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Rao VL, Shin JW, Klaas JP, Lanzino G. Concurrent Moyamoya-like Intracranial Steno-Occlusive Disease and Dural Arteriovenous Fistulas. AJNR Am J Neuroradiol 2024; 45:708-711. [PMID: 38697786 DOI: 10.3174/ajnr.a8197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/15/2024] [Indexed: 05/05/2024]
Abstract
The simultaneous presentation of intracranial steno-occlusive disease, Moyamoya disease, or Moyamoya-like vasculopathy and dural arteriovenous fistulas (DAVFs) has been documented in very few case reports worldwide. We aimed to better characterize this association by reviewing the clinical and radiologic findings of 4 patients with concurrent intracranial steno-occlusive disease or Moyamoya-like vasculopathy and DAVFs evaluated in our institution. All 4 patients were of Asian descent. One patient presented with ischemic stroke secondary to intracranial stenosis, 2 presented with symptoms related to the DAVF, and the diagnosis was incidental in the fourth patient. Three patients underwent embolization of the DAVF, which was followed by surgical ligation in 2. One patient underwent extracranial-intracranial bypass for Moyamoya-like intracranial steno-occlusive disease. One patient is being managed conservatively with close follow-up. Our case series details findings in 4 patients with associated intracranial steno-occlusive disease and DAVFs. Further studies and reporting of similar cases are necessary to establish whether this is pure coincidence or if there is indeed a relationship between these 2 conditions, especially in certain ethnic groups.
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Affiliation(s)
- Vaishnavi L Rao
- From the Department of Neurosurgery (V.L.R., G.L.), Mayo Clinic, Rochester, Minnesota
| | - Jee Won Shin
- Mayo Clinic Alix School of Medicine (J.W.S.), Rochester, Minnesota
| | - James P Klaas
- Department of Neurology (J.P.K.), Mayo Clinic, Rochester, Minnesota
| | - Giuseppe Lanzino
- From the Department of Neurosurgery (V.L.R., G.L.), Mayo Clinic, Rochester, Minnesota
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2
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Voldřich R, Grygar J, Charvát F, Netuka D. Natural course of partially embolized carotid-cavernous fistulas. J Neuroimaging 2024; 34:376-385. [PMID: 38343141 DOI: 10.1111/jon.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND AND PURPOSE To present the first study analyzing the clinical and radiological course of carotid-cavernous fistulas (CCFs) following incomplete embolization. The study compares magnetic resonance angiography (MRA) to plain angiography (digital subtraction angiography [DSA]) and investigates the long-term ophthalmological impact of residual fistula. METHODS Fistulas classified as partially embolized after the last endovascular treatment were prospectively followed with DSA, MRA, and ophthalmological examination. Both direct and indirect CCFs were included. RESULTS Twenty-one CCFs were included in the study. Nine (43%) fistulas were direct and 12 (57%) were indirect. A favorable clinical outcome of modified Rankin scale ≤2 was recorded in 19 (90%) patients at the last follow-up. Postinterventional ophthalmologic examinations in 16 patients revealed no negative effects of residual fistulas; five remaining patients refused to undergo further examination. Spontaneous thrombosis and complete occlusion of the CCF were demonstrated in 90% of patients, with a mean time to occlusion of 5.7 ± 4.7 months. Fourteen (66%) patients completed the full imaging follow-up (MRA and DSA). In 21% of these cases, discrepancy between the two imaging modalities was observed-MRA failed to detect persistent fistulas identified by DSA. CONCLUSIONS The goal of CCF treatment is safe and complete embolization. However, if adequate flow reduction is achieved, both direct and indirect CCFs tend to spontaneously thrombose. Residual flow does not result in ophthalmological deterioration until the fistula is completely closed. MRA may not be sufficiently sensitive to detect residues of fistulas including cortical venous drainage. Therefore, complete CCF closure should be confirmed through DSA.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neurooncology, Charles University, First Faculty of Medicine, Military University Hospital, Prague, Czech Republic
| | - Jan Grygar
- Department of Ophthalmology, Charles University, First Faculty of Medicine, Military University Hospital, Prague, Czech Republic
| | - František Charvát
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Charles University, First Faculty of Medicine, Military University Hospital, Prague, Czech Republic
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3
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Golub D, Lynch DG, Mehta SH, Donaldson H, Shah KA, White TG, Quach ET, Papadimitriou K, Kuffer AF, Woo HH, Link TW, Patsalides A, Dehdashti AR. The role of surgical disconnection for posterior fossa pial arteriovenous fistulas and dural fistulas with pial supply: an illustrative case series. Neurosurg Rev 2024; 47:189. [PMID: 38658425 DOI: 10.1007/s10143-024-02407-y] [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: 12/12/2023] [Revised: 01/26/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Pial arteriovenous fistulas (pAVFs) are rare vascular malformations characterized by high-flow arteriovenous shunting involving a cortical arterial supply directly connecting to venous drainage without an intermediate nidus. Dural arteriovenous fistulas (dAVFs) can infrequently involve additional pial feeders which can introduce higher flow shunting and increase the associated treatment risk. In the posterior fossa, arteriovenous fistula (AVF) angioarchitecture tends to be particularly complex, involving either multiple arterial feeders-sometimes from both dural and pial origins-or small caliber vessels that are difficult to catheterize and tend to be intimately involved with functionally critical brainstem or upper cervical cord structures. Given their rarity, published experience on microsurgical or endovascular treatment strategies for posterior fossa pAVFs and dAVFs with pial supply remains limited. METHODS Retrospective chart review from 2019-2023 at a high-volume center identified six adult patients with posterior fossa pAVFs that were unable to be fully treated endovascularly and required microsurgical disconnection. These cases are individually presented with a technical emphasis and supported by comprehensive angiographic and intraoperative images. RESULTS One vermian (Case 1), three cerebellopontine angle (Cases 2-4) and two craniovertebral junction (Cases 5-6) posterior fossa pAVFs or dAVFs with pial supply are presented. Three cases involved mixed dural and pial arterial supply (Cases 1, 4, and 6), and one case involved a concomitant microAVM (Case 2). Endovascular embolization was attempted in four cases (Cases 1-4): The small caliber and tortuosity of the main arterial feeder prevented catheterization in two cases (Cases 1 and 3). Partial embolization was achieved in Cases 2 and 4. In Cases 5 and 6, involvement of the lateral spinal artery or anterior spinal artery created a prohibitive risk for endovascular embolization, and surgical clip ligation was pursued as primary management. In all cases, microsurgical disconnection resulted in complete fistula obliteration without evidence of recurrence on follow-up imaging (mean follow-up 27.1 months). Two patients experienced persistent post-treatment sensory deficits without significant functional limitation. CONCLUSIONS This illustrative case series highlights the technical difficulties and anatomical limitations of endovascular management for posterior fossa pAVFs and dAVFs with pial supply and emphasizes the relative safety and utility of microsurgical disconnection in this context. A combined approach involving partial preoperative embolization-when the angioarchitecture is permissive-can potentially decrease surgical morbidity. Larger studies are warranted to better define the role for multimodal intervention and to assess associated long-term AVF obliteration rates in the setting of pial arterial involvement.
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Affiliation(s)
- Danielle Golub
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA.
| | - Daniel G Lynch
- Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA
| | - Shyle H Mehta
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Hayley Donaldson
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kevin A Shah
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Timothy G White
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Eric T Quach
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | | | | | - Henry H Woo
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Thomas W Link
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Athos Patsalides
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
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4
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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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Ohgaki F, Suenaga J, Shimizu N, Yamamoto T. De novo progressive dural arteriovenous fistula with putamen hemorrhage associated with long-term Down syndrome: A case report and literature review. Radiol Case Rep 2023; 18:2329-2334. [PMID: 37179806 PMCID: PMC10172633 DOI: 10.1016/j.radcr.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023] Open
Abstract
Dural arteriovenous fistula (DAVF) is considered an acquired change in blood flow related to factors such as craniotomy, trauma, and infection. However, several factors related to its development remain unknown. Here, we present a case of a 48-year-old man with Down syndrome and Eisenmenger syndrome. He had a history of craniotomy for multiple brain abscesses, followed by the occurrence of a de novo straight sinus (StS) DAVF within the last 2 years. The patient presented with right putamen hemorrhage due to venous congestion by a StS DAVF. The shunt flow was occluded by transarterial embolization using Onyx. Several studies have reported on DAVF models induced by venous congestion and hypoxemia. In this case, local venous congestion due to craniotomy for multiple brain abscesses was considered as one of the causes of DAVF. Complication of venous thrombosis or chronic hypoxemia due to Eisenmenger syndrome might have led to its progression. Especially in DAVF cases with Down syndrome, concomitant symptoms such as hypoxemia due to congenital heart failure and coagulopathy could worsen the disease state progressively.
