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Ahmed S, Arora A, Kulanthaivelu K, Saini J, Menon D, Chakrabarti D. Utility of 3D T1-weighted turbo spin echo black blood sequence for the diagnosis of cerebral venous thrombosis. Emerg Radiol 2023; 30:443-451. [PMID: 37341879 DOI: 10.1007/s10140-023-02150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/08/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Accurate assessment of dural sinus, deep and cortical venous thrombosis on MR imaging is challenging. The aim of this study is to evaluate the accuracy of 3D-T1 turbo spin echo (T1S), sequences in detecting venous thrombosis and comparing it with susceptibility-weighted imaging (SWI), magnetic resonance venography (MRV) and post contrast T1 magnetization-prepared rapid acquisition gradient echo (T1C). METHODS A blinded retrospective observational analysis of 71 consecutive patients evaluated for cerebral venous thrombosis (CVT) and 30 control patients was performed. Multimodality reference standard adopted included T1C, SWI with MRV. Sub-analyses in superficial, deep and cortical venous segments were performed in addition to correlation of signal intensity of thrombus with the clinical stage. RESULTS A total of 2222 segments in 101 complete MRI examinations were evaluated. Sensitivity/specificity/positive predictive value/negative predictive value/accuracy and precision of T1S for detection of cortical vein thrombosis was 0.994/1/1/0.967/0.995/1, 1/0.874/0.949/1/0.963/0.950 for detection of superficial venous sinus thrombosis and 1/1/1/1/1/1 for deep venous thrombosis. The AUC yield for T1S was 0.997 for cortical, 1 for deep and 0.988 for superficial venous segments. CONCLUSION T1S paralleled the accuracy of conventional sequences in the overall detection of CVT but showed superior accuracy in the detection of cortical venous thrombosis. It makes a fitting addition to the CVT MRI protocol in scenarios demanding negation of gadolinium administration.
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Affiliation(s)
- Sabha Ahmed
- Department of Neuroimaging and Interventional Radiology, NIMHANS, Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Ankit Arora
- Department of Neuroimaging and Interventional Radiology, NIMHANS, Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, NIMHANS, Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, NIMHANS, Hosur Road, Bengaluru, Karnataka, 560029, India.
| | - Deepak Menon
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
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Carletti F, Vilela P, Jäger HR. Imaging Approach to Venous Sinus Thrombosis. Radiol Clin North Am 2023; 61:501-519. [PMID: 36931766 DOI: 10.1016/j.rcl.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Cerebral venous thrombosis (CVT) is a rare cerebrovascular disease caused by an occlusion of the cerebral venous sinuses or cortical veins. It has a favorable prognosis if diagnosed and treated early. CVT can be difficult to diagnose on clinical grounds, and imaging plays a key role. We discuss clinical features and provide an overview of current neuroimaging methods and findings in CTV.
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Affiliation(s)
- Francesco Carletti
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
| | - Pedro Vilela
- Neuroradiology Department. Lisbon Western University Center (Centro Hospitalar Lisboa Ocidental -CHLO), Lisbon Portugal; Imaging Department, Hospital da Luz Lisbon, Portugal
| | - Hans Rolf Jäger
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
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Goldman-Yassen AE, Shifrin A, Mirsky DM, Vossough A, Licht DJ, Feygin T. Torcular Dural Sinus Malformation: Fetal and Postnatal Imaging Findings and Their Associations With Clinical Outcomes. Pediatr Neurol 2022; 135:28-37. [PMID: 35973328 DOI: 10.1016/j.pediatrneurol.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Torcular dural sinus malformations (tDSMs) are rare vascular malformations that present in fetuses and infants. Existing data on prognostic imaging features, as well as the associated morbidity and mortality, are limited and variable. We therefore reviewed cases of tDSMs diagnosed on fetal magnetic resonance imaging (MRI) at our referral center to identify pre- and postnatal MRI imaging features associated with long-term outcomes. METHODS We searched our imaging database for fetal and postnatal MRI reports of tDSM cases. The electronic medical record was then reviewed for pre- and postnatal clinical data, including follow-up imaging. Neurological outcomes were characterized using the previously reported scale based on the Bicêtre Score. Imaging features association with outcome scores were compared using the Fisher exact test. RESULTS Sixteen cases of tDMS diagnosed by fetal MRI with postnatal clinical follow-up were identified, 11 of whom underwent postnatal MRI. The majority of cases of tDSM (73%) decreased in size or resolved on postnatal follow-up study without treatment. Restricted diffusion and parenchymal hemorrhage on fetal MRI were the only imaging features identified significantly associated with unfavorable neurological outcome or death, present in two patients with poor outcomes (two of two) and only one with a normal outcome (one of 14) (P = 0.025). CONCLUSIONS Findings of tDSM on fetal MRI most often regress and/or resolve with normal or mild neurological outcomes, with the most significant predictor of poor outcome being the presence of parenchymal injury on fetal MRI. In addition, a subset will present with venolymphatic malformations.
