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Bleuze MM, Fricano E, Farrell JM, Brady JE. A calvarial osteolytic lesion of probable vascular origin in a Maya juvenile from the Classic Period ( 250-900 CE). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2024; 46:9-15. [PMID: 38865934 DOI: 10.1016/j.ijpp.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 05/31/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE This case study evaluates a focal osteolytic lesion in the right sulcus sinus transversi of an isolated os occipitale. MATERIALS The os occipitale is from a juvenile from the Cueva de Sangre at the Classic Period (250-900 CE) site of Dos Pilas, Guatemala METHODS: The lesion was examined macroscopically, microscopically, and radiographically. RESULTS The oval lesion has a well-circumscribed margin, endocranial origin, and involves cortical destruction of the inner and outer tables. Subperiosteal bone reaction around the lesion is present on the ectocranial surface. Skeletal evidence of increased vascularity, diploë expansion, and perimortem fracture near the lesion are not observed. CONCLUSIONS The lesion appears to reflect a response to the presence of an expansile process that has caused pressure erosion. The anatomical location of the lesion and the endocranial origin suggest a probable vascular anomaly, such as a vascular malformation. SIGNIFICANCE This case study represents one of the few bioarchaeological evaluations of probable vascular anomaly in a juvenile. As such, it expands our knowledge about vascular anomalies in the past and provides a comparative and core reference for guiding future paleopathological investigations on cranial osteolytic lesions. LIMITATIONS The skeletal assemblage is commingled and fragmentary preventing the assessment of the distribution of lesions across the skeleton. SUGGESTIONS FOR FUTURE RESEARCH Further scrutiny of bioarchaeological collections is needed to better understand the distribution of vascular anomalies in the past.
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Affiliation(s)
- Michele M Bleuze
- Department of Anthropology, California State University, 5151 State University Drive, Los Angeles, CA 90032, USA.
| | - Ellen Fricano
- Medical Anatomical Sciences, Western University of Health Sciences, 309 E Second St, Pomona, CA 91766, USA
| | - Jessica M Farrell
- Affiliated Pathologists of the Central Coast (APCC), P.O. Box 5007, San Luis Obispo, CA 93403, USA
| | - James E Brady
- Department of Anthropology, California State University, 5151 State University Drive, Los Angeles, CA 90032, USA
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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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Cheon JE, Kim JH. Congenital Intracranial Vascular Malformations in Children : Radiological Overview. J Korean Neurosurg Soc 2024; 67:270-279. [PMID: 38665114 PMCID: PMC11079561 DOI: 10.3340/jkns.2024.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
Prompt medical attention is crucial for congenital intracranial vascular malformations in children and newborns due to potential severe outcomes. Imaging is pivotal for accurate identification, given the diverse risks and treatment strategies. This article aims to enhance the identification and understanding of congenital intracranial vascular abnormalities including arteriovenous malformation, arteriovenous fistula, cavernous malformation, capillary telangiectasia, developmental venous anomaly, and sinus pericranii in pediatric patients.
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Affiliation(s)
- Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Ji Hye Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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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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5
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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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6
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Saliou G, Deiva K, Möhlenbruch MA, Lubicz B. Anticoagulation helps shrink giant venous lakes and arteriovenous fistulas in dural sinus malformation. J Neurointerv Surg 2024; 16:183-186. [PMID: 36804768 DOI: 10.1136/jnis-2022-019923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Dural sinus malformations (DSMs) associated with high flow arteriovenous shunts are a challenging disease in babies that can lead to severe neurological damage or death. We report our treatment strategy in seven consecutive DSMs. METHODS We performed a retrospective analysis of seven consecutive patients from four centres, treated with transarterial embolization and anticoagulants. RESULTS Mean clinical and imaging follow-up was 2.8 years (IQR1-3 1.8-5.3). At baseline, the median size of the dilated venous pouch (giant lake) was 35 mm (IQR1-3 24-41) that decreased to a normal or near normal venous collector diameter of median size 11.5 mm (IQR1-3 8.5-13.8). This was achieved after a median of two embolization sessions targeted on dural feeders (IQR1-3 1.5-2.5), leaving associated pial feeders untreated. There were no cerebral hemorrhagic complications during the anticoagulation treatment. Median percentage of shunt remaining after embolization was 30% (IQR1-3 12-30), which spontaneously decreased with anticoagulation and even after discontinuation of anticoagulation, in parallel with the reduction in diameter of the dilated sinus, up to healing (or near healing). At the last clinical assessment, the modified Rankin Scale score was 0 in four patients, 1 in one patient, and 3 in two patients. CONCLUSIONS Anticoagulants may help to potentiate transarterial embolization in DSMs in babies by decreasing venous dilatation and reducing the remaining arteriovenous shunt, particularly the pial feeders. We did not observe recurrence of arteriovenous shunts after treatment, especially during anticoagulation treatment. Further studies are needed to support our findings.