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Huang X, Shen H, Fan C, Chen J, Meng R. Clinical characteristics and outcome of dural arteriovenous fistulas secondary to cerebral venous sinus thrombosis: a primary or secondary event? BMC Neurol 2023; 23:131. [PMID: 36997877 PMCID: PMC10061836 DOI: 10.1186/s12883-023-03141-6] [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: 08/06/2022] [Accepted: 02/27/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The Dural Arteriovenous Fistulas (DAVFs) secondary to cerebral venous sinus thrombosis (CVST) are rather rare. The aim of present study is to investigate the clinical and radiological features, and treatment outcome of DAVFS in patients following CVST. METHODS Data about demographic information, clinical presentations, radiological findings, as well as treatment and outcome of DAVFs sequence to CVST were collected to analysis from January 2013 to September 2020 in this retrospective study. RESULTS Fifteen patients with DAVFs after CVST were included in the study. The median age was 41 years (range17-76 years). Ten patients (66.67%) were male and 6 patients (33.33%) were female. The median duration of presenting CVST was 182 days (Range 20-365). Mean time from diagnosis of CVST to confirmation of DAVFs was 97 days (range 36-370 days). The most common manifestations of DAVFs following CVST were headache and visual disturbance seen in 7 patients respectively. Five patients had pulsatile tinnitus (%) and 2 had nausea/vomiting. The DAVFs are most frequently located at the transverse/sigmoid sinus (7/15, 46.67%), followed by the superior sagittal the sinus and confluence sinus (6/15, 40.00%) respectively. Angiography of DAVFs revealed Board type I in seven (46.7%) patients, Board type II and III in 4(26.7%) patients, respectively. The Cognard I was noted in seven (46.7%), Cognard IIa and IV in 3 patients, IIb and III in one patient, respectively. The main feeding arteries of DAVFs most commonly originate from the branches of the external carotid artery in 6 (40.0%) patients. The other DAVFs are conjointly supplied by multiple feeders from internal and external carotid artery and vertebral arteries. Fourteen (93.33%) patients were treated with endovascular embolization and none of the patients had permanent deficits during follow-up. CONCLUSION Intracranial DAVFs following CVST are rare presentations. Most patients have a good outcome after timely interventional therapy. Continued observation and follow-up of (DSA) are important to find DAVFs secondary to CVST.
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Affiliation(s)
- Xiaoqin Huang
- Departments of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Huixin Shen
- Departments of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunnqiu Fan
- Departments of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Departments of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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7
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Yamazaki H, Ozaki T, Kidani T, Fujimi Y, Nonaka M, Umegaki M, Yokota C, Fujinaka T. Coexisting filum terminale arteriovenous fistula and filum terminale lipoma treated with single-stage surgery: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22474. [PMID: 36647255 PMCID: PMC9844529 DOI: 10.3171/case22474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Both filum terminale arteriovenous fistulas (FTAVFs) and filum terminale lipomas (FTLs) are rare. Because of this rarity, there is a paucity of data regarding concomitant FTAVF and FTL, and the optimal treatment remains to be defined. The authors describe a patient with coexisting FTAVF and FTL treated with single-stage surgery. OBSERVATIONS A man in his 70s was referred to the authors' department because of a suspected spinal vascular malformation seen on magnetic resonance imaging that was performed to investigate lower limb weakness, intermittent claudication, and urinary incontinence. Previous imaging had shown a terminal lipoma with an internal flow void. Computed tomography angiography and digital subtraction angiography revealed an FTAVF, the feeder being a lateral sacral artery. The patient was treated surgically with curative intent. The FTL and tethered cord that had been identified by imaging were treated in the same procedure. Postoperative digital subtraction angiography showed absence of the abnormal vessels. The patient was discharged home on the 19th postoperative day. LESSONS When considering treatment, it is important to determine whether symptoms are attributable mainly to FTL, tethered cord, or FTAVF. One-stage treatment is useful because it eliminates both the FTAVF and the factors that led to its development.
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Affiliation(s)
- Hiroki Yamazaki
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Chuo-ku, Osaka, Japan,Department of Neurosurgery, Suita Municipal Hospital, Suita, Japan; and
| | - Tomohiko Ozaki
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Chuo-ku, Osaka, Japan
| | - Tomoki Kidani
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Chuo-ku, Osaka, Japan
| | - Yosuke Fujimi
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Chuo-ku, Osaka, Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, Kansai Medical University, Hirakata, Japan
| | - Masao Umegaki
- Department of Neurosurgery, Suita Municipal Hospital, Suita, Japan; and
| | - Chisato Yokota
- Department of Neurosurgery, Suita Municipal Hospital, Suita, Japan; and
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Chuo-ku, Osaka, Japan
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Patel TJ, Zaslavsky K, Nicholson P, Margolin E. Hypercoagulability in patients with indirect carotid cavernous fistulas. Eye (Lond) 2022; 36:1982-1987. [PMID: 34635794 PMCID: PMC9500034 DOI: 10.1038/s41433-021-01801-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To assess patients with indirect carotid-cavernous fistulas (CCF) for evidence of hypercoagulable state (HS) by combination of comprehensive medical questionnaire and laboratory testing. METHODS Patients with confirmed diagnosis of CCF treated between 2003 and 2019 were included and administered a questionnaire screening for HS risk factors and undergone laboratory investigations which included complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibody titres), Factor V Leiden, prothrombin, protein C, protein S, antithrombin III, homocysteine, prothrombin G20210, CALR and JAK2 mutation screening. Participants with abnormal laboratory testing and/or past history of ischemic stroke, atrial fibrillation, cancer or hypercoagulability-associated hereditary disorders were deemed to have HS. RESULTS Twenty-two patients were enrolled. Seventeen were women and the mean age at diagnosis was 60. Fourteen (64%) had evidence of HS: six on medical history, three with laboratory evidence and five with both. Eight (36%) had current abnormal hypercoagulability markers. One had a diagnosis of Klippel-Trenaunay Syndrome, but no others had evidence of hereditary thrombophilia. Nine were on anti-coagulation initiated after diagnosis of stroke or atrial fibrillation discovered on average 5.5 years after the diagnosis of CCF. CONCLUSION A total of 64% percent of patients with previous indirect CCF had evidence of underlying HS indicating that hypercoagulability might play a role in the pathogenesis of CCF. The results support need for comprehensive testing for underlying HS in patients with indirect CCFs to better identify, manage, and prevent further thromboembolic events.
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Affiliation(s)
- Trishal Jeeva Patel
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada
| | - Kirill Zaslavsky
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada
| | - Patrick Nicholson
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Edward Margolin
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada.
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Tu T, Peng Z, Song Z, Ma Y, Zhang H. New insight into DAVF pathology—Clues from meningeal immunity. Front Immunol 2022; 13:858924. [PMID: 36189220 PMCID: PMC9520480 DOI: 10.3389/fimmu.2022.858924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, with the current access in techniques, studies have significantly advanced the knowledge on meningeal immunity, revealing that the central nervous system (CNS) border acts as an immune landscape. The latest concept of meningeal immune system is a tertiary structure, which is a comprehensive overview of the meningeal immune system from macro to micro. We comprehensively reviewed recent advances in meningeal immunity, particularly the new understanding of the dural sinus and meningeal lymphatics. Moreover, based on the clues from the meningeal immunity, new insights were proposed into the dural arteriovenous fistula (DAVF) pathology, aiming to provide novel ideas for DAVF understanding.
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Affiliation(s)
- Tianqi Tu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenghong Peng
- Department of Health Management Center, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yongjie Ma, ; Hongqi Zhang,
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yongjie Ma, ; Hongqi Zhang,
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Sinovenous outflow in lateral sinus dural arteriovenous fistulas after stereotactic radiosurgery: a retrospective longitudinal imaging study. Acta Neurochir (Wien) 2022; 164:2409-2418. [PMID: 35831724 DOI: 10.1007/s00701-022-05310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate sinovenous outflow restriction (SOR) in lateral sinus dural arteriovenous fistulas (LSDAVFs) after Gamma Knife radiosurgery (GKRS) and its association with complete obliteration. METHODS We retrospectively (1995-2019) enrolled 39 patients with LSDAVFs who had undergone GKRS alone and evaluated their angiography and magnetic resonance imaging (MRI) before and after GKRS. The LS conduits ipsilateral and contralateral to the DAVFs were scored using a 5-point scoring system, with scores ranging from 0 (total occlusion) to 4 (fully patent). SOR was defined by a conduit score < 2. Demographics, imaging features, and outcomes were compared between patients with and without ipsilateral SOR after GKRS. Logistic regression analysis was performed to estimate the odds ratio (OR) for obliteration with the imaging findings. RESULTS After a median angiographic follow-up of 28 months for the 39 patients, the ipsilateral LS became more restrictive (median conduit score before and after GKRS: 2 vs. 1, p = .011). Twenty-one patients with ipsilateral SOR after GKRS had a significantly lower obliteration rate (52.4% vs. 94.4%, p = .005) than those without SOR. Follow-up SOR was independently associated with a lower obliteration rate (OR 0.05, p = .017) after adjustment for age, cortical venous reflux, and absent sinus flow void on MRI. CONCLUSION This study demonstrates a restrictive change of outflow in LSDAVFs after GKRS and a lower obliteration rate in patients with SOR. Follow-up imaging for SOR may help predict outcomes of these patients.
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Duquette E, Dowlati E, Abdullah T, Felbaum DR, Mai JC, Sur S, Armonda RA, Liu AH. De Novo dural arteriovenous fistulas after endovascular treatment: Case illustration and literature review. Interv Neuroradiol 2022:15910199221118517. [PMID: 35924383 DOI: 10.1177/15910199221118517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intracranial dural arteriovenous fistulas (dAVF) account for nearly 10-15% of all arteriovenous malformations. Although the majority of dAVF are effectively cured after endovascular intervention, there are cases of dAVFs that may recur after radiographic cure. We present the case of a 69-year-old female with de novo formation of three dAVFs in different anatomic locations after successive endovascular treatments. The patient's initial dAVF was identified in the right posterior frontal convexity region and obliterated with transarterial and transvenous embolization. The patient returned eight years later due to left-sided pulsatile tinnitus and a new dAVF in the left greater sphenoid wing region was seen on angiography. This was treated with transvenous embolization with complete resolution. One year later, she developed left sided pulsatile tinnitus again and was found to have a left carotid-cavernous dAVF. This is the first case report to our knowledge of the formation of three de novo dAVFs over multiple years in distinct anatomical locations. We also review the literature regarding de novo dAVFs after endovascular treatment which includes 16 cases. De novo dAVF formation is likely due to numerous factors including changes in venous flow and aberrant vascular development. It is important to further understand the relationship between endovascular treatment and recurrent dAVF formation to prevent subsequent malformations.
