize DAVF presentation, angioarchitecture, and treatment outcomes. METHODS Children with intracranial DAVFs between 1986 and 2013 were retrospectively identified from the neurointerventional database at the authors' institution. Demographics, clinical presentation, lesion angioarchitecture, treatment approaches, angiographic outcomes, and clinical outcomes were assessed. RESULTS DAVFs constituted 5.7% (22/423) of pediatric intracranial arteriovenous shunting lesions. Twelve boys and 10 girls presented between 1 day and 18 years of age; boys presented at a median of 1.3 years and girls presented at a median of 4.9 years. Four of 8 patients ≤ 1 year of age presented with congestive heart failure compared with 0/14 patients > 1 year of age (p = 0.01). Five of 8 patients ≤ 1 year old presented with respiratory distress compared with 0/14 patients > 1 year old (p = 0.0021). Ten of 14 patients > 1 year old presented with focal neurological deficits compared with 0/8 patients ≤ 1 year old (p = 0.0017). At initial angiography, 16 patients harbored a single intracranial DAVF and 6 patients had 2-6 DAVFs. Eight patients (38%) experienced DAVF obliteration by the end of treatment. Good clinical outcome (modified Rankin Scale score 0-2) was documented in 77% of patients > 1 year old at presentation compared with 57% of patients ≤ 1 year old at presentation. Six patients (27%) died. CONCLUSIONS Young children with DAVFs presented predominantly with cardiopulmonary symptoms, while older children presented with focal neurological deficits. Compared with other pediatric vascular shunts, DAVFs had lower rates of angiographic obliteration and poorer clinical outcomes.
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Affiliation(s)
| | | | - Neil Maluste
- Department of Neurology, University of California, Los Angeles, California
| | | | | | | | - Christopher F Dowd
- Departments of 1 Radiology and Biomedical Imaging.,Neurology.,Neurological Surgery, and.,Anesthesia and Perioperative Care, University of California, San Francisco; and
| | - Randall T Higashida
- Departments of 1 Radiology and Biomedical Imaging.,Neurology.,Neurological Surgery, and.,Anesthesia and Perioperative Care, University of California, San Francisco; and
| | - Van V Halbach
- Departments of 1 Radiology and Biomedical Imaging.,Neurology.,Neurological Surgery, and.,Anesthesia and Perioperative Care, University of California, San Francisco; and
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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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Lasjaunias P. Angioarchitecture and Natural History of Dural Arteriovenous Shunts. Interv Neuroradiol 2016; 3:313-7. [DOI: 10.1177/159101999700300406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/1997] [Accepted: 10/13/1997] [Indexed: 11/16/2022] Open
Affiliation(s)
- P. Lasjaunias
- Unité de Neuroradiologie Vasculare Diagnostique et Thérapeutique, Hôpital de Bicětre; Le Kremlin Bicětre, 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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Leu S, Valavanis A, Baltsavias G. Langer-Giedion syndrome associated with congenital dural arterio-venous fistula. Childs Nerv Syst 2015; 31:801-4. [PMID: 25293531 DOI: 10.1007/s00381-014-2570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
Langer-Giedion syndrome (LGS) is a rare disease caused by deletion of chromosome 8q23.3-q24.11. Clinical manifestations include among others multiple exostoses, short stature, intellectual disability, and typical facial dysmorphism. Dural arterio-venous shunts (DAVS) in the pediatric age are rare lesions, which have been classified into three types: dural sinus malformations (DSM), infantile type DAVS (IDAVS), and adult type DAVS (ADAVS). We report a case of a patient with a known LGS who was diagnosed with complex intracranial dural AV fistula at the age of 20. An association between LGS and intracranial dural AV fistulas has to our knowledge never been reported before.