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Affiliation(s)
- Adam E Goldman-Yassen
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
| | - Anna Shifrin
- North Shore Radiological Associates, Winchester, Massachusetts
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel J Licht
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tamara Feygin
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Krystkiewicz K, Wrona D, Tosik M, Birski M, Szylberg Ł, Morawska A, Furtak J, Wałęsa C, Stopa K, Harat M. Dural sinus thrombosis after resection of vestibular schwannoma using suboccipital retrosigmoid approach-thrombosis classification and management proposal. Neurosurg Rev 2022; 45:2211-2219. [PMID: 35061140 DOI: 10.1007/s10143-022-01741-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
Dural sinus thrombosis is one of the complications after posterior fossa surgery. However, that topic is not described well with regard to vestibular schwannoma surgery using the unique suboccipital retrosigmoid approach. We analyzed retrospectively medical records and radiological investigations of 116 patients. The including criteria were histopathologically confirmed vestibular schwannoma operated on using the retrosigmoid approach, preoperative and postoperative contrast-enhanced MRI, and at least 1-year follow-up. The patient group included 36% males and 64% females. The average age was 47.3 ± 13.9 years. Sixty percent of the tumors were classified as T4b according to the Hannover scale and their mean volume was 13.73 ± 10.28 cm3. There were no signs of thrombosis preoperatively. Postoperative changes in the dural sinuses were found in 26 (22%) cases. In 7 (27%) cases, there was an external compression by the hemostatic agent, and in 19 (73%) cases, a thrombus was visualized in the sinus lumen. The size of the sinus, age, and the tumor size were not risk factors for thrombosis, whereas an intraoperative sinus injury was a statistically significant risk factor (p = 0.0012). All of the patients diagnosed with thrombosis were in good clinical condition in long-term follow-up, except one fatal case. Complete recanalization was observed in 58% of cases after 1-year follow-up. Postoperative changes in the dural venous sinuses are a frequent finding after vestibular schwannoma surgery using the suboccipital retrosigmoid approach. Intraoperative dural injury is a risk factor for thrombosis. Thrombosis in that group of patients is usually asymptomatic and does not influence the prognosis.
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Affiliation(s)
- Kamil Krystkiewicz
- Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, Pabianicka 62, 95-513, Łódź, Poland. .,Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland.
| | - Dawid Wrona
- Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, Pabianicka 62, 95-513, Łódź, Poland
| | - Marcin Tosik
- Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, Pabianicka 62, 95-513, Łódź, Poland
| | - Marcin Birski
- Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland
| | - Łukasz Szylberg
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland.,Department of Tumor Pathology and Pathomorphology, Oncology Center, Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland.,Department of Pathomorphology, 10th Military Clinical Hospital, Bydgoszcz, Poland
| | - Anna Morawska
- Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland
| | - Jacek Furtak
- Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland
| | - Cezary Wałęsa
- Department of Radiology, 10th Military Clinical Hospital, Bydgoszcz, Poland
| | - Konrad Stopa
- Department of Radiology, 10th Military Clinical Hospital, Bydgoszcz, Poland
| | - Marek Harat
- Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland.,Department of Neurosurgery and Neurology, Collegium Medicum of the Nicolaus Copernicus University, Bydgoszcz, Poland
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Wierzbowski KA, Wing SE, Brown BP, Martinez ML, Golomb MR. Fetal Cerebral Sinovenous Thrombosis and Dural Sinus Malformation. Pediatr Neurol 2022; 126:89-93. [PMID: 34763246 DOI: 10.1016/j.pediatrneurol.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fetal cerebral sinovenous thrombosis (CSVT) and dural sinus malformation (DSM) are rare types of fetal cerebral venous pathology that are becoming increasingly recognized as fetal imaging advances. Fetal DSMs are a common source of fetal CSVT, although CSVT may occur without a DSM. The literature on these disorders is limited. METHODS Cases of fetal CSVT and DSM were identified retrospectively through a query of the Indiana University Health fetal imaging archive from 2007 to 2021. RESULTS Seven cases were identified, all of whom were alive at birth. A DSM was present in six. Treatments after birth included enoxaparin sodium (3), embolization (3), and shunt placements (1). Five cases had documented regression or complete resolution of the thrombus and/or malformation. One was lost to follow-up, one died from complications of hydrocephalus at nine months, one was receiving physical and occupational therapy at last follow-up at three months, one had concern for autism and mild gait abnormality at 21 months, two had concern for speech delay (18 months and 24 months), and one had normal development at most recent follow-up (four years). CONCLUSIONS Positive short-term outcomes may occur for some cases of fetal CSVT and DSM. However, risk factors and best treatments are not clear, and long-term outcome data are limited. There is a need for further study.