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Affiliation(s)
| | - Ehsan Dowlati
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
| | - Taha Abdullah
- 89013Touro College of Osteopathic Medicine, New York, NY, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Samir Sur
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Ai-Hsi Liu
- Department of Radiology, 8405MedStar Washington Hospital Center, Washington, DC, USA
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Yajima H, Miyawaki S, Koizumi S, Kiyofuji S, Hongo H, Segawa M, Kin T, Nakatomi H, Saito N. Development of a sigmoid sinus dural arteriovenous fistula secondary to sigmoid sinus thrombosis after resection of a foramen magnum meningioma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22253. [PMID: 36088557 PMCID: PMC9706339 DOI: 10.3171/case22253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The precise etiology of dural arteriovenous fistula (DAVF) is still unknown. The authors reported a case of delayed postoperative sigmoid sinus (SS) DAVF secondary to SS thrombosis after resection of a foramen magnum meningioma through a suboccipital craniotomy. OBSERVATIONS The authors visualized the clear architecture of the DAVF using fusion three-dimensional computer graphics (3DCG) images reconstructed from multimodal imaging studies. These fusion 3DCG images revealed that the feeders of the DAVF had connected through neovascularization to the SS at the previous thrombus site. The authors also reviewed previously reported cases of DAVFs that developed after craniotomy. LESSONS This study indicated that SS stenosis and occlusion with sinus thrombosis are possible risk factors for delayed postoperative DAVF that demand special consideration.
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Affiliation(s)
- Hirohisa Yajima
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Kiyofuji
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Hongo
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masafumi Segawa
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taichi Kin
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Medical Information Engineering, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; and
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Neurosurgery, Kyorin University, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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13
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Matsubara S, Takai H, Enomoto N, Hara K, Hirai S, Sunada Y, Yamada S, Tao Y, Ogawa Y, Yagi K, Uno M. Anterior cranial fossa osseous arteriovenous fistula of the crista galli with bone erosion: patient series. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022. [PMCID: PMC9379729 DOI: 10.3171/case2243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Although an anterior cranial fossa dural arteriovenous fistula (ACFdAVF) is thought to have a fistula on the dura near the olfactory groove, the detailed angioarchitecture remains unreported. OBSERVATIONS In case 1, a 65-year-old man was found to have an asymptomatic ACFAVF. His computed tomography angiography (CTA)-maximum intensity projection (MIP) showed the shunt point in the crista galli (CG), with the intradural drainer penetrating the destroyed bone of the CG. In case 2, a 78-year-old man had a past history of intracerebral hemorrhage and was found to have an ACFAVF. The rotational angiography (RA)-MIP showed the intraosseous fistula in the CG with the drainer passing through a tiny bone defect of the CG. In case 3, a 35-year-old man was investigated for epilepsy. The RA-MIP showed an osseous arteriovenous fistula (AVF) in the anterior cranial base, with the drainer penetrating the skull osteolytic site. In case 4, a 73-year-old woman was found to have an asymptomatic ACFAVF. Her RA-MIP showed the osseous AVF with the drainer penetrating the CG with bone erosion. LESSSONS All patients were diagnosed with anterior cranial fossa osseous AVF rather than dAVF, with bone erosion in the CG. These findings should be noted at the time of diagnosis and treatment.
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Affiliation(s)
- Shunji Matsubara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hiroki Takai
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Noriya Enomoto
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Keijiro Hara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Satoshi Hirai
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshihiro Sunada
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Shodai Yamada
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshifumi Tao
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yukari Ogawa
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
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14
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Lozouet M, Gilard V, Nassihi A, Marie J, Derrey S. Ruptured dural arteriovenous fistula and sinus venous thrombosis following surgical resection of a vestibular schwannoma: Case report and review of the literature. Neurochirurgie 2022; 68:688-692. [DOI: 10.1016/j.neuchi.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
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15
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Sim SY. Pathophysiology and classification of intracranial and spinal dural AVF. J Cerebrovasc Endovasc Neurosurg 2022; 24:203-209. [PMID: 35443276 PMCID: PMC9537653 DOI: 10.7461/jcen.2022.e2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/13/2021] [Indexed: 11/23/2022] Open
Abstract
Dural arteriovenous fistulas (DAVFs) are pathologic shunts between pachymeningeal arteries and dural venous channel. DAVFs are relatively rare, however, DAVFs can lead to significant morbidity and mortality due to intracranial hemorrhage and non-hemorrhagic neurologic deterioration related to leptomeningeal venous drainage. The etiology and pathophysiology of DAVFs is not fully understood. Several hypotheses for development of DAVF and classifications for predicting risk of hemorrhage and neurological deficit have been proposed to help clinical decision making according to its natural history. Herein, incidence, etiology, pathophysiology of development of intracranial and spinal DAVF including their classifications are briefly described with short historical review.
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Affiliation(s)
- Sook Young Sim
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Goyang, Korea
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16
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Liu P, Shi Y, Li S, Liu Y, Zhou Y, Song Y, Zhu W, An Q. Pathology and Protein Changes of the Spinal Dural Arteriovenous Fistula Arterial Draining Vein Under Sustained High Vascular Pressure. Front Neurol 2021; 12:713355. [PMID: 34630287 PMCID: PMC8498570 DOI: 10.3389/fneur.2021.713355] [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: 05/25/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
Object: Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular shunt lesion. Although pathological changes in the SDAVF draining vein (SDAVF-DV) have been elucidated, protein changes remain enigmatic. We investigated the pathology and protein changes in the SDAVF-DV under sustained high vascular pressure. Methods: Three SDAVF-DV samples were compared with superficial temporal artery (STA) and superficial temporal vein (STV) samples as controls. Vascular structure was revealed by hematoxylin and eosin (H&E) and Masson staining; and cell distribution, extracellular matrix, and inflammation infiltration were observed by immunohistochemistry. Label-free quantitative proteomics was performed, and the peptide mixture was fractionated and analyzed by liquid chromatography–tandem mass spectrometry (LC-MS/MS) to identify differentially expressed proteins. Bioinformatics analysis of the differentially expressed proteins was performed using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and protein–protein interaction (PPI) networks. Results: H&E and Masson staining showed an artery-like structure of the SDAVF-DV. Immunostaining showed that vWF+ cells were not continuous in the SDAVF-DV. Although α-SMA+ and AT1+ cells were more abundant in the STV than in the SDAVF-DV, piezo-1 expression was lower in the SDAVF-DV. The SDAVF-DV showed different distributions of elastin, COL I, and COL III. COL IV and COL VI were decreased in the SDAVF-DV, while CD45+ cells and COX-1 were increased compared with those in the controls. No differences in CD68 expression and COX-2 staining were observed between the SDAVF-DV and controls. Compared with the STA, 95 proteins were upregulated and 303 proteins were downregulated in the SDAVF-DV. The most differential GO terms in each category were the adenylate cyclase-modulating G protein-coupled receptor signaling pathway, U6 snRNP, and SH3 domain binding. The most differentially expressed KEGG protein pathway was focal adhesion. Compared with the STV, the SDAVF-DV had 158 upregulated proteins and 362 downregulated proteins. The most differential GO terms in each category were lamellipodium assembly, U6 snRNP, and SH3 domain binding; and the most differentially expressed KEGG protein pathway was dilated cardiomyopathy. PPI analysis revealed PPIs among the top 300 proteins. Conclusions: The SDAVF-DV exhibits specific pathology and protein expression changes under sustained high vascular pressure. The results of the present study provide insights into the pathogenesis of SDAVF formation at the protein level as well as a scientific foundation for further exploration of the pathophysiological mechanism of the SDAVF.
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Affiliation(s)
- Peixi Liu
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Yuan Shi
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Sichen Li
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Yingjun Liu
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Yingjie Zhou
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yaying Song
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Qingzhu An
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
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17
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Matsubara S, Toi H, Takai H, Miyazaki Y, Kinoshita K, Sunada Y, Yamada S, Tao Y, Enomoto N, Minami YO, Hirai S, Yagi K, Nakashima H, Uno M. Variations and management for patients with craniocervical junction arteriovenous fistulas: Comparison of dural, radicular, and epidural arteriovenous fistulas. Surg Neurol Int 2021; 12:411. [PMID: 34513175 PMCID: PMC8422467 DOI: 10.25259/sni_557_2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/15/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Craniocervical junction arteriovenous fistulas (CCJAVFs) are known to be rare, but variations and clinical behaviors remain controversial. Methods: A total of 11 CCJAVF patients (M: F=9:2, age 54–77 years) were investigated. Based on the radiological and intraoperative findings, they were categorized into three types: dural AVF (DAVF), radicular AVF (RAVF), and epidural AVF (EDAVF). Results: There were four symptomatic patients (subarachnoid hemorrhage in two, myelopathy in one, and tinnitus in one) and seven asymptomatic patients in whom coincidental CCJAVFs were discovered on imaging studies for other vascular diseases (arteriovenous malformation in one, intracranial DAVF in two, ruptured cerebral aneurysm in two, and carotid artery stenosis in two). Of these 11 patients, 2 (18.2%) had multiple CCJAVFs. Of 14 lesions, the diagnoses were DAVF in 5, RAVF in 3, and EDAVF in 6 (C1–C2 level ratio =5:0, 2:1, 3:3). Patients with DAVF/RAVF in four lesions with intradural venous reflux underwent surgery, although an RAVF remained in one lesion after embolization/radiation. Since all six EDAVFs, two DAVFs, and one RAVF had neither feeder aneurysms nor significant symptoms, no treatment was provided; of these nine lesions, one DAVF and one RAVF remained unchanged, whereas six EDAVFs showed spontaneous obliteration within a year. Unfortunately, however, one DAVF bled before elective surgery. Conclusion: CCJAVFs have many variations of shunting site, angioarchitecture, and multiplicity, and they were frequently associated with coincidental vascular lesions. For symptomatic DAVF/RAVF lesions with intradural drainage, surgery is preferred, whereas asymptomatic EDAVFs without dangerous drainage may obliterate during their natural course.