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Affiliation(s)
- Severina Leu
- Department of Neuroradiology, University Hospital of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland,
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microRNAs in the Malignant Transformation Process. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 889:1-21. [DOI: 10.1007/978-3-319-23730-5_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
Background:Dural sinus malformation (DSM) is a term used to describe congenital vascular malformations characterized by massive dilation of one or more dural sinuses: these dilatations are typically associated with arteriovenous shunts. Such malformations can present antenatally but their early natural history and anatomy is poorly defined.Methods:We reviewed five years of autopsy experience and retrieved three primary vascular malformations of the fetal dural sinuses with ultrasound, magnetic resonance imaging (MRI) and post-mortem correlation.Results:Fetal ultrasound and MRI obtained between 19 and 23 weeks gestational age demonstrated in all cases dilation of the dural sinuses. In two cases vascular thromboses were present in either the dilated dural sinus (one of three) or the associated arteriovenous fistula (one of three). All cases were autopsied at 22-23 weeks gestational age. In one there was imaging and autopsy evidence of remodeling of the dural sinuses associated with a pial arteriovenous fistula. In two cases, no arteriovenous malformation was identified on initial imaging, but only became evident at autopsy. One case showed morphological overlap with vein of Galen aneurysmal malformation, with a midline arteriovenous shunt and vein of Galen ectasia. The other demonstrated a perisylvian dural arteriovenous fistula.Conclusion:In utero thrombosis of feeding vascular malformations or of the dural sinus malformation may be prominent. The early in utero developmental trajectory of dural sinus malformation (DSM) is poorly defined and deserves further study.
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Abstract
Pediatric dural arteriovenous malformations (dAVMs) are rare lesions that have a high mortality rate and require complex management. The authors report 3 cases of pediatric dAVMs that presented with macrocrania and extracranial venous distension. Dural sinus thrombosis developed in 2 of the cases prior to any intervention, which is an unusual occurrence for this particular disease. All 3 cases were treated using staged endovascular embolization with a favorable outcome in 1 case and a poor outcome in the other 2 cases. Complications developed in all cases and included dural sinus thrombosis, parenchymal hemorrhage, intracranial venous hypertension, and seizures. The strategies and challenges used in managing these patients will be presented and discussed, along with a review of the literature. While outcomes remain poor, the authors conclude that prompt treatment with endovascular embolization provides the best results for children with these lesions. A well-established venous collateral circulation draining directly to the internal jugular veins may further improve the rate of favorable outcome after embolization.
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Affiliation(s)
- Shaun P Appaduray
- Department of Neurosurgery, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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40
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Toma AK, Davagnanam I, Ganesan V, Brew S. Cerebral Arteriovenous Shunts in Children. Neuroimaging Clin N Am 2013; 23:757-70. [DOI: 10.1016/j.nic.2013.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moon K, Ducruet AF, Crowley RW, Klas K, Bristol R, Albuquerque FC. Complex dural arteriovenous fistula in Bannayan-Riley-Ruvalcaba syndrome. J Neurosurg Pediatr 2013; 12:87-92. [PMID: 23662932 DOI: 10.3171/2013.3.peds12551] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this paper the authors report the case of a complex dural arteriovenous fistula (dAVF) with high-risk features in a 14-year-old girl with Bannayan-Riley-Ruvalcaba syndrome (BRRS), a phosphatase and tensin homolog-associated syndrome, presenting with signs and symptoms of increased intracranial pressure (ICP) that had previously been attributed to pseudotumor cerebri. This fistula was obliterated following 2 stages of embolization, and the patient experienced immediate symptomatic improvement. At the 2-month follow-up evaluation, the fistula remained angiographically occluded, and her symptoms continue to improve. This is the third reported case of an intracranial dAVF in a patient with BRRS. Because high-risk dAVFs can result in devastating morbidity, early detection with vascular imaging is crucial for patients with BRRS presenting with signs of increased ICP. Goals of treatment should include complete fistula obliteration whenever possible.