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Affiliation(s)
- Katherine A Wierzbowski
- Division of Child Neurology, Department of Neurology, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Sarah E Wing
- Division of Child Neurology, Department of Neurology, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon P Brown
- Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Mesha L Martinez
- Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Meredith R Golomb
- Division of Child Neurology, Department of Neurology, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.
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Pai V, Khan I, Sitoh YY, Purohit B. Pearls and Pitfalls in the Magnetic Resonance Diagnosis of Dural Sinus Thrombosis: A Comprehensive Guide for the Trainee Radiologist. J Clin Imaging Sci 2020; 10:77. [PMID: 33365199 PMCID: PMC7749941 DOI: 10.25259/jcis_187_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022] Open
Abstract
Dural sinus thrombosis (DST) is a potentially fatal neurological condition that can be reversed with early diagnosis and prompt treatment. Non-enhanced CT scan is often the first imaging investigation in patients presenting with acute neurological symptoms; however, its poor sensitivity in detecting DST is a major drawback. Magnetic resonance (MR) imaging offers multiple advantages such as excellent contrast resolution and unenhanced venography possibilities, making it the mainstay in the non-invasive diagnosis of DST. However, physiological variations, evolution of thrombi, and incorrect selection/application of MR techniques can lead to false positive and false negative interpretations impacting patient management and outcome. This article discusses the MR techniques useful to diagnose DST and describes pitfalls, with troubleshooting methods, to ensure an accurate diagnosis. We have used multiple diagrammatic illustrations and MR images to highlight pertinent take-home points and to serve as an easy guide for day-to-day clinical practice.
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Affiliation(s)
- Vivek Pai
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Iram Khan
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Yih Yian Sitoh
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Bela Purohit
- Department of Neuroradiology, National Neuroscience Institute, Singapore
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7
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Liby P, Lomachinsky V, Petrak B, Kyncl M, Montarroyos UR, Tichy M. Torcular dural sinus malformations: a grading system proposal. Childs Nerv Syst 2020; 36:2707-2716. [PMID: 32198580 DOI: 10.1007/s00381-020-04569-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Torcular dural sinus malformations (tDSMs) are congenital complex vascular anomalies often referred as a single unit. Nevertheless, they possess distinct anatomical features, clinical diversity, and markedly different outcomes. OBJECTIVE On the basis of our institutional experience and analysis of published data, we propose a grading system. METHODS We have identified 44 papers to which we added our four institutional cases for a total of 126 patients. Eight predictor variables were studied. In order to assess their individual impact on mortality and possible correlations, a logistic regression model was constructed through a stepwise forward process. RESULTS Overall mortality was 22.1%. Mortality was higher in tDSM patients diagnosed postnatally, 40.7% versus a 15.6% in prenatally found cases (p = 0.007). We divided the patients into four grades. Grade I comprised patients with no feeder evidence and possessed the best outcomes (mortality of 7.55%). Mortality rose for grades II and III defined respectively by scarce and multiple feeders. Brain damage was the defining feature of grade IV. A mortality of 75% could be observed within this grade. Grade IV was further divided into grades IVa (antenatal) and IVb (postnatal cases). Furthermore, our logistic regression model found that brain damage (OR 11.3, p < 0.001, 95% CI 2.97-42.91) and patent feeders (OR 4, p = 0.03, 95% CI 1.15-13.86) were major determinants of poor outcome (area under ROC curve of 81.44%). CONCLUSION The grading system (tDSM-GS) streamlines classification into four different grades facilitating both diagnosis, clinical decision-making, and proper prognostication.