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Affiliation(s)
- Shunji Matsubara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroyuki Toi
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroki Takai
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Yuko Miyazaki
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Keita Kinoshita
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshihiro Sunada
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Shodai Yamada
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshifumi Tao
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Noriya Enomoto
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | | | - Satoshi Hirai
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | | | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
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18
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Wan Y, Hurford R, Iorga R, Jeyaretna S, Ganau M, Patel U. Posterior fossa dural arteriovenous fistula presenting as 'head-turning syncope': a case report. Acta Neurol Belg 2021; 122:1357-1359. [PMID: 33988821 DOI: 10.1007/s13760-021-01701-6] [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] [Received: 12/15/2020] [Accepted: 05/03/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Yizhou Wan
- Department of Neurosurgery, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
| | - Robert Hurford
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Robert Iorga
- Department of Neurosurgery, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Sanjeeva Jeyaretna
- Department of Neurosurgery, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Mario Ganau
- Department of Neurosurgery, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Umang Patel
- Department of Neurosurgery, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
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19
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Ngui JZ, Higginbotham G, Kanesen D, Lau JH, Tang IP, Liew DNS. A caroticocavernous fistula without vascular injury following endoscopic transsphenoidal excision of a tuberculum sellae meningioma-A case report. Clin Case Rep 2021; 9:e04117. [PMID: 34026157 PMCID: PMC8122126 DOI: 10.1002/ccr3.4117] [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: 12/22/2020] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
Caroticocavernous fistulae can occur following transsphenoidal surgery even without evidence of carotid artery injury. A role of vascularized flap reconstruction may be contributory.
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Affiliation(s)
- Jesse Zen Ngui
- Neurosurgery DepartmentSarawak General HospitalKuchingMalaysia
| | | | | | - Jia Him Lau
- Radiology DepartmentHospital Kuala LumpurKuala LumpurMalaysia
| | - Ing Ping Tang
- ENT DepartmentUniversiti Malaysia Sarawak Faculty of MedicineKuchingMalaysia
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20
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Dural arteriovenous fistula formation following bilateral middle meningeal artery embolization for the treatment of a chronic subdural hematoma: a case report. Acta Neurochir (Wien) 2021; 163:1069-1073. [PMID: 33387043 DOI: 10.1007/s00701-020-04696-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
Here is reported a case of dural arteriovenous fistula (DAVF) formation following middle meningeal artery (MMA) embolization. A 64-year-old male patient was operated for a bilateral CSDH by burr-hole craniostomy. Prophylactic post-operative MMA embolization was performed with 300-500-μm calibrated microparticles. The patient was admitted 3 months later for a left CSDH recurrence. Digital subtraction angiography demonstrated formation of a superior sagittal sinus DAVF fed by both superficial temporal arteries. This case highlights the possible role of local tissue hypoxia as a significant component of DAVF pathogenesis. Moreover, it has potential implications for MMA embolization as a management strategy for CSDH.
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21
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Alkhaibary A, Almutairi OT, Elarjani T, Okal FM, Alhussinan MA, Bafaquh M, Alturki AY. The Top-100 most cited articles on dural arteriovenous fistula: A bibliometric analysis. J Cerebrovasc Endovasc Neurosurg 2021; 23:23-34. [PMID: 33540960 PMCID: PMC8041511 DOI: 10.7461/jcen.2021.e2020.09.003] [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: 09/03/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Dural arteriovenous fistula (DAVF) is a rare pathological vascular lesion with variable clinical manifestations. Since 1968, several articles have been published to address spinal and cranial DAVFs. The aim of this study is to identify, analyse, and review the pertinent literature of the top-100 most cited articles on DAVFs published to date. Methods A title-specific, keyword-based search with no time restriction was performed in June 2020. The Scopus database was used to identify the top-100 most cited articles on DAVFs. The term “dural arteriovenous fistula” was used as a search keyword. The search results were arranged in descending order based on the total citation count. The top-100 articles were categorized into ten categories. Results Between 1968 and 2020, a total of 2298 articles were published on DAVFs. The top-100 most cited articles were published between 1983 and 2012. The total number of citations for the top-100 articles was 12393 (123 citations/article). Most articles (34%) were investigating the clinical aspect of DAVFs. The country contributing to the most impactful and highest volume of publications (46%) was the United States. The Mayo Clinic was the most active institute in contribution. Most articles (29%) were published by the Journal of Neurosurgery. Conclusions In the top-100 most cited articles on DAVF, most studies were published in neurosurgery/neuroradiology-dedicated journals. This bibliometric analysis identifies the publication trends and provides a comprehensive overview of the most influential articles addressing DAVFs.
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Affiliation(s)
- Ali Alkhaibary
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Othman T Almutairi
- Department of Adult Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Turki Elarjani
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Fahad M Okal
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | | | - Mohammed Bafaquh
- Department of Adult Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Y Alturki
- Department of Adult Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.,Neurocritical Care Division, Critical Care Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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22
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Liu T, Ke J, Qi R, Zhang L, Zhang Z, Xu Q, Zhong Y, Lu G, Chen F. Altered functional connectivity of the amygdala and its subregions in typhoon-related post-traumatic stress disorder. Brain Behav 2021; 11:e01952. [PMID: 33205889 PMCID: PMC7821579 DOI: 10.1002/brb3.1952] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/06/2020] [Accepted: 10/31/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND New evidence suggests that the centromedial amygdala (CMA) and the basolateral amygdala (BLA) play different roles in threat processing. Our study aimed to investigate the effects of trauma and post-traumatic stress disorder (PTSD) on the functional connectivity (FC) of the amygdala and its subregions. METHODS Twenty-seven patients with typhoon-related PTSD, 33 trauma-exposed controls (TEC), and 30 healthy controls (HC) were scanned with a 3-Tesla magnetic resonance imaging scanner. The FCs of the BLA, the CMA, and the amygdala as a whole were examined using a seed-based approach, and then, the analysis of variance was used to compare the groups. RESULTS We demonstrated that the BLA had a stronger connectivity with the prefrontal cortices (PFCs) and angular gyrus in the PTSD group than in the TEC group. Additionally, compared with the PTSD and the HC groups, the TEC group exhibited decreased and increased BLA FC with the ventromedial PFC and postcentral gyrus (PoCG), respectively. Furthermore, the PTSD group showed abnormal FC between the salience network and default-mode network, as well as the executive control network. Compared with the HC group, the TEC group and the PTSD group both showed decreased BLA FC with the superior temporal gyrus (STG). Finally, the FCs between the bilateral amygdala (as a whole) and the vmPFC, and between the BLA and the vmPFC have a negative correlation with the severity of PTSD. CONCLUSIONS Decreased BLA-vmPFC FC and increased BLA-PoCG FC may reflect PTSD resilience factors. Trauma leads to decreased connectivity between the BLA and the STG, which could be further aggravated by PTSD.
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Affiliation(s)
- Tao Liu
- Department of Neurology, Hainan General Hospital (Hainan Hospital Affiliated to Hainan Medical College), Haikou, Hainan Province, China
| | - Jun Ke
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Li Zhang
- Key Laboratory of Psychiatry and Mental Health of Hunan Province, Mental Health Institute, the Second Xiangya Hospital, National Technology Institute of Psychiatry, Central South University, Changsha, Hunan Province, China
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu Province, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Hospital Affiliated to Hainan Medical College), Haikou, Hainan Province, China
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Abstract
The complex development of the brain vascular system can be broken down by embryonic stages and anatomic locations, which are tightly regulated by different factors and pathways in time and spatially. The adult brain is relatively quiescent in angiogenesis. However, under disease conditions, such as trauma, stroke, or tumor, angiogenesis can be activated in the adult brain. Disruption of any of the factors or pathways may lead to malformed vessel development. In this chapter, we will discuss factors and pathways involved in normal brain vasculogenesis and vascular maturation, and the pathogenesis of several brain vascular malformations.
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Affiliation(s)
- Yao Yao
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, Athens, GA, United States
| | - Sonali S Shaligram
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California San Francisco, San Francisco, CA, United States
| | - Hua Su
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California San Francisco, San Francisco, CA, United States.
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24
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Dural arteriovenous fistula is a rare cause of a pulsating noise in the ear
(clinical observation and literature review). КЛИНИЧЕСКАЯ ПРАКТИКА 2020. [DOI: 10.17816/clinpract35227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The article describes the clinical manifestations of dural arteriovenous fistula, which is an abnormal communication between the arteries of the dura mater and venous sinuses or cortical veins. Information on the etiology and pathogenesis of such malformation in domestic literature is limited to a few publications. Diagnosis is based on the identification of visual (pulsation of the earlobe) and acoustic phenomena in the patient, the presence of neuroimaging, in particular MR angiography, a shunt between the posterior auricular artery (branch of the external carotid artery) and the dural venous sinuses. The best treatment method is neurosurgical intervention using endovascular surgery.