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Affiliation(s)
- Guillaume Saliou
- Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- UNIL, Lausanne, Switzerland
| | - Kumaran Deiva
- Service de Neuropédiatrie, Hôpital Bicêtre Service de Neuropédiatrie, Le Kremlin-Bicetre, France
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Boris Lubicz
- Diagnostic and Interventional Neuroradiology, Hôpital Universitaire Erasme, Bruxelles, Belgium
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7
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Maleknia PD, Hale AT, Savage C, Blount JP, Rocque BG, Rozzelle CJ, Johnston JM, Jones JGA. Characteristics and outcomes of pediatric dural arteriovenous fistulas: a systematic review. Childs Nerv Syst 2024; 40:197-204. [PMID: 37864710 DOI: 10.1007/s00381-023-06156-z] [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: 08/24/2023] [Accepted: 09/09/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Dural arteriovenous fistulas (dAVF) are arteriovenous shunts in communication with the dural vasculature in the brain or spine. Apart from single-center series, risk factors and treatment outcomes for pediatric dAVFs are largely undescribed. METHODS We performed a systematic literature review of pediatric (< 18 years at diagnosis) intracranial and spinal dAVF according to PRISMA guidelines. We queried PubMed, CINAHL, SCOPUS, and Embase databases without time/date restriction. Search strings included a variety of MeSH keywords relating to dural AV fistulas in combination with MeSH keywords related to pediatric cases (see Appendix). Manuscripts describing patients diagnosed with dural sinus malformations or pial AVF were excluded. RESULTS We identified 61 studies describing 69 individual patients. Overall, dAVF were more common in males (55.1%) with a mean age of diagnosis (5.17 ± 4.42 years). Approximately 20.2% of patients presented with cardiovascular disease (CVD), and 31.9% were discovered incidentally on neuroimaging studies. Transverse-sigmoid junction was the most common location (17.3%). Ninety-three percent (64 patients) were treated, most commonly using endovascular embolization (68.1%) followed by surgery (8.7%) and radiosurgery (2.9%). Almost half (43.8%) of dAVFs were completely obliterated. Of the 64 procedures, there were 19 neurological complications (29.7%) of varying severity where 12.5% were considered transient (i.e., pseudomeningocele) and 17.2% permanent (i.e., mortality secondary to acute sinus thrombosis, etc.). CONCLUSION There is a paucity of information on pediatric dAVFs. This systematic review summarizes the published cases of dAVFs in the pediatric population. While the rate of missing data is high, there is publication bias, and precise details regarding complications are difficult to ascertain, this review serves as a descriptive summary of pediatric dAVFs.
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Affiliation(s)
- Pedram D Maleknia
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew T Hale
- Department of Neurosurgery, University of Alabama at Birmingham, FOT Suite 1060, 1720 2nd Ave S, Birmingham, AL, 35294, USA.
| | - Cody Savage
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brandon G Rocque
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Curtis J Rozzelle
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Johnston
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jesse G A Jones
- Department of Neurosurgery, University of Alabama at Birmingham, FOT Suite 1060, 1720 2nd Ave S, Birmingham, AL, 35294, USA
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Diagnostic Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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8
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Scullen T, Milburn J, Mathkour M, Bui C, Dumont A. Neonatal high-flow anterior circulation dural arteriovenous fistulae successfully treated with subtotal endovascular embolization; A case report. Clin Neurol Neurosurg 2023; 232:107876. [PMID: 37499551 DOI: 10.1016/j.clineuro.2023.107876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023]
Abstract
High-flow grade-III dural arteriovenous fistulae(dAVF) represent rare abnormal vascular connections with a high risk of rupture. Management involves obliteration of both the fistulous connection as well as the draining venous network with preservation of normal vasculature. We describe and multiple neonatal dAVFs inducing cardiomyopathy via high-flow grade III shunting in the anterior circulation successfully treated via transvenous and transarterial embolization.
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Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - James Milburn
- Department of Radiology, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Cuong Bui
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Aaron Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA.