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Affiliation(s)
- P Liby
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, Prague 5, 150 06, Prague, Czech Republic.
| | - V Lomachinsky
- Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil
| | - B Petrak
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - M Kyncl
- Department of Radiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - U R Montarroyos
- Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil
| | - M Tichy
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, Prague 5, 150 06, Prague, Czech Republic
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Idiculla PS, Gurala D, Palanisamy M, Vijayakumar R, Dhandapani S, Nagarajan E. Cerebral Venous Thrombosis: A Comprehensive Review. Eur Neurol 2020; 83:369-379. [PMID: 32877892 DOI: 10.1159/000509802] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebral sinus venous thrombosis (CSVT) is a relatively rare, potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. A literature search on PubMed using the keyword "Cerebral sinus venous thrombosis" was performed. We searched for the epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and treatment of CSVT. All full-text articles in the last 10 years, in adults (>18 years), and the English language were included. We aim to give a comprehensive review of CSVT, with a primary focus on the management of the disease. SUMMARY The literature search revealed 404 articles that met our criteria. CSVT is a relatively rare condition that accounts for approximately 1% of all forms of stroke. They can be subdivided into acute, subacute, and chronic forms based on the time of onset of clinical symptoms. It is a multifactorial disease, and the major forms of clinical presentation include isolated intracranial hypertension syndrome, focal neurological deficits, and cavernous sinus syndrome. MRI with magnetic resonance venogram (MRV) is considered the gold standard for diagnosis. Anticoagulation with heparin or low-molecular-weight heparin is the mainstay of treatment. Endovascular management is indicated for those cases with severe symptoms or worsening of symptoms despite anticoagulation therapy. Favorable outcomes have been reported in patients who receive early diagnosis and treatment. CONCLUSION CSVT is a potentially fatal neurological condition that is often under-diagnosed due to its nonspecific presentation. Timely diagnosis and treatment can reduce morbidity and mortality, remarkably improving the outcome in affected individuals.
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Affiliation(s)
| | - Dhineshreddy Gurala
- Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
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Cellerini M, Francavilla R, Testoni C, Maffei M, Zucchelli M, Ghizzi C. Dural sinus mechanical thrombectomy and continuous local rt-PA infusion in a child with refractory intracranial hypertension and progressive visual loss: A case report. Surg Neurol Int 2020; 11:253. [PMID: 33024591 PMCID: PMC7533100 DOI: 10.25259/sni_236_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/05/2020] [Indexed: 11/04/2022] Open
Abstract
Background Children with intracranial hypertension are at risk for visual loss and their visual function must be closely monitored. Surgery with the insertion of a ventriculoperitoneal shunt is imperative when vision is threatened. Case Description Herein, we report a case of a 5-year-old boy whose refractory intracranial hypertension and severe, progressive visual loss (secondary to a chronic, otogenic, right sigmoid sinus thrombosis, and a contralateral sinus tight stenosis) were resolved by a combination of continuous (6 h), locoregional, infusion of recombinant tissue plasminogen activator (rt-PA), and mechanical thrombectomy. Conclusion The association of in loco and continuous infusion of recombinant tissue plasminogen activator (rt- PA) with mechanical thrombectomy resulted in effective in partially reopening the occluded sinus and facilitating a good clinical recovery. This combined endovascular approach may represent an alternative, less invasive, therapeutic option to surgery in children with intracranial hypertension caused by chronic cerebral venous sinus thrombosis.
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Affiliation(s)
- Martino Cellerini
- Department of Neuroradiology, ISNB - IRCCS, Bologna, Emilia-Romagna, Italy
| | - Rosa Francavilla
- Department of Pediatrics, Maggiore Hospital, ISNB - IRCCS, Bologna, Emilia-Romagna, Italy
| | - Caterina Testoni
- Departments of Anaesthesiology ISNB - IRCCS, Bologna, Emilia-Romagna, Italy
| | - Monica Maffei
- Department of Neuroradiology, ISNB - IRCCS, Bologna, Emilia-Romagna, Italy
| | - Mino Zucchelli
- Departments of Neurosurgery, ISNB - IRCCS, Bologna, Emilia-Romagna, Italy
| | - Chiara Ghizzi
- Department of Pediatrics, Maggiore Hospital, ISNB - IRCCS, Bologna, Emilia-Romagna, Italy
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Liby P, Lomachinsky V, Petrak B, Kyncl M, Charvat F, Padr R, Tichy M. Torcular dural sinus malformations: a single-center case series and a review of literature. Childs Nerv Syst 2020; 36:333-41. [PMID: 31267184 DOI: 10.1007/s00381-019-04280-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Torcular dural sinus malformations (tDSMs) are rare vascular pathologies with various anatomoclinical pictures and prognosis. We analyzed our case series and corroborated the complexity of this rare unit by a review of literature. CASE SERIES From 2003 to 2018, we treated four tDSMs patients. The evolution of three postnatally diagnosed cases of similar angioarchitecture contrasted with a fourth antenatally diagnosed case with significant torcular thrombosis. All patients were examined by computed tomography, magnetic resonance imaging, CT angiography, and MRI angiography. Three patients underwent digital subtraction angiography with embolization of feeders. Unusual pathological images were depicted. CONCLUSIONS Early diagnosis along with embolization of feeders and lake could improve the outcome for tDSM patients with dural arteriovenous shunts. Ventriculoperitoneal shunt implantation before endovascular treatment led to significant worsening of both clinical presentation and MRI picture. For patients who persist with hydrocephalus despite the endovascular approach, we suggest endoscopic third ventriculostomy as a first-line treatment option. Antenatally diagnosed patients with thrombosed lakes constitute a prognostically better group of patients. Spontaneous thrombosis and remodelation of the lake can, however, still leave neurological sequelae, as observed in our patient.