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Affiliation(s)
- Karam Moon
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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Roccatagliata L, Bracard S, Holmin S, Soderman M, Rodesch G. Pediatric intracranial arteriovenous shunts: a global overview. Childs Nerv Syst 2013; 29:907-19. [PMID: 23624781 DOI: 10.1007/s00381-013-2114-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cerebral arteriovenous shunts (CAVS) in the pediatric population cannot be compared to those in adults as they present different anatomical, physiological, and pathological characteristics concerning the arterial and venous vasculature and the cerebrospinal fluid physiology. These lesions develop in a maturing brain, of which expression is difficult to assess, with a potential for recovery different from that in adults. DISCUSSION Their impact on the brain will be different in the antenatal period, in neonates, in infants, and in children, with variable symptoms according to each age group. We review different classifications of pediatric CAVS (according to the anatomical space in which they develop, their type and architecture, and the age at which they reveal), describe their evolution, and discuss the current role of endovascular treatment in the management of these vascular lesions.
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Affiliation(s)
- Luca Roccatagliata
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, 40 Rue Worth, Suresnes, France
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Sato Y, Fujita Y, Anami A, Yumoto Y, Fukushima K, Wake N. Doppler sonographic evaluation of arteriovenous shunt flow in a fetus with dural sinus malformation. J Obstet Gynaecol Res 2013; 39:1081-4. [DOI: 10.1111/jog.12023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 11/08/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Yuka Sato
- Department of Obstetrics and Gynecology; Kyushu University Hospital; Fukuoka Japan
| | - Yasuyuki Fujita
- Department of Obstetrics and Gynecology; Kyushu University Hospital; Fukuoka Japan
| | - Ai Anami
- Department of Obstetrics and Gynecology; Kyushu University Hospital; Fukuoka Japan
| | - Yasuo Yumoto
- Department of Obstetrics and Gynecology; Kyushu University Hospital; Fukuoka Japan
| | - Kotaro Fukushima
- Department of Obstetrics and Gynecology; Kyushu University Hospital; Fukuoka Japan
| | - Norio Wake
- Department of Obstetrics and Gynecology; Kyushu University Hospital; Fukuoka Japan
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Iizuka Y, Koda E, Tsutsumi Y, Konishi Y, Ashida H, Nakanishi T, Funabiki M. Neonatal dural arteriovenous fistula at the confluence presenting with paralysis of the orbicularis oris muscle. Neuroradiol J 2013; 26:47-51. [PMID: 23859167 PMCID: PMC5278863 DOI: 10.1177/197140091302600108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 01/27/2013] [Indexed: 11/15/2022] Open
Abstract
A male neonate presented a dural arteriovenous fistula (DAVF) at the confluence with paralysis of the orbicularis oris muscle. The interesting features in our case were the clinical symptoms (orbicularis oris muscle paralysis at birth), angioarchitecture (high-flow arteriovenous shunts at the confluence) and the size and hemodynamic flow (mid-sized venous pouch) of the fistula. Additionally, the embolization technique (i.e., occipital artery approach, closing shunts with pure glue) automatically resulted in the immediate and complete closure of accessory feeders without any additional treatment, and the midterm clinical outcome was good. We succeeded improving the symptoms of a neonate with a congenital high-flow DAVF by closing a fistula using a small amount of glue.
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Affiliation(s)
- Y Iizuka
- Department of Radiology, Toho University Ohashi Medical Center; Tokyo, Japan.
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Prise en charge des malformations vasculaires cérébrales découvertes en période ante- ou néonatale. Arch Pediatr 2013; 20:74-81. [DOI: 10.1016/j.arcped.2012.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/02/2012] [Accepted: 10/26/2012] [Indexed: 11/22/2022]
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De novo multiple dural arteriovenous fistulas and arteriovenous malformation after embolization of cerebral arteriovenous fistula: case report. Childs Nerv Syst 2012; 28:1981-3. [PMID: 22940850 DOI: 10.1007/s00381-012-1878-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND A cerebral arteriovenous fistula is a rare neurovascular abnormality. It is very scarce when presenting with other cerebral arteriovenous malformations after embolization. METHOD We reported a case primarily presenting with cerebral arteriovenous fistula. When the fistula was embolized completely, de novo multiple dural arteriovenous fistulas and a small arteriovenous malformation occurred due to the hemodynamic change after the embolization. Embolization of parts of the fistulas for the second time led to an untreatable malformation which became curable. At the third time, the remaining fistula was cured. RESULTS The mechanism of the dural arteriovenous fistula and treatment strategy were discussed. CONCLUSION Venous hypertension is the main factor causing a dural arteriovenous fistula. Embolization of the fistulas step by step is recommended.