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9
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Hanai S, Muroi A, Hitaka D, Murakami T, Sato M, Matsumaru Y, Ishikawa E. Remodeling of venous drainage after the treatment of dural sinus malformation with arteriovenous shunts in a neonate: a case report and literature review. Childs Nerv Syst 2023:10.1007/s00381-023-05961-w. [PMID: 37085623 DOI: 10.1007/s00381-023-05961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
Dural sinus malformations (DSMs) are rare congenital vascular diseases characterized by a giant venous pouch with or without arteriovenous shunts. We present a neonatal case of DSM that was diagnosed prenatally and treated via endovascular intervention in the early postnatal period. The patient presented with a large DSM involving the torcular Herophilion prenatal magnetic resonance imaging (MRI). Enlargement of the head circumference and respiratory failure rapidly progressed after birth. On the 5th day after birth, the neonate underwent endovascular occlusion via the umbilical artery. The arteriovenous shunt was occluded, and the reflux from the enlarged venous pouch to the dural sinus was decreased. No additional procedure other than ventriculoperitoneal shunting was required. The neonate's development slowly caught up to normal parameters. Follow-up MRI demonstrated the successful development of the venous drainage system. DSMs are characterized by an abnormally dilated dural sinus, which can block the venous return and ultimately increase intracranial pressure and cerebral ischemia. Long-term follow-up indicates that an abnormally developed dural sinus can be reconstructed by appropriate and timely treatment.
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Affiliation(s)
- Sho Hanai
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Ai Muroi
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan.
| | - Daisuke Hitaka
- Department of Pediatrics, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Takashi Murakami
- Department of Pediatrics, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
- Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
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10
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Saway BF, Porto GBF, Sattur MG, Domingo RA, Triano M, Al Kasab S, Eskandari R, Lena JR. Giant Pediatric Dural Arteriovenous Fistula Management Using a Combined Operative Approach in a Hybrid Neuroendovascular Surgery Suite: Technical Nuances and Review of Literature. Oper Neurosurg (Hagerstown) 2023; 24:e248-e254. [PMID: 36701686 DOI: 10.1227/ons.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/18/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Pediatric intracranial dural arteriovenous fistulas (dAVFs) are rare, complex entities usually presenting with macrocephaly from increased intracranial pressures at a young age. In the setting of a symptomatic intracranial dAVF that has undergone multiple endovascular treatments with subsequent recurrence or failed embolization attempts, the intracranial venous system can become inaccessible by traditional transvenous and transarterial routes. Direct puncture of the venous sinus for endovascular access after surgical exposure is a viable option. OBJECTIVE To describe the technical nuances and available literature for direct puncture of the venous sinus for endovascular access in a pediatric patient with dAVF. METHODS The clinical characteristics were reviewed and reported for a patient who underwent direct puncture of the venous sinus for endovascular access. In addition, a literature review was conducted for relevant literature pertaining to this technique and its associated indications, outcomes, and complications. RESULTS Only 2 other reports of direct puncture of venous sinus for endovascular access after surgical exposure were found in the literature. Our patient achieved a favorable outcome with complete dAVF obliteration. CONCLUSION Direct puncture of the venous sinus for endovascular access after surgical exposure for complex dAVFs that are inaccessible by transvenous or transarterial routes is a practical and safe approach to intracranial venous access that should be part of the vascular neurosurgeon's arsenal.
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Affiliation(s)
- Brian Fabian Saway
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Guilherme B F Porto
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mithun G Sattur
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Matthew Triano
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ramin Eskandari
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jonathan R Lena
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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11
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Baker A, Caton MT, Smith ER, Narsinh KH, Amans MR, Higashida RT, Cooke DL, Dowd CF, Hetts SW. Evolving indications for pediatric neurointerventional radiology: A single institutional 25-year experience in infants less than one year of age and a brief historical review. Interv Neuroradiol 2023:15910199231154689. [PMID: 36760130 DOI: 10.1177/15910199231154689] [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: 02/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Pediatric neurointerventional radiology is an evolving subspecialty with growing indications and technological advancement such as miniaturization of devices and decreased radiation dose. The ability to perform these procedures is continuously balanced with necessity given the inherently higher risks of radiation and cerebrovascular injury in infants. The purpose of this study is to review our institution's neurointerventional experience in infants less than one year of age to elucidate trends in this patient population. METHODS We retrospectively identified 132 patients from a neurointerventional database spanning 25 years (1997-2022) who underwent 226 procedures. Treatment type, indication, and location as well as patient demographics were extracted from the medical record. RESULTS Neurointerventional procedures were performed as early as day of life 0 in a patient with an arteriovenous shunting malformation. Average age of intervention in the first year of life is 5.9 months. Thirty-eight of 226 procedures were completed in neonates. Intra-arterial chemotherapy (IAC) for the treatment of retinoblastoma comprised 36% of neurointerventional procedures completed in infants less than one year of age followed by low flow vascular malformations (21.2%), vein of Galen malformations (11.5%), and dural arteriovenous fistulas (AVF) (9.3%). Less frequent indications include non-Galenic pial AVF (4.4%) and tumor embolization (3.0%). The total number of interventions has increased secondary to the onset of retinoblastoma treatment in 2010 at our institution. CONCLUSION The introduction of IAC for the treatment of retinoblastoma in the last decade is the primary driver for the increased trend in neurointerventional procedures completed in infants from 1997 to 2022.