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11
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Shioya A, Mashiko R, Shiigai M, Nakai Y, Takahashi N, Kobayashi H, Irie T, Tamaoka A. Dural Sinus Thrombosis with Nonsymptomatic Persistent Falcine Sinus: A Case Report. J Stroke Cerebrovasc Dis 2019; 28:104309. [PMID: 31402085 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/21/2019] [Accepted: 07/21/2019] [Indexed: 11/18/2022] Open
Abstract
A 24-year-old woman was admitted to our hospital after convulsive status epilepticus. A cerebral magnetic resonance venography revealed a persistent fetal falcine sinus. Additionally, the posterior third of the superior sagittal sinus was hypoplastic and the abnormal deep venous drainage was accompanied. These abnormalities had already been detected by magnetic resonance imaging several years ago. In the present scan, we discovered a sinus thrombosis in the hypoplastic superior sagittal sinus. In the cerebral angiography, we observed delayed venous return in the left parieto-occipital lobe and hypothesized that cerebral venous stasis due to the thrombus caused the convulsive status epilepticus. The patient was treated with intravenous administration of heparin along with an antiepileptic drug, and she recovered with no neurological defects. In the present case, the falcine sinus and the anomalous venous return were likely congenital while the status epilepticus was derived from thrombosis in the hypoplastic superior sagittal sinus. Although the falcine sinus functioned as an alternative pathway for the superior sagittal sinus, the hypoplastic superior sagittal sinus itself may also play an important role as a venous drainage channel.
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Affiliation(s)
- Ayako Shioya
- Department of Neurology, Mito Kyodo General Hospital, Tsukuba University Hospital Mito Area Medical Education Center, Ibaraki, Japan; Address correspondence to Ayako Shioya, MD, PhD, Department of Neurology, Mito Kyodo General Hospital, Tsukuba University Hospital Mito Area Medical Education Center, 3-2-7, Miyamachi, Mito, Ibaraki 310-0015, Japan.
| | - Ryota Mashiko
- Department of Neurosurgery, Mito Kyodo General Hospital, Tsukuba University Hospital Mito Area Medical Education Center, Ibaraki, Japan
| | - Masanari Shiigai
- Department of Radiology, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Yasunobu Nakai
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | | | - Hiroyuki Kobayashi
- Department of General Internal Medicine, Mito Kyodo General Hospital, Tsukuba University Hospital Mito Area Medical Education Center, Ibaraki, Japan
| | - Toshiyuki Irie
- Department of Radiology, Mito Kyodo General Hospital, Tsukuba University Hospital Mito Area Medical Education Center, Ibaraki, Japan
| | - Akira Tamaoka
- Department of Neurology, Facility of Medicine, University of Tsukuba, Ibaraki, Japan
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Mohanty A, Godwin K, Albitar MF, Malkani G. Bilateral Transverse Sinus Thrombosis following Craniotomy and Cranial Reconstruction for Sagittal Craniosynostosis. Pediatr Neurosurg 2019; 54:411-415. [PMID: 31597142 DOI: 10.1159/000503106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Craniotomy and cranial reconstruction is the most common procedure for children older than 6 months with craniosynostosis. Dural sinus thrombosis after this surgery has not been well reported in the literature. CASE PRESENTATION This 2-year-old child underwent a bilateral craniotomy and cranial reconstruction for sagittal craniosynostosis. He had a partial thickness tear of the wall of the right transverse sinus which was uneventfully managed. Postoperative imaging showed evidence of bilateral thrombosis of the transverse sinus with a small occipital hemorrhage. He was started on low-molecular-weight heparin. Follow-up imaging showed nonprogression of the thrombosis. Four days later, he developed pulmonary hemorrhage, had an extended period of low oxygenation and hypotension with acute respiratory distress syndrome, and had to be ventilated for a prolonged period. Follow-up MRI showed evidence of extensive bilateral cortical hypointensities possibly due to hypoxemia. At the last follow-up, he continued to be grossly neurologically impaired. CONCLUSION Thrombosis of the dural sinuses is a very rare occurrence after an extensive craniotomy and cranial reconstruction. However, it should be considered during the postoperative period and, if diagnosed, it should be treated with anticoagulants. Avoiding a direct sinus injury during reflection of the craniotomy flap and covering the exposed sinus with moist cottonoids during the surgery is advocated to prevent sinus thrombosis.