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25
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Tsumoto T, Yabuzaki H, Nishiyama A, Tanaka Y, Matsuda Y, Terada T. Cavernous Sinus Dural Arteriovenous Fistulas: General Aspects. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:565-571. [PMID: 37502144 PMCID: PMC10370657 DOI: 10.5797/jnet.ra.2020-0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/11/2020] [Indexed: 07/29/2023]
Abstract
Cavernous sinus (CS) dural arteriovenous fistulas (AVF), which are most common in middle-aged females, present with benign symptoms such as exophthalmos, chemosis, and orbital bruit. Benign CS dural AVF without cortical venous drainage (CVD) have the rare potential for development of CVD with neurological symptoms, even without treatment. On the other hand, aggressive type AVF with CVD can cause more aggressive symptoms such as cerebral hemorrhage. As symptoms are highly related to the drainage pattern, it is important to understand the anatomy of the CS itself, shunt point, and draining vein when treating the lesion. In general, the drainage route is gradually diminished by thrombosis and compartmentalization within the CS according to progression of the angiographical stage. At the restrictive stage, the disease is usually treated by endovascular treatment, particularly transvenous embolization.
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Affiliation(s)
- Tomoyuki Tsumoto
- Department of Neurological Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Hajime Yabuzaki
- Department of Neurological Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Akira Nishiyama
- Department of Neurological Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Yuko Tanaka
- Department of Neurological Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Yoshikazu Matsuda
- Department of Neurological Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tomoaki Terada
- Department of Neurological Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Abstract
BACKGROUND Pial arterial supplies are sometimes found in patients with dural arteriovenous fistulas (DAVFs), though their characteristics have rarely been clarified. OBJECTIVE To investigate the characteristics of pial arterial supplies in DAVFs and to discuss their pathophysiology and treatment. METHODS Two hundred four consecutive patients with intracranial DAVFs over 11 yr were retrospectively reviewed. Clinical factors and radiological findings, including the presence of pial arterial supplies, were evaluated. Supply from a pial artery was classified into 2 categories: dilated pre-existing dural branches of pial arteries, and a "pure" pial supply. RESULTS Twenty-three of 204 patients (11.3%) showed an additional pial arterial supply. Multivariate analysis identified 3 independent predictors of a pial arterial supply: younger age (P < .0005), DAVF within the tentorium (P = .0162), and presence of venous dilatation (P = .0001). A dilated pre-existing dural branch of a pial artery was identified in 17 patients, while 8 had a pure pial supply. Of these 23 patients, 17 underwent interventional therapy. No postoperative intracranial hemorrhage or infarction occurred in patients with pial arterial supplies. CONCLUSION An additional pial supply is not uncommon in DAVFs and may be explained by a rich physiological pial arterial supply to the dura mater from the posterior circulation, while potential angiogenesis due to venous hypertension remains speculative. Prior to interventional treatment for DAVFs, recognition of a pial arterial supply to the DAVF might influence the treatment strategy and could help avoid inadvertent retrograde embolization of brain supplying vessels through the pial network.
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Affiliation(s)
- Takahiro Osada
- Division of Neuroradiology, Joint Depa-rtment of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Timo Krings
- Division of Neuroradiology, Joint Depa-rtment of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Yokoyama S, Nakagawa I, Kotsugi M, Wajima D, Wada T, Kichikawa K, Nakase H. Dural Arteriovenous Fistula Arising after Intracranial Surgery in Posterior Fossa of Nondominant Sinus: Two Cases and Literature Review. Asian J Neurosurg 2019; 14:602-606. [PMID: 31143294 PMCID: PMC6516029 DOI: 10.4103/ajns.ajns_5_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The results of recent clinical and experimental studies suggest that the most important factor associated with the pathogenesis of dural arteriovenous fistula (AVF) is sinus thrombosis and subsequent venous or intrasinus hypertension. Here, we describe two patients who each developed a dural AVF after a posterior fossa craniotomy on the side of the nondominant or hypoplastic transverse (TS)-sigmoid (SS) sinuses. A 63-year-old female underwent surgical resection of a meningioma in the left cerebellopontine angle. Preoperative subtraction digital angiography (DSA) revealed a hypoplastic, ipsilateral left TS-SS and the sinus occlusion was revealed after surgery. Sixteen months later, she presented with a progressive left retroauricular, pulse-synchronous bruit. An AVF in the left TS-SS region was diagnosed by DSA and treated with transvenous coil embolization. The patient recovered without neurological deterioration. A 56-year-old female underwent surgical removal of an epidermoid tumor in the right cerebellopontine angle. Preoperative DSA revealed severe, ipsilateral right TS stenosis and the sinus occlusion was revealed after surgery. Two years later, she presented with the progressive right retroauricular, pulse-synchronous bruit, which was diagnosed by DSA as dural AVF in the right TS-SS region. She was treated with transvenous coil embolization and recovered without neurological deterioration. Sinus manipulation during intracranial surgery carries a potential risk of dural AVF development and this should be carefully considered, even when the ipsilateral TS-SS is nondominant or appears hypoplastic.
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Affiliation(s)
- Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Nara Prefecture, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Nara Prefecture, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Nara Prefecture, Japan
| | - Daisuke Wajima
- Department of Neurosurgery, Nara Medical University, Nara Prefecture, Japan
| | - Takeshi Wada
- Department of Radiology, Nara Medical University, Nara Prefecture, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Nara Prefecture, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara Prefecture, Japan
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Yang HC, Lin CJ, Luo CB, Lee CC, Wu HM, Guo WY, Chung WY, Liu KD. Treatment Outcomes of Cavernous Sinus Dural Arteriovenous Fistulas: Comparison of Radiosurgery and Endovascular Embolisation. Clin Neuroradiol 2019; 30:321-330. [PMID: 31098665 DOI: 10.1007/s00062-019-00787-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment (EVT) and stereotaxic gamma-knife radiosurgery (GKRS) can both effectively treat cavernous sinus dural arteriovenous fistulas (CSDAVF). This study compared the prognostic factors and treatment effectiveness of GKRS and EVT for different CSDAVF types. METHODS The charts of 200 patients undergoing GKRS and 105 patients undergoing EVT were reviewed for data on symptoms (e.g. orbital, cavernous, ocular, and cerebral). The CSDAVFs were classified into proliferative, restrictive, and late restrictive types. The prognostic factors for complete obliteration (CO) were evaluated in both the GKRS and EVT groups and the latent period to CO was measured. For statistical analysis χ2-tests were used to compare final CO rates for EVT and GKRS across the three CSDAVF types. RESULTS The EVT and cavernous symptoms were significant independent predictors of CO. The CO rate after EVT (97.9%) was significantly higher than that after GKRS (63.5%) for restrictive CSDAVFs (P < 0.001) but not for proliferative or late restrictive types. In the GKRS group, cavernous symptoms (hazard ratio, HR: 0.557) and target volume (HR: 0.853) predicted CO, but only target volume remained significant in multivariate analysis. In the EVT group, the latent period to CO was shortest for restrictive CSDAVFs (3.2 ± 1.6 months, P = 0.05). CONCLUSION Angioarchitecture did not affect treatment outcomes. Cavernous symptoms were strongly associated with lower complete obliteration rates in the GKRS but not the EVT group. The EVT method remains the treatment of choice, especially for restrictive CSDAVFs; however, compared to EVT, GKRS had lower complication rates and similar therapeutic effects for proliferative type fistulas.
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Affiliation(s)
- Huai-Che Yang
- Neurologic Institute, Department of Neurosurgery, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC.
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC.
- Department of Radiology, Tri-service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
| | - Cheng-Chia Lee
- Neurologic Institute, Department of Neurosurgery, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Wen-Yuh Chung
- Neurologic Institute, Department of Neurosurgery, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Kang-Du Liu
- Neurologic Institute, Department of Neurosurgery, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
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Koduri S, Wilkinson DA, Griauzde JM, Gemmete JJ, Maher CO. Development of bilateral dural arteriovenous fistulae following pial synangiosis for moyamoya syndrome: case report. J Neurosurg Pediatr 2019; 24:9-13. [PMID: 30978680 DOI: 10.3171/2019.2.peds18603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/08/2019] [Indexed: 11/06/2022]
Abstract
Moyamoya syndrome predisposes patients to ischemic or hemorrhagic stroke due to progressive narrowing of intracranial vessels with subsequent small-vessel collateralization. Dural arteriovenous fistulae (DAVFs) are most commonly noted after venous sinus or cortical vein thrombosis and are believed to be primarily due to venous hypertension and elevated sinus pressures, although there is no known association with moyamoya syndrome, or with surgical treatment for moyamoya disease (MMD). The authors present the case of a 14-year-old girl with Down syndrome treated using pial synangiosis for MMD who subsequently was noted to have bilateral DAVFs. This case provides a new perspective on the origins and underlying pathophysiology of both moyamoya syndrome and DAVFs, and also serves to highlight the importance of monitoring the moyamoya population closely for de novo cerebrovascular changes after revascularization procedures.
