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Arun A, Amans MR, Higgins N, Brinjikji W, Sattur M, Satti SR, Nakaji P, Luciano M, Huisman TAGM, Moghekar A, Pereira VM, Meng R, Fargen K, Hui FK. A proposed framework for cerebral venous congestion. Neuroradiol J 2022; 35:94-111. [PMID: 34224274 PMCID: PMC8826290 DOI: 10.1177/19714009211029261] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND While venous congestion in the peripheral vasculature has been described and accepted, intracranial venous congestion remains poorly understood. The characteristics, pathophysiology, and management of cerebral venous stasis, venous hypertension and venous congestion remain controversial, and a unifying conceptual schema is absent. The cerebral venous and lymphatic systems are part of a complex and dynamic interaction between the intracranial compartments, with interplay between the parenchyma, veins, arteries, cerebrospinal fluid, and recently characterized lymphatic-like systems in the brain. Each component contributes towards intracranial pressure, occupying space within the fixed calvarial volume. This article proposes a framework to consider conditions resulting in brain and neck venous congestion, and seeks to expedite further study of cerebral venous diagnoses, mechanisms, symptomatology, and treatments. METHODS A multi-institution retrospective review was performed to identify unique patient cases, complemented with a published case series to assess a spectrum of disease states with components of venous congestion affecting the brain. These diseases were organized according to anatomical location and purported mechanisms. Outcomes of treatments were also analyzed. Illustrative cases were identified in the venous treatment databases of the authors. CONCLUSION This framework is the first clinically structured description of venous pathologies resulting in intracranial venous and cerebrospinal fluid hypertension. Our proposed system highlights unique clinical symptoms and features critical for appropriate diagnostic work-up and potential treatment. This novel schema allows clinicians effectively to approach cases of intracranial hypertension secondary to venous etiologies, and furthermore provides a framework by which researchers can better understand this developing area of cerebrovascular disease.
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Affiliation(s)
- Anirudh Arun
- Department of Radiology and
Radiological Science, Johns Hopkins University School of Medicine, USA,Anirudh Arun, Department of Radiology and
Radiological Science, Johns Hopkins University School of Medicine, 600 North
Wolfe Street, Baltimore, MD 21287, USA.
| | - Matthew R Amans
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | | | | | - Mithun Sattur
- Department of Neurosurgery, Medical
University of South Carolina, USA
| | - Sudhakar R Satti
- Department of Neurointerventional
Surgery, ChristianaCare Christiana Hospital, USA
| | - Peter Nakaji
- Department of Neurosurgery, Banner
University Medical Center, USA
| | - Mark Luciano
- Department of Neurosurgery, Johns
Hopkins University School of Medicine, USA
| | | | - Abhay Moghekar
- Department of Neurology, Johns
Hopkins University School of Medicine, USA
| | - Vitor M Pereira
- Department of Medical Imaging,
Toronto Western Hospital, Canada
| | - Ran Meng
- Department of Neurology, Xuanwu
Hospital, China
| | - Kyle Fargen
- Department of Neurosurgery, Wake
Forest School of Medicine, USA
| | - Ferdinand K Hui
- Department of Radiology and
Radiological Science, Johns Hopkins University School of Medicine, USA
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Guniganti R, Giordan E, Chen CJ, Abecassis IJ, Levitt MR, Durnford A, Smith J, Samaniego EA, Derdeyn CP, Kwasnicki A, Alaraj A, Potgieser ARE, Sur S, Chen SH, Tada Y, Winkler E, Phelps RRL, Lai PMR, Du R, Abla A, Satomi J, Starke RM, van Dijk JMC, Amin-Hanjani S, Hayakawa M, Gross BA, Fox WC, Bulters D, Kim LJ, Sheehan J, Lanzino G, Piccirillo JF, Kansagra AP, Zipfel GJ. Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR): rationale, design, and initial characterization of patient cohort. J Neurosurg 2021; 136:951-961. [PMID: 34507282 DOI: 10.3171/2021.1.jns202790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cranial dural arteriovenous fistulas (dAVFs) are rare lesions, hampering efforts to understand them and improve their care. To address this challenge, investigators with an established record of dAVF investigation formed an international, multicenter consortium aimed at better elucidating dAVF pathophysiology, imaging characteristics, natural history, and patient outcomes. This report describes the design of the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) and includes characterization of the 1077-patient cohort. METHODS Potential collaborators with established interest in the field were identified via systematic review of the literature. To ensure uniformity of data collection, a quality control process was instituted. Data were retrospectively obtained. RESULTS CONDOR comprises 14 centers in the United States, the United Kingdom, the Netherlands, and Japan that have pooled their data from 1077 dAVF patients seen between 1990 and 2017. The cohort includes 359 patients (33%) with Borden type I dAVFs, 175 (16%) with Borden type II fistulas, and 529 (49%) with Borden type III fistulas. Overall, 852 patients (79%) presented with fistula-related symptoms: 427 (40%) presented with nonaggressive symptoms such as tinnitus or orbital phenomena, 258 (24%) presented with intracranial hemorrhage, and 167 (16%) presented with nonhemorrhagic neurological deficits. A smaller proportion (224 patients, 21%), whose dAVFs were discovered incidentally, were asymptomatic. Many patients (85%, 911/1077) underwent treatment via endovascular embolization (55%, 587/1077), surgery (10%, 103/1077), radiosurgery (3%, 36/1077), or multimodal therapy (17%, 184/1077). The overall angiographic cure rate was 83% (758/911 treated), and treatment-related permanent neurological morbidity was 2% (27/1467 total procedures). The median time from diagnosis to follow-up was 380 days (IQR 120-1038.5 days). CONCLUSIONS With more than 1000 patients, the CONDOR registry represents the largest registry of cranial dAVF patient data in the world. These unique, well-annotated data will enable multiple future analyses to be performed to better understand dAVFs and their management.
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Affiliation(s)
| | - Enrico Giordan
- Departments of4Neurological Surgery and.,5Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ching-Jen Chen
- 6Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | | | - Michael R Levitt
- 7Department of Neurological Surgery and.,8Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Andrew Durnford
- 9Department of Neurosurgery, University of Southampton, University Hospital Southampton, United Kingdom
| | - Jessica Smith
- 10Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Edgar A Samaniego
- Departments of12Neurology and.,13Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Colin P Derdeyn
- Departments of12Neurology and.,13Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amanda Kwasnicki
- 14Department of Neurological Surgery, University of Illinois at Chicago, Illinois
| | - Ali Alaraj
- 14Department of Neurological Surgery, University of Illinois at Chicago, Illinois
| | - Adriaan R E Potgieser
- 15Department of Neurological Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Samir Sur
- 16Department of Neurological Surgery and Radiology, University of Miami, Florida
| | - Stephanie H Chen
- 16Department of Neurological Surgery and Radiology, University of Miami, Florida
| | - Yoshiteru Tada
- 17Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ethan Winkler
- 18Weill Institute for Neurosciences, Department of Neurosurgery, University of California, San Francisco, California
| | - Ryan R L Phelps
- 18Weill Institute for Neurosciences, Department of Neurosurgery, University of California, San Francisco, California
| | - Pui Man Rosalind Lai
- 19Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rose Du
- 19Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adib Abla
- 18Weill Institute for Neurosciences, Department of Neurosurgery, University of California, San Francisco, California
| | - Junichiro Satomi
- 17Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Robert M Starke
- 16Department of Neurological Surgery and Radiology, University of Miami, Florida
| | - J Marc C van Dijk
- 15Department of Neurological Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sepideh Amin-Hanjani
- 14Department of Neurological Surgery, University of Illinois at Chicago, Illinois
| | - Minako Hayakawa
- Departments of12Neurology and.,13Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bradley A Gross
- 11Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - W Christopher Fox
- 10Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Diederik Bulters