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Affiliation(s)
- Aaron Mohanty
- Department of Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, Texas, USA,
| | - Krystalynne Godwin
- Department of Anesthesiology, Clear Lake Regional Medical Center, Webster, Texas, USA
| | | | - Gautam Malkani
- Department of Pediatrics, Clear Lake Regional Medical Center, Webster, Texas, USA
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Bushnaq SA, Qeadan F, Thacker T, Abbas M, Carlson AP. High-Risk Features of Delayed Clinical Progression in Cerebral Venous Thrombosis: A Proposed Prediction Score for Early Intervention. Interv Neurol 2018; 7:297-307. [PMID: 30410505 DOI: 10.1159/000487960] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/23/2018] [Indexed: 11/19/2022]
Abstract
Background Anticoagulation is the mainstay treatment for cerebral venous thrombosis (CVT). A subset of patients might deteriorate despite anticoagulation, and in such cases, endovascular therapy is recommended. Methods A retrospective review was performed on subjects with CVT from January 2005 to October 2016. The primary outcome was clinical deterioration. Bivariate analysis, multiple logistic regression modeling, and linear discriminant analysis were used to determine a predictive model for deterioration; the results from these models were used to construct a CVT score in order to measure the individual likelihood of deterioration. Results We identified 147 subjects with CVT. The majority were treated with anticoagulation (n = 109, 74.15%); 38 (25.85%) were found to have deterioration, 12 (8.16%) of whom underwent endovascular intervention. The most important risk factors of deterioration, per bivariate analysis, included decreased level of consciousness (odds ratio [OR] = 5.76; 95% confidence interval [CI] 2.59-12.77) and papilledema (OR = 4.52; 95% CI 1.55-13.18). The final multivariable model also included CVT location score (number of sinuses involved), oral contraceptive pill use, sodium level, platelet count, and seizure activity on presentation. This model had a predictive ability to identify deterioration of 83.2%, with a sensitivity of 71.4% and a specificity of 76.2%. Patients with a CVT score of ≥5 have at least 50% chance of deterioration. Conclusions Decreased mental status, seizure activity, papilledema, number of involved sinuses, as well as sodium level and platelet count are the most important factors in predicting deterioration after CVT. This group may represent a subset of patients in whom early endovascular therapy may be considered.
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Affiliation(s)
- Saif A Bushnaq
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Fares Qeadan
- Clinical Translational Science Center, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Tapan Thacker
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Mohammad Abbas
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Andrew P Carlson
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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14
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Azeemuddin M, Awais M, Mubarak F, Rehman A, Baloch NUA. Prevalence of subarachnoid haemorrhage among patients with cranial venous sinus thrombosis in the presence and absence of venous infarcts. Neuroradiol J 2018; 31:496-503. [PMID: 29890915 DOI: 10.1177/1971400918783060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Introduction In patients with cranial venous sinus thrombosis, the occurrence of subarachnoid haemorrhage in association with haemorrhagic venous infarcts is a well described phenomenon. However, the presence of subarachnoid haemorrhage in patients with cranial venous sinus thrombosis in the absence of a haemorrhagic venous infarct is exceedingly rare. Methods We retrospectively reviewed charts and scans of all patients who had cranial venous sinus thrombosis confirmed by magnetic resonance venography at our hospital between September 2004 and May 2015. The presence of subarachnoid haemorrhage was ascertained on fluid-attenuated inversion recovery, susceptibility-weighted imaging and/or unenhanced computed tomography scans by a single experienced neuroradiologist. Statistical analysis was performed using the Statistical Package for Social Sciences version 20. Differences in the proportion of haemorrhagic venous infarcts among patients with subarachnoid haemorrhage versus those without subarachnoid haemorrhage were compared using the chi-square test. A P value of less than 0.05 was considered significant. Results A total of 138 patients who had cranial venous sinus thrombosis were included in the study. Seventy-three (52.9%) were women and the median age of subjects was 35 (interquartile range 22-47) years. Venous infarcts and haemorrhagic venous infarcts were noted in 20/138 (14.5%) and 62/138 (44.9%) cases, respectively. Subarachnoid haemorrhage was present in 15/138 (10.9%) cases and, in three cases, subarachnoid haemorrhage occurred in the absence of a venous infarct. Haemorrhagic venous infarcts were more prevalent ( P = 0.021) among patients with subarachnoid haemorrhage (11/15) than in those without subarachnoid haemorrhage (51/123). Conclusion In patients with cranial venous sinus thrombosis, subarachnoid haemorrhage can occur even in the absence of a haemorrhagic venous infarct. The recognition of cranial venous sinus thrombosis as the underlying cause of subarachnoid haemorrhage is important to avoid misdiagnosis and inappropriate management.