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Land T, Teo M, Bhattacharya J, Brown J. Cerebellar haemorrhage in a 12-year-old girl with giant dural sinus malformation. Br J Neurosurg 2012; 26:412-4. [DOI: 10.3109/02688697.2012.654836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Multimodality treatment of intracranial dural arteriovenous fistulas in the Onyx era: a single center experience. World Neurosurg 2010; 73:365-79. [PMID: 20849795 DOI: 10.1016/j.wneu.2010.01.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 01/14/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND The results of treatment of intracranial dural arteriovenous fistulas (DAVFs) since Onyx became available as an embolic agent at our institution is reported. An algorithm is presented for treatment of DAVFs with Onyx, and the role of endovascular transvenous, surgical, and radiosurgical approaches are presented. METHODS Thirty-two patients with DAVFs treated between November 2005 and November 2008 by endovascular embolization, surgery, or radiosurgery were identified by a retrospective chart review. Treatment strategies were based on the location or complexity of the fistula and the patient's clinical status. Data collected included DAVF characteristics, obliteration rates, complications, and outcomes. The results were analyzed and correlated with the treatment modality. RESULTS Presenting symptoms were as follows: hemorrhage (n = 12 patients), headaches (n = 12), tinnitus (n = 5), orbital symptoms (n = 7), and seizures (n = 1). Thirty patients were treated by endovascular embolization (transarterial only with Onyx-21, transvenous only with platinum coils-6, transarterial [Onyx] and transvenous [coils]-3). Five patients (4 after incomplete/failed embolization) had surgical excision of the fistula. Three patients were treated with Gamma Knife radiosurgery (primary-1, 2 after incomplete/failed embolization). The locations of the fistulas were transverse sigmoid (10 patients), petrotentorial (7 patients), indirect carotid cavernous fistula (7 patients), parasagittal/falcine (3 patients), middle fossa dura (3 patients), torcula (1 patient), and anterior fossa dura (1 patient). The distribution of patients according to Borden classification was I-6, II-13, and III-13. Complete obliteration of the fistula was achieved in 26/32 (81%) patients after multimodal treatment. All surgical cases had complete obliteration. In the high-risk group with cortical venous reflux, 23/26 (89%) patients were cured. Endovascular complications included a stuck microcatheter tip with fracture of the tip in two patients and cranial nerves V and VII palsies in one patient. At last follow-up (range 1-36 months), 24 patients had modified Rankin score of 0-2, 5 patients had modified Rankin score of 3-5, and 3 patients were dead. Two patients died during admission due to the insult of the hemorrhage, and one died after an accidental fall with subsequent traumatic subdural hematoma. CONCLUSIONS Multimodality treatment of DAVFs has high success rates for cure at our center. Transarterial embolization with Onyx has become the primary treatment for intracranial DAVFs at our center and is associated with high safety profile and efficacy. Transvenous coil embolization is still preferred in DAVFs with supply from arterial branches supplying cranial nerves, predominant internal carotid artery feeders and potential extracranial-intracranial collateral anastomosis. In our series, patients with incompletely treated DAVFs were treated with surgery and those with partially treated type I fistulas had radiosurgery for palliation.