- 9Department of Neurosurgery, University of Southampton, University Hospital Southampton, United Kingdom
| | - Louis J Kim
- 7Department of Neurological Surgery and.,8Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Jason Sheehan
- 6Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Giuseppe Lanzino
- Departments of4Neurological Surgery and.,5Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jay F Piccirillo
- 3Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri
| | - Akash P Kansagra
- 1Department of Neurological Surgery.,2Mallinckrodt Institute of Radiology, and
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Hallak B, Kurzbuch AR, Fournier JY, Bouayed S. Spontaneous transethmoidal meningoencephalocele presenting in the form of recurrent unilateral nasal discharge: discussion of the diagnosis and endoscopic surgical management. BMJ Case Rep 2020; 13:13/5/e234703. [PMID: 32404373 PMCID: PMC7228147 DOI: 10.1136/bcr-2020-234703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Meningoencephaloceles of the skull base most commonly occur as a sequela of head trauma or they can more rarely be congenital malformations. Several types of encephalocele exist depending on anatomic features and localisation. Clinical presentation and symptoms can vary. Different methods of management and repair of the concurring skull base defects have been described and ranging vary from endoscopic to open surgical approaches. We report the case of a 56-year-old Caucasian woman with the diagnosis of right sided spontaneous transethmoidal meninoencephalocele. Clinical presentation of this rare pathology, methods of diagnostic and management and its outcome are presented. Spontaneous skull base meningoencephaloceles are rare entities, without clear underlying etiologies. Multidisciplinary management is recommended. The transnasal endoscopic approach provides a wide skull base exposure with more advantages and less morbidity in comparison with the conventional open approach.
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Affiliation(s)
- Bassel Hallak
- Otorhinolaryngology, Hospital of Sion, Sion, Switzerland
| | | | | | - Salim Bouayed
- Otorhinolaryngology, Hospital of Sion, Sion, Switzerland
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Letourneau-Guillon L, Cruz JP, Krings T. CT and MR imaging of non-cavernous cranial dural arteriovenous fistulas: Findings associated with cortical venous reflux. Eur J Radiol 2015; 84:1555-1563. [PMID: 26047821 DOI: 10.1016/j.ejrad.2015.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/15/2015] [Accepted: 04/20/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the conventional CT and MR findings of DAVFs in relation to the venous drainage pattern on digital subtraction angiography (DSA). MATERIALS AND METHODS Cross-sectional imaging findings (CT and/or MR) in 92 patients were compared to the presence of cortical venous reflux (CVR) on DSA. RESULTS Imaging features significantly more prevalent in patients with CVR included: abnormally dilated and tortuous leptomeningeal vessels (92% vs. 4%, p<0.001) or medullary vessels (69% vs. 0%, p<0.001), venous ectasias (45% vs. 0%, p<0.001) and focal vasogenic edema (38% vs. 0%, p<0.001). The following findings trended towards association but did not reach the p value established following Bonferroni correction: dilated external carotid artery branches (71% vs. 38%, p=0.005), cluster of vessels surrounding dural venous sinus (50% vs. 19%, p=0.009), presence of hemorrhage (33 vs. 12%, p=0.040), and parenchymal enhancement (21% vs. 0%, p=0.030). CONCLUSION In the appropriate clinical setting, recognition of ancillary signs presumably related to venous arterialization and congestion as well as arterial feeder hypertrophy should prompt DSA confirmation to identify DAVFs associated with CVR.
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Affiliation(s)
- Laurent Letourneau-Guillon
- Toronto Western Hospital-University Health Network and the University of Toronto, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario, Canada
| | - Juan Pablo Cruz
- Toronto Western Hospital-University Health Network and the University of Toronto, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario, Canada
| | - Timo Krings
- Toronto Western Hospital-University Health Network and the University of Toronto, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario, Canada.
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