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Affiliation(s)
- Amanda Baker
- Department of Radiology and Biomedical Imaging, 8785University of California, San Francisco, CA, USA
| | - Michael Travis Caton
- Department of Radiology and Biomedical Imaging, 8785University of California, San Francisco, CA, USA
| | - Eric R Smith
- Department of Radiology and Biomedical Imaging, 8785University of California, San Francisco, CA, USA
| | - Kazim H Narsinh
- Department of Radiology and Biomedical Imaging, 8785University of California, San Francisco, CA, USA
| | - Matthew R Amans
- Department of Radiology and Biomedical Imaging, 8785University of California, San Francisco, CA, USA
| | - Randall T Higashida
- Department of Radiology and Biomedical Imaging, 8785University of California, San Francisco, CA, USA
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, 8785University of California, San Francisco, CA, USA
| | - Christopher F Dowd
- Department of Radiology and Biomedical Imaging, 8785University of California, San Francisco, CA, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, 8785University of California, San Francisco, CA, USA
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12
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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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13
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De Leacy R, Ansari SA, Schirmer CM, Cooke DL, Prestigiacomo CJ, Bulsara KR, Hetts SW. Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg 2022; 14:1118-1124. [PMID: 35414599 DOI: 10.1136/neurintsurg-2021-018632] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this review is to summarize the data available for the role of angiography and embolization in the comprehensive multidisciplinary management of brain arteriovenous malformations (AVMs METHODS: We performed a structured literature review for studies examining the indications, efficacy, and outcomes for patients undergoing endovascular therapy in the context of brain AVM management. We graded the quality of the evidence. Recommendations were arrived at through a consensus conference of the authors, then with additional input from the full Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee and the SNIS Board of Directors. RESULTS The multidisciplinary evaluation and treatment of brain AVMs continues to evolve. Recommendations include: (1) Digital subtraction catheter cerebral angiography (DSA)-including 2D, 3D, and reformatted cross-sectional views when appropriate-is recommended in the pre-treatment assessment of cerebral AVMs. (I, B-NR) . (2) It is recommended that endovascular embolization of cerebral arteriovenous malformations be performed in the context of a complete multidisciplinary treatment plan aiming for obliteration of the AVM and cure. (I, B-NR) . (3) Embolization of brain AVMs before surgical resection can be useful to reduce intraoperative blood loss, morbidity, and surgical complexity. (IIa, B-NR) . (4) The role of primary curative embolization of cerebral arteriovenous malformations is uncertain, particularly as compared with microsurgery and radiosurgery with or without adjunctive embolization. Further research is needed, particularly with regard to risk for AVM recurrence. (III equivocal, C-LD) . (5) Targeted embolization of high-risk features of ruptured brain AVMs may be considered to reduce the risk for recurrent hemorrhage. (IIb, C-LD) . (6) Palliative embolization may be useful to treat symptomatic AVMs in which curative therapy is otherwise not possible. (IIb, B-NR) . (7) The role of AVM embolization as an adjunct to radiosurgery is not well-established. Further research is needed. (III equivocal, C-LD) . (8) Imaging follow-up after apparent cure of brain AVMs is recommended to assess for recurrence. Although non-invasive imaging may be used for longitudinal follow-up, DSA remains the gold standard for residual or recurrent AVM detection in patients with concerning imaging and/or clinical findings. (I, C-LD) . (9) Improved national and international reporting of patients of all ages with brain AVMs, their treatments, side effects from treatment, and their long-term outcomes would enhance the ability to perform clinical trials and improve the rigor of research into this rare condition. (I, C-EO) . CONCLUSIONS Although the quality of evidence is lower than for more common conditions subjected to multiple randomized controlled trials, endovascular therapy has an important role in the management of brain AVMs. Prospective studies are needed to strengthen the data supporting these recommendations.