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Affiliation(s)
| | - Muhammad Awais
- 1 Department of Radiology, Aga Khan University Hospital, Pakistan.,2 Department of Radiology, Dow University of Health Sciences, Pakistan
| | - Fatima Mubarak
- 1 Department of Radiology, Aga Khan University Hospital, Pakistan
| | - Abdul Rehman
- 3 Department of Biological and Biomedical Sciences, Aga Khan University, Pakistan
| | - Noor Ul-Ain Baloch
- 3 Department of Biological and Biomedical Sciences, Aga Khan University, Pakistan
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15
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Hachem LD, Mansouri A, Chen J, Pirouzmand F. Feasibility of real-time intraoperative fluorescence imaging of dural sinus thrombosis. J Clin Neurosci 2018; 52:153-155. [PMID: 29650453 DOI: 10.1016/j.jocn.2018.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
Abstract
Dural sinus thrombosis is a well-recognized and potentially serious complication following lateral skull base surgery. Methods of diagnosis are limited to post-operative computerized tomography scans or magnetic resonance venography. There are currently no reports of an intraoperative technique used to detect dural sinus thrombosis. Here, we describe the case of a 62-year-old woman who underwent translabyrinthine resection of a right vestibular schwannoma with no evidence of sinus thrombosis on pre-operative scans. Following tumor resection, patency of the sigmoid sinus was assessed intraoperatively using indocyanine green (ICG) videography which revealed a lack of flow in the right sigmoid sinus. Postoperative CT scan confirmed thrombosis of the right sigmoid sinus. We present the first report of real-time intraoperative diagnosis of sigmoid sinus thrombosis during removal of a vestibular schwannoma. ICG videography may be used for intraoperative visualization of dural sinus integrity and patency during prolonged or technically challenging microsurgical procedures. This technique may enable periodic monitoring and early identification of filling defects which can guide further intraoperative strategies and postoperative monitoring.
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Affiliation(s)
- Laureen D Hachem
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.
| | - Alireza Mansouri
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Joseph Chen
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Farhad Pirouzmand
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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16
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Pescatori L, Tropeano MP, Mancarella C, Prizio E, Santoro G, Domenicucci M. Post traumatic dural sinus thrombosis following epidural hematoma: Literature review and case report. World J Clin Cases 2017; 5:292-298. [PMID: 28798925 PMCID: PMC5535321 DOI: 10.12998/wjcc.v5.i7.292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/22/2016] [Accepted: 03/17/2017] [Indexed: 02/05/2023] Open
Abstract
Dural sinus thrombosis following a head trauma is a rare condition, described in literature along with the lack of consensus regarding diagnosis and management. We present a case of a fifty-year-old man with a head injury and combined supratentorial-subtentorial epidural hematoma who was treated conservatively through the administration of low molecular weight heparin. The diagnosis and management of this condition are discussed based on a literature review. The early diagnosis may prevent potentially treatable poor outcomes.
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17
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Mammen S, Keshava SN, Moses V, Aaron S, Ahmed M, Chiramel GK, Mani SE, Alexander M. Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis. Indian J Radiol Imaging 2017; 27:82-87. [PMID: 28515593 PMCID: PMC5385784 DOI: 10.4103/0971-3026.202956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: In dural venous sinus thrombosis (DVST), the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST. Materials and Methods: Eight patients with magnetic resonance imaging (MRI)-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System®. In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year. Results: Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS), with 5/8 (62%) patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months), and there were no new neurological events during the follow-up period. Conclusion: Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up.