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Biscoito L. Intracranial Vascular Malformations. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Intracranial Vascular Malformations. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_79-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen CC, Cho YD, Yoo DH, Moon J, Lee J, Kang HS, Kim JE, Cho WS, Han MH. Endovascular management of multiple intracranial dural arteriovenous fistulas. J Neuroradiol 2018; 46:390-397. [PMID: 30448429 DOI: 10.1016/j.neurad.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/15/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE Multiply occurring intracranial dural arteriovenous fistulas (dAVFs) have been documented but rarely occur, and neither pathogenesis nor prognosis is clearly understood. This study was conducted to analyze angiographic characteristics of multiple dAVFs and to chronicle our treatment experience. METHODS Between April, 2002 and January, 2018, data prospectively collected from 310 patients with intracranial dAVFs were systematically reviewed, assessing clinical and anatomic outcomes of endovascular treatment in 32 patients with multiple dAVFs (≥ 2 fistulas each). Lesions were categorized as multifocal or diffuse type, depending on presentation, and further characterized as progressive or non-progressive disease. RESULTS Overall, 18 patients (56.3%) experienced aggressive presentations, including intracerebral hemorrhage or venous infarction. Cortical venous reflux (CVR) was observed in 26 patients (81.3%), and sinus thrombosis or occlusion was seen in 24 (75.0%). Clinical outcomes in patients with multifocal fistulas (n = 11) were excellent (100%), marked by a moderately high rate of complete occlusion (54.5%). Those with progressive disease (n = 10) regularly displayed certain angiographic findings, namely diffuse configuration (100%), sinus thrombosis (100%), and CVR (100%). Complete anatomic obliteration was achieved in 12 patients (37.5%), and in 26 patients (81.3%), clinical outcomes were favorable. CONCLUSION Multiple dAVFs are typically aggressive at presentation, given strong associations with CVR and sinus thrombosis. In diffuse-type fistulas, the potential to recur or progress is high. Although definitive treatment poses a challenge, outcomes of endovascular therapeutics may be still optimized in this setting through strategic procedural modifications and careful follow-up monitoring.
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Affiliation(s)
- Ching-Chang Chen
- Department of Neurosurgery, Chang Gung University and Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jusun Moon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeongjun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Chen GZ, Ke Y, Qin K, Dong MQ, Zeng SJ, Lin XF, Zhan SQ, Tang K, Peng C, Ding XW, Zhou D. Analysis of the Expression of Angioarchitecture-related Factors in Patients with Cerebral Arteriovenous Malformation. Chin Med J (Engl) 2018; 130:2465-2472. [PMID: 29052569 PMCID: PMC5684641 DOI: 10.4103/0366-6999.216413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Cerebral arteriovenous malformation (cAVM) is a type of vascular malformation associated with vascular remodeling, hemodynamic imbalance, and inflammation. We detected four angioarchitecture-related cytokines to make a better understanding of the potential aberrant signaling in the pathogenesis of cAVM and found useful proteins in predicting the risk of cerebral hemorrhage. Methods: Immunohistochemical analysis was conducted on specimens from twenty patients with cAVM diagnosed via magnetic resonance imaging and digital subtraction angiography and twenty primary epilepsy controls using antibodies against vascular endothelial growth factor receptor-2 (VEGFR-2), matrix metalloproteinase-9 (MMP-9), vascular cell adhesion molecule (VCAM-1), and endothelial nitric oxide synthase (eNOS). Western blotting and real-time fluorescent quantitative polymerase chain reaction (PCR) were performed to determine protein and mRNA expression levels. Student's t-test was used for statistical analysis. Results: VEGFR-2, MMP-9, VCAM-1, and eNOS expression levels increased in patients with cAVM compared with those in normal cerebral vascular tissue, as determined by immunohistochemical analysis. In addition, Western blotting and real-time PCR showed that the protein and mRNA expression levels of VEGFR-2, MMP-9, VCAM-1, and eNOS were higher in the cAVM group than in the control group, all the differences mentioned were statistically significant (P < 0.05). Conclusions: VEGFR-2, MMP-9, VCAM-1, and eNOS are upregulated in patients with cAVM and might play important roles in angiogenesis, vascular remodeling, and migration in patients with cAVM. MMP-9, VEGFR-2, VCAM-1, and eNOS might be potential excellent group proteins in predicting the risk of cerebral hemorrhage at arteriovenous malformation.
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Affiliation(s)
- Guang-Zhong Chen
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Yu Ke
- Department of Biomedical Engineering, Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, College of Life Science and Technology, Jinan University, Guangzhou, Guangdong 510632, China
| | - Kun Qin
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Meng-Qi Dong
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Shao-Jian Zeng
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Xiao-Feng Lin
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Sheng-Quan Zhan
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Kai Tang
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Chao Peng
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Xiao-Wen Ding
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Dong Zhou
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
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Tsuei YS, Chou YE, Chen WH, Luo CB, Yang SF. Polymorphism in dural arteriovenous fistula: matrix metalloproteinase-2-1306 C/T as a potential risk factor for sinus thrombosis. J Thromb Haemost 2018; 16:802-808. [PMID: 29431912 DOI: 10.1111/jth.13973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Indexed: 11/28/2022]
Abstract
Essentials Sinus thrombosis may play a crucial role in development of dural arteriovenous fistula (DAVF). Little is known about the association between gene polymorphism and the development of DAVF. MMP-2-1306 C/T showed a higher prevalence rate in DAVF cases with sinus thrombosis. MMP-2-1306C/T polymorphism is likely a potential risk factor for sinus thrombosis in DAVF. SUMMARY Background Dural arteriovenous fistula (DAVF) is a rare but important cerebrovascular disorder in adults. Little is known about the molecular genetic pathogenesis underlying DAVF development. Objectives To investigate the associations of gene polymorphisms and DAVF. Materials and Methods By the use of real-time PCR genotyping, seven single-nucleotide polymorphisms (SNPs) of angiogenesis-related genes were analyzed in 72 DAVF patients. Pertinent clinical and imaging data were subgrouped on the basis of location (cavernous sinus versus lateral sinus), lesions (single versus multiple), cerebral venous reflux (CVR) grading (Borden I versus Borden II/III), and sinus thrombosis (with versus without). Results We found that individuals carrying the polymorphic allele of matrix metalloproteinase (MMP)-2-1306 C/T (rs243865) had a significantly increased risk of sinus thrombosis in DAVF (odds ratio 6.2; 95% confidence interval 1.7-22.9). There was a weak difference in associations of tissue inhibitor of metalloproteinase (TIMP)-2 (rs2277698) gene polymorphism and DAVF patients subgrouped by CVR grading. Conclusions These preliminary results indicate that MMP-2-1306 C/T, but not MMP-9, TIMP-1, TIMP-2, and vascular endothelial growth factor A SNP variants, is a risk factor for the development of sinus thrombosis in DAVF patients.
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Affiliation(s)
- Y-S Tsuei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Y-E Chou
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - W-H Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-B Luo
- Institute of Biomedical Engineering, Yuanpei University, Hsinchu, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Radiology, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - S-F Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
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Horiuchi Y, Iwanami A, Akiyama T, Hikata T, Watanabe K, Yagi M, Fujita N, Okada E, Nagoshi N, Tsuji O, Ishii K, Yoshida K, Nakamura M, Matsumoto M. Spinal arteriovenous fistula coexisting within a spinal lipoma: report of two cases. Spinal Cord Ser Cases 2017; 3:17079. [PMID: 29423285 PMCID: PMC5798916 DOI: 10.1038/s41394-017-0011-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/09/2017] [Accepted: 09/15/2017] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Spinal lipoma and spinal arteriovenous fistula (sAVF) are different pathologies and their co-existence is extremely rare. Here we reported two cases of adult-onset sAVF occurring within a spinal lipoma and with review the literature in an attempt to identify the mechanisim of and optimal treatment of this condition. CASE PRESENTATION Case 1 was a 51-year-old man who was treated by embolization of the feeding artery and ligation of the draining vein. Case 2 was a 53-year-old man who was treated by embolization and resection of the tumor containing the shunt zone. In both cases, symptoms improved after surgery. However, in Case 1, angiography at 1 month after the surgery revealed recurrence of the arteriovenous shunt. DISCUSSION A literature search revealed only nine other similar case reports. All cases, including ours occurred in adults. In almost all cases, the shunt was located within the spinal lipoma. Pathologic examination revealed venous hypertension, but no evidence of congenital vascular malformation. Given that lipomas release angiogenic factors, the presence of a spinal lipoma may indicate its involvement in the development of acquired sAVF. Our two cases might represent a new subtype of sAVF. Based on our experiences, we recommend resection of the tumor containing the shunt for the management of sAVF.
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Affiliation(s)
- Yosuke Horiuchi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akio Iwanami
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Present Address: Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Hikata
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ken Ishii
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Orthopedic Surgery, International University of Health and Welfare, Chiba, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Meila D, Schmidt C, Melber K, Grieb D, Jacobs C, Jacobs C, Lanfermann H, Brassel F. Delayed and incomplete treatment may result in dural fistula development in children with Vein of Galen malformation. Interv Neuroradiol 2017; 24:82-87. [PMID: 29125026 DOI: 10.1177/1591019917741755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The association of dural arteriovenous fistulas (DAVF) in children with Vein of Galen malformation (VGM) has recently been reported for the first time. In a larger series of cases treated with transarterial NBCA embolization, 30% had DAVF. We wanted to analyze the development of DAVF in our cohort of children with VGM and to evaluate whether their occurrence depends on different treatment timing and embolic materials. We analyzed 43 VGM cases treated with a combined transarterial and transvenous approach between 2003 and 2016. In our early series until 2011, we used coils solely in 21 children. Since 2012, 22 children were treated with the combination of coils and Onyx. In the early series treated with coils solely, no case presented initially with or developed DAVF over time on follow-up angiograms. In our recent series we found four cases (9%) with DAVF. In two patients (5%), DAVF were found on the initial angiogram. Both patients presented at our department at age >2 years and were not treated elsewhere before. One patient (2%) presented at our department with too proximal occlusion of arterial feeders performed at another institution before. Only one patient (2%) developed DAVF in our department after the transarterial use of Onyx. Interestingly, this child did not develop DAVF as long as we used coils solely and his DAVF was localized exactly where an Onyx cast was identified. In conclusion, delayed and incomplete treatment may have a considerable impact on the occurrence of DAVF in VGM.