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Affiliation(s)
- Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sameer A Ansari
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Daniel L Cooke
- Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | | | - Ketan R Bulsara
- Division of Neurosurgery, University of Connecticut, Farmington, Connecticut, USA
| | - Steven W Hetts
- Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
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14
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Sporns PB, Fullerton HJ, Lee S, Kim H, Lo WD, Mackay MT, Wildgruber M. Childhood stroke. Nat Rev Dis Primers 2022; 8:12. [PMID: 35210461 DOI: 10.1038/s41572-022-00337-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/09/2023]
Abstract
Stroke is an important cause of neurological morbidity in children; most survivors have permanent neurological deficits that affect the remainder of their life. Stroke in childhood, the focus of this Primer, is distinguished from perinatal stroke, defined as stroke before 29 days of age, because of its unique pathogenesis reflecting the maternal-fetal unit. Although approximately 15% of strokes in adults are haemorrhagic, half of incident strokes in children are haemorrhagic and half are ischaemic. The causes of childhood stroke are distinct from those in adults. Urgent brain imaging is essential to confirm the stroke diagnosis and guide decisions about hyperacute therapies. Secondary stroke prevention strongly depends on the underlying aetiology. While the past decade has seen substantial advances in paediatric stroke research, the quality of evidence for interventions, such as the rapid reperfusion therapies that have revolutionized arterial ischaemic stroke care in adults, remains low. Substantial time delays in diagnosis and treatment continue to challenge best possible care. Effective primary stroke prevention strategies in children with sickle cell disease represent a major success, yet barriers to implementation persist. The multidisciplinary members of the International Pediatric Stroke Organization are coordinating global efforts to tackle these challenges and improve the outcomes in children with cerebrovascular disease.
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Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, Benioff Children's Hospital, University of California at San Francisco, San Francisco, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Helen Kim
- Departments of Anesthesia and Perioperative Care, and Epidemiology and Biostatistics, Center for Cerebrovascular Research, University of California at San Francisco, San Francisco, CA, USA
| | - Warren D Lo
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany.
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15
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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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16
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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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17
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Ku JC, Hanak B, Muthusami P, Narvacan K, Girgis H, terBrugge K, Krings T, Rutka JT, Dirks P. Improving long-term outcomes in pediatric torcular dural sinus malformations with embolization and anticoagulation: a retrospective review of The Hospital for Sick Children experience. J Neurosurg Pediatr 2021; 28:469-475. [PMID: 34330098 DOI: 10.3171/2021.3.peds20921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Torcular dural sinus malformations (tDSMs) are rare pediatric cerebrovascular malformations characterized by giant venous lakes localized to the midline confluence of sinuses. Historical clinical outcomes of patients with these lesions were poor, though better prognoses have been reported in the more recent literature. Long-term outcomes in children with tDSMs are uncertain and require further characterization. The goal of this study was to review a cohort of tDSM patients with an emphasis on long-term outcomes and to describe the treatment strategy. METHODS This study is a single-center retrospective review of a prospectively maintained data bank including patients referred to and cared for at The Hospital for Sick Children for tDSM from January 1996 to March 2019. Each patient's clinical, radiological, and demographic information, as well as their mother's demographic information, was collected for review. RESULTS Ten patients with tDSM, with a mean follow-up of 58 months, were included in the study. Diagnoses were made antenatally in 8 patients, and among those cases, 4 families opted for either elective termination (n = 1) or no further care following delivery (n = 3). Of the 6 patients treated, 5 had a favorable long-term neurological outcome, and follow-up imaging demonstrated a decrease or stability in the size of the tDSM over time. Staged embolization was performed in 3 patients, and anticoagulation was utilized in 5 treated patients. CONCLUSIONS The authors add to a growing body of literature indicating that clinical outcomes in tDSM may not be as poor as initially perceived. Greater awareness of the lesion's natural history and pathophysiology, advancing endovascular techniques, and individualized anticoagulation regimens may lead to continued improvement in outcomes.