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Affiliation(s)
- Suraj Mammen
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Vinu Moses
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sanjith Aaron
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Munawwar Ahmed
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - George K Chiramel
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunithi E Mani
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mathew Alexander
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
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18
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Jean WC, Felbaum DR, Stemer AB, Hoa M, Kim HJ. Venous sinus compromise after pre-sigmoid, transpetrosal approach for skull base tumors: A study on the asymptomatic incidence and report of a rare dural arteriovenous fistula as symptomatic manifestation. J Clin Neurosci 2017; 39:114-117. [PMID: 28089417 DOI: 10.1016/j.jocn.2016.12.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/27/2016] [Indexed: 11/27/2022]
Abstract
The sigmoid sinus is routinely exposed and manipulated during pre-sigmoid, transpetrosal approaches to the skull base, but there is scant data available on the incidence of venous sinus compromise after surgery. We encountered a dural arteriovenous fistula as a result of sigmoid sinus occlusion and examined the incidence of venous sinus thrombosis or narrowing after transpetrosal surgeries. We performed a retrospective analysis of a series of patients treated by the senior surgeons (WCJ, MH, HJK), who underwent either a posterior petrosectomy or translabyrinthine approach for various skull base tumors. All available clinical and radiographic data were thoroughly examined in each patient to determine the post-operative fate of the venous sinuses. Of the 52 available patients, five patients were discovered post-operatively to have a narrowed or constricted sigmoid sinus ipsilateral to the surgery, whereas another five patients were diagnosed with asymptomatic sinus thrombosis either in the transverse or sigmoid or both. None of these patients experienced symptoms, nor were there any instance of ischemic or hemorrhagic complications. However, there was one additional patient who presented with pulsatile tinnitus 2years after surgery. His angiogram showed an occlusion of the ipsilateral sigmoid sinus and a posterior fossa dural arteriovenous fistula. A two-stage transvenous and transarterial embolization was successful in eliminating the fistula. Technical considerations to avoid sinus injuries during pre-sigmoid, transpetrosal surgery are discussed.
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Affiliation(s)
- Walter C Jean
- Department of Neurosurgery, George Washington University, United States.
| | | | - Andrew B Stemer
- Department of Neurology, Georgetown University, United States
| | - Michael Hoa
- Department of Otolaryngology, Georgetown University, United States
| | - H Jeffrey Kim
- Department of Otolaryngology, Georgetown University, United States
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19
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Singh S, Ramakrishnaiah RH, Hegde SV, Glasier CM. Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings. Pediatr Radiol 2016; 46:67-72. [PMID: 26358702 DOI: 10.1007/s00247-015-3458-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/13/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. OBJECTIVE To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. MATERIALS AND METHODS We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. RESULTS In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. CONCLUSION Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage.
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Affiliation(s)
- Sumit Singh
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA.
| | - Raghu H Ramakrishnaiah
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Shilpa V Hegde
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Charles M Glasier
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
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Wanke I, Rüfenacht DA. The Dural AV-Fistula (DAVF), the Most Frequent Acquired Vascular Malformation of the Central Nervous System (CNS). Clin Neuroradiol 2015; 25 Suppl 2:325-32. [PMID: 26308245 DOI: 10.1007/s00062-015-0449-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
Acquired arteriovenous malformations, such as is the case with dural arteriovenous fistulae (DAVF), are the consequence of a pathological new arterial ingrowth into venous spaces that reaches directly the venous lumen, without interposition of a capillary network, thereby creating an AV-shunt.The following concise text will provide elements in regards to diagnosis, indication for treatment discussion and choice of endovascular treatment (EVT) method.
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Affiliation(s)
- I Wanke
- Center of Diagnostic and Interventional Neuroradiology, Klinik Hirslanden, Witellikerstrasse 40, 8032, Zürich, Switzerland. .,Chair of Interventional Neuroradiology, Dep. of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - D A Rüfenacht
- Center of Diagnostic and Interventional Neuroradiology, Klinik Hirslanden, Witellikerstrasse 40, 8032, Zürich, Switzerland
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21
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Choi HJ, Cho CW, Kim YS, Cha JH. Giant arachnoid granulation misdiagnosed as transverse sinus thrombosis. J Korean Neurosurg Soc 2008; 43:48-50. [PMID: 19096547 DOI: 10.3340/jkns.2008.43.1.48] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 01/02/2008] [Indexed: 12/13/2022] Open
Abstract
We experienced a case of giant arachnoid granulation misdiagnosed as dural sinus thrombosis. A 66-year-old woman presented with a one month history of progressive occipital headache. Computed tomography angiography and cerebral angiography showed a round filling defect at the transverse sinus which was speculated as a transverse sinus thrombosis. Anticoagulation therapy was performed to prevent worsening of thrombosis for 2 weeks and then a Gadolinium-enhanced magnetic resonance imaging scan was performed. The filling defect lesion at the transverse sinus revealed a non-enhancing granule with central linear enhancement, which was compatible with giant arachnoid granulation. We checked the intrasinus pressure difference across the lesion the through the dural sinus in order to exclude the lesion as the cause of headache. Normal venous pressure with no significant differential pressure across the lesion was noted. Headache was treated with medical therapy.
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Affiliation(s)
- Hyuk Jin Choi
- Department of Neurosurgery, Maryknoll Medical Center, Busan Catholic Health System, Busan, Korea
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