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Affiliation(s)
- Dan Meila
- 1 Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
| | - Cynthia Schmidt
- 2 Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
| | - Katharina Melber
- 2 Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
| | - Dominik Grieb
- 2 Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
| | - Cornelius Jacobs
- 3 Department of Traumatology Medical Center, University of Bonn, Bonn, Germany
| | - Collin Jacobs
- 4 Department of Orthodontics Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heinrich Lanfermann
- 1 Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
| | - Friedhelm Brassel
- 2 Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
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Chen JG, Li ZX, Zhang DF, Wang JY, Hou LJ. Cerebral venous sinus thrombosis complicated with acute development of dural arteriovenous fistula: A case report. J Clin Neurosci 2017; 44:225-226. [DOI: 10.1016/j.jocn.2017.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/27/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
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Hetts SW, Yen A, Cooke DL, Nelson J, Jolivalt P, Banaga J, Amans MR, Dowd CF, Higashida RT, Lawton MT, Kim H, Halbach VV. Pial Artery Supply as an Anatomic Risk Factor for Ischemic Stroke in the Treatment of Intracranial Dural Arteriovenous Fistulas. AJNR Am J Neuroradiol 2017; 38:2315-2320. [PMID: 28970244 DOI: 10.3174/ajnr.a5396] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 08/03/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although intracranial dural arteriovenous fistulas are principally supplied by dural branches of the external carotid, internal carotid, and vertebral arteries, they can also be fed by pial arteries that supply the brain. We sought to determine the frequency of neurologic deficits following treatment of intracranial dural arteriovenous fistulas with and without pial artery supply. MATERIALS AND METHODS One hundred twenty-two consecutive patients who underwent treatment for intracranial dural arteriovenous fistulas at our hospital from 2008 to 2015 were retrospectively reviewed. Patient data were examined for posttreatment neurologic deficits; patients with such deficits were evaluated for imaging evidence of cerebral infarction. Data were analyzed with multivariable logistic regression. RESULTS Of 122 treated patients, 29 (23.8%) had dural arteriovenous fistulas with pial artery supply and 93 (76.2%) had dural arteriovenous fistulas without pial arterial supply. Of patients with pial artery supply, 4 (13.8%) had posttreatment neurologic deficits, compared with 2 patients (2.2%) without pial artery supply (P = .04). Imaging confirmed that 3 patients with pial artery supply (10.3%) had cerebral infarcts, compared with only 1 patient without pial artery supply (1.1%, P = .03). Increasing patient age was also positively associated with pial supply and treatment-related complications. CONCLUSIONS Patients with dural arteriovenous fistulas supplied by the pial arteries were more likely to experience posttreatment complications, including ischemic strokes, than patients with no pial artery supply. The approach to dural arteriovenous fistula treatment should be made on a case-by-case basis so that the risk of complications can be minimized.
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Affiliation(s)
- S W Hetts
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.)
| | - A Yen
- School of Medicine (A.Y., J.B.)
| | - D L Cooke
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.)
| | - J Nelson
- Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.)
| | - P Jolivalt
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.).,Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.)
| | | | - M R Amans
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.)
| | - C F Dowd
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.).,Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.).,Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.).,Neurology (C.F.D., R.T.H., V.V.H.), University of California, San Francisco, San Francisco, California
| | - R T Higashida
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.).,Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.).,Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.).,Neurology (C.F.D., R.T.H., V.V.H.), University of California, San Francisco, San Francisco, California
| | - M T Lawton
- Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.)
| | - H Kim
- Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.)
| | - V V Halbach
- From the Department of Radiology and Biomedical Imaging (S.W.H., D.L.C., P.J., M.R.A., C.F.D., R.T.H., V.V.H.).,Departments of Anesthesia and Perioperative Care (J.N., P.J., C.F.D., R.T.H., H.K., V.V.H.).,Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.).,Neurology (C.F.D., R.T.H., V.V.H.), University of California, San Francisco, San Francisco, California
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Elia C, Minasian T, Noufal M, Chhabra V. Pial-Dural Intracranial Arteriovenous Fistula with Flow-Associated Aneurysmal Rupture-Case Report with Review of Literature and Proposal on the Mechanism of Hemorrhage and Treatment Options. World Neurosurg 2017; 105:1040.e15-1040.e19. [PMID: 28676463 DOI: 10.1016/j.wneu.2017.06.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vascular anomalies in the form of dural arteriovenous fistulas (DAVFs), arteriovenous malformations, and aneurysms are well described in the literature. Pial arteriovenous fistulas (PAVFs) are described to a lesser extent in the literature. When these anomalies are combined, diagnosis and treatment become complex. CASE DESCRIPTION A 55-year-old man presented with PAVF/DAVF with a ruptured flow-related aneurysm in the distal left posterior inferior cerebellar artery, which required surgical clipping and disconnection. We performed a PubMed search of all identifiable cases of PAVFs in adults. We then identified which cases had components of DAVFs and flow-related aneurysms. We identified 51 PAVF cases and identified which patients presented with hemorrhage and the treatment modalities of all cases. Of 51 cases identified, 4 were a DAVF/FRA, and 5 were a PAVF/DAVF. One case of PAVF/DAVF/FRA was identified. CONCLUSIONS The exact mechanism of PAVF/DAVF formation is unknown. Hemorrhage predilection of PAVF/DAVF is more difficult to predict than a sole fistula, likely secondary to the complex flow dynamics. To our knowledge, this literature review is the largest review to date regarding PAVFs in adult patients and can provide insight into decision making when evaluating treatment options.
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Affiliation(s)
- Christopher Elia
- Division of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California; Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA.
| | - Tanya Minasian
- Division of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California
| | - Mazen Noufal
- Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA
| | - Vaninder Chhabra
- Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA
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Grady C, Gesteira Benjamin C, Kondziolka D. Radiosurgery for dural arteriovenous malformations. HANDBOOK OF CLINICAL NEUROLOGY 2017; 143:125-131. [PMID: 28552134 DOI: 10.1016/b978-0-444-63640-9.00012-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Intracranial dural arteriovenous malformations (DAVFs) are relatively uncommon vascular lesions characterized by the direct connection of dural arteries into dural venous sinuses or leptomeningeal veins. Strategies for the treatment of these complex lesions have evolved significantly over the past three decades, and include open surgical disconnection, endovascular embolization, stereotactic radiosurgery (SRS), or a combination of these approaches. Radiosurgical intervention is unique in offering significant benefits to patients while exposing them to few of the risks associated with more invasive interventions. In this chapter we provide an overview of DAVFs and discuss the features of these lesions that affect management. We focus, in particular, on radiosurgical management of these lesions, describing present treatment paradigms, the procedure for the treatment of DAVFs with SRS, and expected clinical outcomes using SRS.
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Affiliation(s)
- Conor Grady
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | | | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA; Center for Advanced Radiosurgery, NYU Langone Medical Center, New York, NY, USA.
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Elhammady MS, Ambekar S, Heros RC. Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas. HANDBOOK OF CLINICAL NEUROLOGY 2017; 143:99-105. [PMID: 28552162 DOI: 10.1016/b978-0-444-63640-9.00009-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dural arteriovenous fistulas are abnormal communications, within the dural leaflets, between meningeal arteries and dural venous sinuses and/or subarachnoid veins. Although many fistulas remain clinically silent and do not require treatment, presence of cortical venous reflux, intracranial bleed, and intolerable symptoms are the main indications for treatment. A thorough understanding of the natural history is of prime importance in the decision making and management of these lesions. In this chapter we discuss the epidemiology and natural history of intracranial dural arteriovenous fistulae.
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Affiliation(s)
| | - Sudheer Ambekar
- Department of Neurosurgery, University of Miami, Miami, FL, USA
| | - Roberto C Heros
- Department of Neurosurgery, University of Miami, Miami, FL, USA
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Interplay between VEGF and Nrf2 regulates angiogenesis due to intracranial venous hypertension. Sci Rep 2016; 6:37338. [PMID: 27869147 PMCID: PMC5116754 DOI: 10.1038/srep37338] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/21/2016] [Indexed: 12/18/2022] Open
Abstract
Venous hypertension(VH) plays an important role in the pathogenesis of cerebral arteriovenous malformations (AVMs) and is closely associated with the HIF-1α/VEGF signaling pathway. Nuclear factor erythroid 2-related factor 2(Nrf2) significantly influences angiogenesis; however, the interplay between Nrf2 and VEGF under VH in brain AVMs remains unclear. Therefore, our study aimed to investigate the interplay between Nrf2 and VEGF due to VH in brain AVMs. Immunohistochemistry indicated that Nrf2 and VEGF were highly expressed in human brain AVM tissues. In vivo, we established a VH model in both wild-type (WT) and siRNA-mediated Nrf2 knockdown rats. VH significantly increased the expression of Nrf2 and VEGF. Loss of Nrf2 markedly inhibited the upregulation of VEGF, as determined by Western blot analysis and qRT-PCR. In vitro, primary brain microvascular endothelial cells (BMECs) were isolated from WT and Nrf2−/− mice, and a VEGF-Nrf2 positive feed-back loop was observed in BMECs. By trans well assay and angiogenesis assay, Nrf2 knockout significantly inhibited the migration and vascular tube formation of BMECs. These findings suggest that the interplay between Nrf2 and VEGF can contribute to VH-induced angiogenesis in brain AVMs pathogenesis.