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Affiliation(s)
- Jerry C Ku
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Brian Hanak
- 3Department of Neurosurgery, Loma Linda University Health, Loma Linda, California
| | - Prakash Muthusami
- 4Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto
| | - Karl Narvacan
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Hidy Girgis
- 5Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa
| | - Karel terBrugge
- 4Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto.,6Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - Timo Krings
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto.,4Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto.,6Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - James T Rutka
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Peter Dirks
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
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18
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Jordan L, Rodgers N, Roberts KD. Transverse sinus dural arteriovenous fistula: a reversible cause of severe pulmonary hypertension in an extremely premature infant. BMJ Case Rep 2021; 14:e239544. [PMID: 33619140 PMCID: PMC7903089 DOI: 10.1136/bcr-2020-239544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Leah Jordan
- Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Nathan Rodgers
- Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Kari D Roberts
- Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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19
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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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20
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Nesbit GM. Neurovascular disease and syndromes: Diagnosis and therapy in children. HANDBOOK OF CLINICAL NEUROLOGY 2020; 176:305-323. [PMID: 33272401 DOI: 10.1016/b978-0-444-64034-5.00015-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pediatric neurovascular disease runs the chronologic spectrum with dramatic changes in the presentation, evaluation, and treatment from the prenatal, perinatal, and infant periods through childhood and adolescence. These diseases are often dynamic throughout this period and the dynamic continues throughout life. There are four major categories: high-flow arteriovenous shunting lesions, arterial aneurysms, low-flow vascular lesions, and vascular occlusive disease. The high-flow lesions can be subdivided into a vein of Galen malformation, non-Galenic arteriovenous fistula, dural sinus malformations and fistula, and arteriovenous malformation. Low-flow vascular lesions include cerebral cavernous malformation, developmental venous anomaly, and capillary telangiectasia. The cerebrovascular occlusive disease can be divided between arterial occlusive disease and cerebral venous sinus thrombosis. The presentation of each of these entities can be very similar, especially in younger children; however, imaging and laboratory analysis can establish the diagnosis leading to the most appropriate therapy. A multidisciplinary team, dedicated to treating pediatric cerebrovascular disease, is important in delivering the best outcomes in these complex diseases. Given the relative rarity of pediatric presentation of cerebrovascular disease, many apply adult concepts to children. A better understanding of the diseases and their difference from adults makes a critical difference in selecting the correct approach.
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Affiliation(s)
- Gary M Nesbit
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, United States.
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21
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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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22
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Lubicz B, Christiaens F. Endovascular treatment of intracranial vascular malformations in children. Dev Med Child Neurol 2020; 62:1124-1130. [PMID: 32533582 DOI: 10.1111/dmcn.14589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
Paediatric intracranial vascular malformations are rare and different from adult ones in vascular anatomy, pathophysiology, and symptoms. Their impact on the brain and their symptoms will differ in the antenatal period, in neonates, infants, and children. Clinical presentation includes seizures, focal neurological deficit, haemorrhage, congestive heart failure, hydrovenous disorder, and developmental delays. These malformations are thus associated with a poor prognosis if left untreated. Therefore, aggressive management is generally recommended and must be performed by a multidisciplinary team with extensive experience. Endovascular treatment is the first-choice treatment for most paediatric intracranial vascular malformations. Indication and timing for treatment should be decided on the basis of a careful assessment of neurological symptoms, growth and development, cardiac and other systemic manifestations, and imaging of the malformation and the brain tissue. WHAT THIS PAPER ADDS: Paediatric intracranial vascular malformations are rare, but their prognosis is poor if left untreated. Improved clinical, anatomical, and pathophysiological understanding of these complex lesions has improved prognosis.
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Affiliation(s)
- Boris Lubicz
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Florence Christiaens
- Department of Pediatric Neurology, Erasme University Hospital, Brussels, Belgium
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23
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Shchehlov DV, Konotopchyk SV, Svyrydiuk OE, Bortnik IM, Momonova MY, Vyval MB. Endovascular Treatment of Intracranial Pial-Dural Arteriovenous Fistula: A Case Report. Surg J (N Y) 2020; 6:e118-e124. [PMID: 32566749 PMCID: PMC7297641 DOI: 10.1055/s-0040-1712533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/24/2020] [Indexed: 10/30/2022] Open
Abstract
Intracranial pial arteriovenous fistula (PAVF) is a rare cerebrovascular pathology characterized by abnormal direct high-flow connection between the pial or cortical feeding artery and draining vein. Dural arteriovenous fistula (DAVF) is a pathological shunt between the meningeal arteries and dural sinuses or meningeal veins. In case of association between PAVF and DAVF, diagnosis and treatment are more challenging. The high-flow arteriovenous shunt and deep venous drainage make PAVF more preferable for endovascular treatment; however, their embolization during single-session procedures can lead to extensive thrombosis of the draining veins and unfavorable outcomes. We present a case report of endovascular embolization of an intracranial PAVF-DAVF in a 2.5-year-old child. At the time of admission, the patient had hydrocephalus, mental retardation, pyramidal insufficiency, and seizures. Occlusion of the fistula was performed during two stages of embolization to reduce the risk of severe venous stasis and venous thrombosis. Guglielmi detachable coils (GDCs) and a liquid embolic agent (Histoacryl with Lipiodol) were used for embolization. The patient recovered well after the procedure, with significant mental improvement. This suggests that the deployment of GDCs in the afferent artery near a fistula before embolization with a liquid embolic agent can minimize the risk of uncontrolled penetration of the embolization into the draining veins and dural sinus. A multisession procedure can be an effective and reasonable method of PAVF and DAVF occlusion among existing treatment options.