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Neurosurgical vascular malformations in children under 1 year of age. Childs Nerv Syst 2010; 26:1381-94. [PMID: 20658296 DOI: 10.1007/s00381-010-1223-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aims to analyze the clinical and radiological findings, timing and type of treatment, and outcome in children under 1 year of age that presented with neurosurgical vascular malformations. METHODS A retrospective review of 23 children under 1 year of age with neurosurgical vascular malformations was performed at a single institution between 1999 and 2009. RESULTS The lesions found in this age group were: 10 vein of Galen aneurysmal malformations (VGAMs), 5 arteriovenous malformations (AVM), 2 pial arteriovenous fistulas (AVF; 1 in the brain and 1 in the spinal cord), 2 cavernous malformations, 2 dural sinus malformations (DSMs) in the posterior fossa with negative angiography which after surgery turned out to be embryonal malformations of dural sinuses, 1 sacular aneurysm, and 1 dural arteriovenous fistula (DAVF) that drained toward the vein of Galen. Of the 10 patients with VGAM, 8 presented choroidal type and 2 mural type. Two patients with choroidal VGAM were born in dramatically severe clinical condition; therefore, we decided to withhold aggressive treatment, and they died within 48 h after birth. The other eight patients with choroidal VGAM received endovascular treatment between 1 and 3 staged embolizations. In four of them, total occlusion was achieved and subtotal and partial in the others. One patient had complications and evolved with severe developmental delay. Another patient with partial occlusion died, and another patient with previous developmental delay stopped treatment because of parental decision making. Five patients evolved with normal development and one with mild delay. Only one patient required shunt. Hydrocephalus was solved after endovascular treatment in the rest of the patients. Regarding the five AVMs, four were treated with microsurgical approach achieving total resection of the lesion and normal developmental milestones except for one patient with brainstem AVM that was admitted with quadriparesis and coma. In the patient with basal ganglia AVM, the lesion spontaneously disappeared. From the two pial AVFs, the frontal one was microsurgically treated and the spinal one received endovascular session achieving 50% of lesion occlusion for which further treatment is needed. The two cavernous malformations were operated achieving total resection with normal development. The two children with DSM received surgical resection without complications and normal development. The rare case of sacular aneurysm at this age was occluded at the time of diagnostic procedure due to the bad clinical condition of the patient and the hematoma was removed immediately in the operating room. The only case of DAVF died of respiratory intercurrence after three sessions of endovascular treatment. CONCLUSIONS In this neonatal age group (first year of life), we can find the whole range of neurosurgical vascular pathology: VGAM, AVM, cavernous malformation, DSM, pial AVF, DAVF, and sacular aneurysm. VGAM is the most frequent vascular malformation during the first year of age. The early treatment of vascular malformations prevents its adverse effects on a developing brain. A multidisciplinary team composed by endovascular and surgical specialists is necessary to discuss and treat each case.
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Jenny B, Zerah M, Swift D, Le Tohic A, Merzoug V, Alvarez H, Grangé G, Rilliet B. Giant dural venous sinus ectasia in neonates. J Neurosurg Pediatr 2010; 5:523-8. [PMID: 20433268 DOI: 10.3171/2009.12.peds0862] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this report, the authors describe 4 recent cases of posterior giant dural venous sinus ectasia in neonates diagnosed during pregnancy and encountered at 3 different institutions. Posterior giant venous sinus ectasia was diagnosed in 4 patients using antenatal ultrasonography and confirmed in 2 patients using prenatal MR imaging and in 3 patients using postnatal MR angiography. In 2 children angiography was performed at the age of 6 months. The pregnancy was terminated in 1 case, and the fetus underwent an autopsy. The 3 children who were born presented with various degree of cardiac insufficiency and were admitted to the intensive care unit after birth. Signs of increased intracranial pressure were present immediately after birth, including a bulging fontanel. No endovascular treatment was used in these cases. Surgery was performed in 2 cases as an attempt to alleviate increased intracranial pressure symptoms, without any real benefit. A slow venous flow in the ectasia was shown by ultrasonography in the case in which the pregnancy was terminated. Angiography or MR angiography did not show an obvious arteriovenous malformation in any of the cases, but an arteriovenous fistula secondary or contributing to the formation of the venous ectasia is one of the physiopathological hypotheses of the cause of this condition. Interestingly, spontaneous progressive thrombosis and regression of the intravascular component of the venous sinus ectasia was observed in all cases. The clinical outcome was acceptable in 1 child (who had a moderate handicap after the surgery) and good for the other 2 children (who had normal neurological development). Stratified thrombi of different ages are found in these giant venous ectasias and develop within the leaves of the dura close to the confluence of the major posterior venous sinuses. Therefore, it appears that the formation of a progressive thrombosis represents the normal evolution of these giant dural venous sinus ectasias, which explains the favorable outcome in some cases without specific surgical treatment, except for resuscitation techniques.
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