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A Case of De Novo Anterior Condylar Dural Arteriovenous Fistula Long after Curative Transvenous Embolization of Contralateral Anterior Condylar Arteriovenous Fistula. Case Rep Med 2016; 2016:6974526. [PMID: 27829838 PMCID: PMC5088320 DOI: 10.1155/2016/6974526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/29/2016] [Indexed: 11/17/2022] Open
Abstract
We report on a 55-year-old man who developed a de novo DAVF in left ACC 5 years after curative transvenous embolization for DAVF in right ACC. Angiography revealed that the de novo lesion demonstrated more aggressive arteriovenous shunt flow than the initial lesion. Successful transvenous embolization was performed for also the second lesion. The authors describe the possible pathophysiological mechanisms and management strategies for this rare occurrence.
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Hetts SW, Moftakhar P, Maluste N, Fullerton HJ, Cooke DL, Amans MR, Dowd CF, Higashida RT, Halbach VV. Pediatric intracranial dural arteriovenous fistulas: age-related differences in clinical features, angioarchitecture, and treatment outcomes. J Neurosurg Pediatr 2016; 18:602-610. [PMID: 27540826 DOI: 10.3171/2016.5.peds15740] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial dural arteriovenous fistulas (DAVFs) are rare in children. This study sought to better characterize DAVF presentation, angioarchitecture, and treatment outcomes. METHODS Children with intracranial DAVFs between 1986 and 2013 were retrospectively identified from the neurointerventional database at the authors' institution. Demographics, clinical presentation, lesion angioarchitecture, treatment approaches, angiographic outcomes, and clinical outcomes were assessed. RESULTS DAVFs constituted 5.7% (22/423) of pediatric intracranial arteriovenous shunting lesions. Twelve boys and 10 girls presented between 1 day and 18 years of age; boys presented at a median of 1.3 years and girls presented at a median of 4.9 years. Four of 8 patients ≤ 1 year of age presented with congestive heart failure compared with 0/14 patients > 1 year of age (p = 0.01). Five of 8 patients ≤ 1 year old presented with respiratory distress compared with 0/14 patients > 1 year old (p = 0.0021). Ten of 14 patients > 1 year old presented with focal neurological deficits compared with 0/8 patients ≤ 1 year old (p = 0.0017). At initial angiography, 16 patients harbored a single intracranial DAVF and 6 patients had 2-6 DAVFs. Eight patients (38%) experienced DAVF obliteration by the end of treatment. Good clinical outcome (modified Rankin Scale score 0-2) was documented in 77% of patients > 1 year old at presentation compared with 57% of patients ≤ 1 year old at presentation. Six patients (27%) died. CONCLUSIONS Young children with DAVFs presented predominantly with cardiopulmonary symptoms, while older children presented with focal neurological deficits. Compared with other pediatric vascular shunts, DAVFs had lower rates of angiographic obliteration and poorer clinical outcomes.
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Affiliation(s)
| | | | - Neil Maluste
- Department of Neurology, University of California, Los Angeles, California
| | | | | | | | - Christopher F Dowd
- Departments of 1 Radiology and Biomedical Imaging.,Neurology.,Neurological Surgery, and.,Anesthesia and Perioperative Care, University of California, San Francisco; and
| | - Randall T Higashida
- Departments of 1 Radiology and Biomedical Imaging.,Neurology.,Neurological Surgery, and.,Anesthesia and Perioperative Care, University of California, San Francisco; and
| | - Van V Halbach
- Departments of 1 Radiology and Biomedical Imaging.,Neurology.,Neurological Surgery, and.,Anesthesia and Perioperative Care, University of California, San Francisco; and
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Ogita S, Endo T, Inoue T, Sato K, Endo H, Tominaga T. Traumatic Spinal Perimedullary Arteriovenous Fistula Induced by a Cervical Glass Stab Injury. World Neurosurg 2016; 96:610.e9-610.e13. [PMID: 27647027 DOI: 10.1016/j.wneu.2016.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/04/2016] [Accepted: 09/06/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the literature, perimedullary arteriovenous fistula (AVF) is an uncommon spinal vascular malformation that is generally regarded as a congenital lesion. To our knowledge, only a few cases of traumatic perimedullary AVF have been reported in the literature so far. CASE DESCRIPTION A 58-year-old man presented with subarachnoid hemorrhage (SAH) resulting from a secondary perimedullary arteriovenous fistula (AVF) induced by a glass stab injury to his right posterior neck. The glass had been removed, and the lacerated dura mater was closed. Hydrocephalus was diagnosed 2 months later, and the patient underwent ventriculoperitoneal shunt placement. Magnetic resonance imaging and digital subtraction angiography subsequently revealed dissection of the extradural right vertebral artery. However, there were no signs of perimedullary AVF. The patient presented 9 months after injury with sudden onset of severe headache, and SAH was diagnosed. Repeat digital subtraction angiography showed that the right vertebral artery dissection remained unchanged and was unlikely to be the underlying cause of SAH. However, a new diagnosis of perimedullary AVF at the craniocervical junction was made, and this was considered as a potential cause of SAH. The lesion was surgically obliterated. The hemosiderin deposits on the surface of the spinal cord confirmed that perimedullary AVF was the origin of SAH. CONCLUSIONS Cervical trauma should be considered as a possible cause of de novo perimedullary AVF. Recognition of this phenomenon is important.
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Affiliation(s)
- Shogo Ogita
- Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Toshiki Endo
- Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
| | - Tomoo Inoue
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Teiji Tominaga
- Tohoku University Graduate School of Medicine, Sendai, Japan
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Tsai LK, Liu HM, Jeng JS. Diagnosis and management of intracranial dural arteriovenous fistulas. Expert Rev Neurother 2016; 16:307-18. [PMID: 26832225 DOI: 10.1586/14737175.2016.1149063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dural arteriovenous fistula (DAVF) is a rare type of acquired intracranial vascular malformation. Recent progress in neuroimaging technology, such as advanced MRI and CT, provides non-invasive methods to accurately diagnose DAVF, including evaluation of the hemodynamics of the drainage veins. The clinical manifestations of DAVFs vary widely and depend on the location and venous drainage pattern of arteriovenous shunting. Patients with high grade DAVFs having cortical venous reflux should receive aggressive treatment to prevent the occurrence of intracranial hemorrhage and other neurological deficits related to venous congestion. Intra-arterial or intravenous endovascular embolization remains the primary therapy for high grade DAVF, while open surgery and stereotactic radiosurgery can serve as alternative treatment options. Early and accurate diagnosis with appropriate treatment is the goal for clinical management of DAVFs to reduce symptoms and prevent the development of venous congestion and stroke.
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Affiliation(s)
- Li-Kai Tsai
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
| | - Hon-Man Liu
- b Department of Medical Imaging , National Taiwan University Hospital , Taipei , Taiwan
| | - Jiann-Shing Jeng
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
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Park A, Kim SW, Chung SA. A Case of Cavernous Sinus Dural Arteriovenous Fistula Following Tolosa-Hunt Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.6.977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Aram Park
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Woo Kim
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Ah Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
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Higashida T. Delayed postoperative dural arteriovenous fistula presenting with progressive dementia. BMJ Case Rep 2015; 2015:bcr-2015-212874. [PMID: 26661287 DOI: 10.1136/bcr-2015-212874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 64-year-old woman underwent right suboccipital craniotomy to treat spontaneous cerebrospinal fluid (CSF) otorrhoea. Although the CSF leak was cured, the patient developed pulsatile tinnitus, ambulatory disturbance and progressive dementia. Four years after the surgery, she presented with generalised seizure. Cerebral angiography showed a dural arteriovenous fistula at the right transverse-sigmoid sinus, which was associated with sinus occlusion, retrograde blood flow in the sinus and diffuse intracranial cortical venous reflux. A combination of endovascular transarterial embolisation and transvenous embolisation with direct sinus puncture was performed. After the procedure, the patient's mental status and cognitive function improved significantly.
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Affiliation(s)
- Tetsuhiro Higashida
- Department of Neurosurgery, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
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Avecillas-Chasín JM, Brin JR, Lopez-Ibor L, Gomez G, Rodriguez-Boto G. Multiple spinal arteriovenous fistulas: A case-based review. Clin Neurol Neurosurg 2015; 139:6-11. [DOI: 10.1016/j.clineuro.2015.08.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/13/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
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Bhogal P, Makalanda HL, Brouwer PA, Gontu V, Rodesch G, Mercier P, Söderman M. Normal pio-dural arterial connections. Interv Neuroradiol 2015; 21:750-8. [PMID: 26494407 DOI: 10.1177/1591019915609137] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/26/2015] [Indexed: 11/15/2022] Open
Abstract
The arterial blood supply to the dura mater is rich, complex and is derived from both the internal and external carotid systems. Endovascular management of a variety of intracranial diseases necessitates a thorough understanding of the dural arterial network. In this article we review the normal contributions of the pial arteries to the blood supply of the dura mater and discuss some aspects of its role in the supply of dural arteriovenous shunts (DAVS).
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Affiliation(s)
| | | | | | | | - Georges Rodesch
- Service de Neuroradiologie Diagnostique et Thérapeutique; World Federation of Interventional and Therapeutic Neuroradiology (WFITN), Hôpital FOCH, France
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