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Affiliation(s)
- D V Shchehlov
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
| | - S V Konotopchyk
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
| | - O E Svyrydiuk
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
| | - I M Bortnik
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
| | - M Y Momonova
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
| | - M B Vyval
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
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24
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Lv X, Jiang C, Wang J. Pediatric intracranial arteriovenous shunts: Advances in diagnosis and treatment. Eur J Paediatr Neurol 2020; 25:29-39. [PMID: 31996298 DOI: 10.1016/j.ejpn.2019.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/24/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
Abstract
Pediatric intracranial arteriovenous shunts (IAVSs) comprise a wide range of lesions, including pial arteriovenous malformation (AVM) and arteriovenous fistula (AVF), dural arteriovenous fistula (DAVF) and vein of Galen aneurysmal malformation (VGAM). We provide an overview of pediatric IAVSs, encompassing both diagnosis and endovascular treatment. We include references from pertinent literature and representative cases from our hospital. Pediatric IAVS are frequently associated two broader conditions, such as capillary malformation-arteriovenous malformation (CM-AVM) and hereditary hemorrhagic telangiectasia (HHT). These conditions and the associated genetic mutations have only recently been described. Their impact on the brain will be different in the prenatal period, in neonates, in infants, and in children, with variable symptoms according to each age group and the current strategies of endovascular treatment in the management of these vascular lesions will be discussed. This review could improve the understanding of pediatric IAVSs and their diagnosis and treatment.
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Affiliation(s)
- Xianli Lv
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Chuhan Jiang
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Wang
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Guo L, Liu T, Lv X. Endovascular embolization of dural arteriovenous fistula in a child presented with slight conjunctival hyperemia. Childs Nerv Syst 2019; 35:2435-2437. [PMID: 31664562 DOI: 10.1007/s00381-019-04397-5] [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: 08/21/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVFs) are rare in pediatrics. A case of DAVF diagnosed because of a slight conjunctival hyperemia and endovascular coil embolization at 2 years old is reported. CASE DESCRIPTION The 2-year-old boy presented with a slight conjunctival hyperemia of the left eye for 1 month. Magnetic resonance imaging (MRI) examination of the head showed abnormal blood flow in the left middle cranial fossa. On digital subtraction angiography, a DAVF with a dural feeder shunt and a venous varix at the middle cranial fossa was confirmed. After transarterial coil embolization, shunt blood flow disappeared. CONCLUSIONS This report describes a case of DAVF with a slight conjunctival hyperemia treated by coil embolization in a child.
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Affiliation(s)
- Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, QILU Children's Hospital of Shandong University, Jinan, Shandong, China
| | - Ting Liu
- Department of Vascular Anomalies and Interventional Radiology, QILU Children's Hospital of Shandong University, Jinan, Shandong, China
| | - Xianli Lv
- Neurosurgical Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Litang Road 168, Changping, Beijing, 102218, China.
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Dinc N, Won SY, Eibach M, Quick-Weller J, Keil F, Berkefeld J, Konczalla J, Marquardt G, Seifert V. Thrombosis of the straight sinus and microbleedings due to deep seated arteriovenous fistula - Hemodynamic changes, cognitive impairment and improvement after microsurgery. A technical report. J Clin Neurosci 2019; 68:317-321. [PMID: 31324470 DOI: 10.1016/j.jocn.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/09/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
Dural arteriovenous fistulas (dAVF) are rare vascular malformations accounting for only 10-15% that may lead to life threatening deficits due to hemodynamic changes in blood supply and pressure conditions. We present a 64-year old patient who was admitted with disorientation and aphasia. Following images confirmed an infratentorial dural fistula draining into the straight sinus. Additional findings were progressive thrombosis of the straight sinus, microbleedings and bithalamic edema due changes in hemodynamic conditions and venous congestion. Microsurgery was performed. After treatment improvement in clinical condition was observed and the venous congestion was regressive. Hemodynamic changes due to infratentorial dAVFs may lead to bleedings in deep regions and worsening of clinical condition fastly. Treatment requires carefully planning and visualization of angioarchitecture. Symptoms and hemodynamic changes are reversible after treatment, which are essential for treatment decisions.
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Affiliation(s)
- Nazife Dinc
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany.
| | - Sae-Yeon Won
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Michael Eibach
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | | | - Fee Keil
- Department of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - Joachim Berkefeld
- Department of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - Jürgen Konczalla
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
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LaHue SC, Kim H, Pawlikowska L, Nelson J, Cooke DL, Hetts SW, Singh V. Frequency and characteristics associated with inherited thrombophilia in patients with intracranial dural arteriovenous fistula. J Neurosurg 2018:1-5. [PMID: 29624150 DOI: 10.3171/2017.10.jns171987] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 10/16/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe pathogenesis of dural arteriovenous fistulas (DAVFs) remains poorly defined. Prior studies on thrombophilia as a risk factor for DAVF development are limited by small sample sizes and poor generalizability.METHODSIn this longitudinal observational study, all patients with intracranial DAVFs evaluated at the University of California, San Francisco from December 1994 through April 2014 were identified. After obtaining patient consent, 3 thrombophilic mutations, factor V Leiden (rs6025), MTHFR (rs1801133), and prothrombin G20210A, were genotyped. The authors evaluated the association of thrombophilia status (presence of any thrombophilic mutation) and clinical and angiographic characteristics using either a 2-sample t-test or Fisher's exact test.RESULTSA total of 116 patients with diagnosed intracranial DAVFs were included in the study. Twenty-five (22%) patients met criteria for thrombophilia. Focal neurological deficits tended to occur more frequently in the thrombophilia group (78% vs 57%, p = 0.09). Angiographic characteristics of DAVFs, including high-risk venous flow pattern, multiplicity of DAVF, and the presence of venous sinus thrombosis, did not differ significantly between the 2 groups but tended to be more common in the thrombophilic than in the nonthrombophilic group.CONCLUSIONSThis study is one of the largest of thrombophilia and DAVF to date. The frequency of mutations associated with thrombophilia in this study was higher than that in the general population.
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Affiliation(s)
- Sara C LaHue
- 1Department of Neurology.,2Department of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Helen Kim
- 3Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care.,4Institute for Human Genetics; and
| | - Ludmila Pawlikowska
- 3Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care.,4Institute for Human Genetics; and
| | - Jeffrey Nelson
- 3Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care
| | - Daniel L Cooke
- 5Department of Radiology and Biomedical Imaging, University of California, San Francisco; and
| | - Steven W Hetts
- 5Department of Radiology and Biomedical Imaging, University of California, San Francisco; and
| | - Vineeta Singh
- 1Department of Neurology.,2Department of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, California
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Guo Y, Yu J, Zhao Y, Yu J. Progress in research on intracranial multiple dural arteriovenous fistulas. Biomed Rep 2017; 8:17-25. [PMID: 29399335 PMCID: PMC5772627 DOI: 10.3892/br.2017.1021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/03/2017] [Indexed: 12/16/2022] Open
Abstract
Intracranial multiple dural arteriovenous fistulas (MDAVFs) are rare lesions that are difficult to treat. The key factors involved in the development of MDAVFs remain unknown. At present, the majority of reports on intracranial MDAVFs are confined to case reports and small case series, and thus understanding of MDAVFs is limited. The current review assesses the available literature to date with the aim of reviewing the progress in research on intracranial MDAVFs. Intracranial MDAVFs may be divided into two types: Synchronous and metachronous. While the exact pathogenesis of MDAVFs is unknown, a number of possible mechanisms are considered relevant. The first is that MDAVFs develop following recanalization of a large sinus thrombosis that involves several sinuses. The second possibility is that a pre-existing DAVF may induce sinus thrombosis or venous hypertension, resulting in a new MDAVF. The third is that MDAVFs are caused by increased angiogenic activity, which may induce the development of MDAVFs. Intracranial MDAVFs have a malignant clinical course, and their symptoms generally rapidly progress following onset. It is therefore important to identify intracranial MDAVFs at an early stage. A number of imaging technologies, including computed tomography (CT), magnetic resonance imaging (MRI), digital subtraction angiography (DSA) and single-photon emission computed tomography (SPECT), may be used to detect MDAVFs. Of these, CT and MRI provide information on brain morphology, SPECT provides brain blood flow information, and DSA is the gold standard that may be used to identify angioarchitecture and hemodynamics. MDAVFs require timely and aggressive treatment, which may include endovascular embolization, surgical resection, radiosurgery and conservative treatment, and in some cases, combined treatments are required. Appropriate and aggressive treatment regimens can markedly improve neurological deficits and cognitive function in patients with MDAVFs.
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Affiliation(s)
- Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jing Yu
- Operating Room, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ying Zhao
- Training Department, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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