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Intracranial Arteriovenous fistulas

S A Amukotuwa, M P Marks, G Zaharchuk, F Calamante, R Bammer, N Fischbein
BACKGROUND AND PURPOSE: Intracranial dural arteriovenous fistulas carry a risk of substantial neurologic complications but can be difficult to detect on structural MR imaging and TOF-MRA. The purpose of this study was to assess the accuracy and added value of 3D pseudocontinuous arterial spin-labeling MR imaging for the detection of these lesions. MATERIALS AND METHODS: This retrospective study included 39 patients with a dural arteriovenous fistula and 117 controls who had undergone both DSA and MR imaging with pseudocontinuous arterial spin-labeling...
March 15, 2018: AJNR. American Journal of Neuroradiology
Dian He, Yuan Li, Yunli Yu, Gang Cai, Fu Ouyang, Yuchan Lin, Hongjuan Lu, Lan Chu
Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disorder that primarily affects the skin and the nervous system. This condition is called segmental NF1 (also called neurofibromatosis type V) when clinical features are limited to one area of the body. Segmental NF1 is generally thought to result from somatic mosaicism due to a postzygotic mutation in the NF1 gene, thus a test for NF1 gene abnormalities in peripheral blood is usually negative. Here we report a 31-year-old male presenting with epileptic seizures, who had a history of neurofibromas confirmed by biopsy, but lacked a family history of neurofibromatosis...
March 1, 2018: Clinical Neurology and Neurosurgery
Takahiro Osada, Timo Krings
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...
March 8, 2018: Neurosurgery
Bernard Florian, Jean-Michel Lemée, Rogatien Faguer, Henri-Dominique Fournier
BACKGROUND: The radiological signs of intracranial dural arteriovenous fistulas (ICDAVFs) are heterogenous. While it is commonly accepted that hyper intense T2 Wedge MRI of the brainstem and cervical cord mainly concern gliomas, it is so far uncommon and probably unknown that ICDAVFs can imitate similar radiological pattern, especially with gadolinium contrast enhancement and cord enlargement. Thus the angiography is poorly documented in the diagnostic work-up. CASE: We report the unusual history of ICDAVFs, revealed by clinical and radiological features that mimicked a medulla or cervical spinal cord glioma...
March 7, 2018: World Neurosurgery
Yen-Heng Lin, Chung-Wei Lee, Yu-Fen Wang, Chi-Ju Lu, Ya-Fang Chen, Hon-Man Liu
BACKGROUND AND PURPOSE: Engorged medullary vein (EMV) in patients with intracranial dural arteriovenous fistula (DAVF) suggests venous congestion. The aim of this study is to investigate its prevalence, pattern, and correlation with clinical findings. MATERIALS AND METHODS: CT angiography (CTA) raw data of DAVF were used for multiplanar reconstruction and then analyzed for the presence and pattern of EMV, which is defined as a dilated vein in the cerebral white matter...
February 19, 2018: Journal of Neurointerventional Surgery
X M Wu, G Zhang, Q Wang, Z X Ni, M Liu, L B Yun, X F Yi
Internal carotid arterial system is the main source of blood supply in brain. In forensic identification practice, blunt injures of internal carotid arterial system usually cause complications such as thrombus, aneurysm and arteriovenous fistula, etc. The deaths following delayed cerebral infarction or intracranial haemorrhage are not rare. At present, literature of deaths caused by blunt injuries of internal carotid arterial system mainly consist of case reports in China. This paper reviews related literature and case reports at home and abroad, and summarizes forensic medical features and identification method of the deaths caused by such injuries...
December 2017: Fa Yi Xue za Zhi
Yunbao Guo, Jing Yu, Ying Zhao, Jinlu Yu
Intracranial multiple dural arteriovenous fistulas (MDAVFs) are rare lesions that are difficult to treat. The key factors involved in the development of MDAVFs remain unknown. At present, the majority of reports on intracranial MDAVFs are confined to case reports and small case series, and thus understanding of MDAVFs is limited. The current review assesses the available literature to date with the aim of reviewing the progress in research on intracranial MDAVFs. Intracranial MDAVFs may be divided into two types: Synchronous and metachronous...
January 2018: Biomedical Reports
Daniel Mantilla, Marine Le Corre, Federico Cagnazzo, Gregory Gascou, Omer Eker, Paolo Machi, Carlos Riquelme, Cyril Dargazanli, Vincent Costalat, Alain Bonafe, Pierre-Henri Lefevre
BACKGROUND AND PURPOSE: Transarterial Onyx embolization is an effective treatment for patients with intracranial dural arteriovenous fistula (DAVF). A study was performed to determine whether the clinical and radiological outcomes after transarterial Onyx treatment were affected by the type of cortical venous drainage (direct vs indirect) of high-grade DAVF. MATERIALS AND METHODS: Between May 2006 and December 2014, demographic data, clinical presentation, angiographic characteristics, and treatment-related outcomes were collected for 54 patients divided into two groups (intracranial DAVF with direct and indirect cortical venous drainage)...
January 30, 2018: Journal of Neurointerventional Surgery
William C Newman, Paul S Kubilis, Brian L Hoh
OBJECTIVE Comorbidities have a significant effect on patient outcomes. Accounting for this effect is especially important in retrospective reviews of large databases; overpowered studies are at risk for finding significant results because of inaccurate patient risk stratification. The authors previously created a neurovascular comorbidities index (NCI) for patients with an unruptured intracranial aneurysm and found that the model's ability to predict patient outcomes was statistically significantly improved over that of the routinely used Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI)...
January 26, 2018: Journal of Neurosurgery
Joseph Touma, Jianping Dai, Andre Gaston, Marianne Gervais, Eric Allaire
OBJECTIVES: Arteriovenous malformations (AVMs) are complex vascular lesions. Surgical excision is the treatment of choice, but is often not achievable. Embolo-sclerotherapy alone is associated with high recurrence rates. This study tested the hypothesis that seeding hydrogel conditioned bone marrow derived mesenchymatous stem cells (BM-MSCs) in an AVM nidus model induces solid microvascular occlusion through endoluminal tissue growth. METHODS: AVMs were modelled as arteriovenous microvascular nidus, using swine rete mirabile, a plexiform intracranial structure composed of arterial microvessels that extensively anastomose...
January 15, 2018: European Journal of Vascular and Endovascular Surgery
Udi Sadeh-Gonike, Nicolas Magand, Xavier Armoiry, Roberto Riva, Paul Emile Labeyrie, Bernadette Lamy, Anne-Claire Lukaszewicz, Jean-Jacques Lehot, Francis Turjman, Benjamin Gory
BACKGROUND: Onyx is important embolic material in the endovascular treatment of intracranial dural arteriovenous fistula (DAVF). However, its impact on DAVF occlusion rates, morbidity, mortality, and complication rates is not fully examined. OBJECTIVE: To improve understanding of safety and effectiveness profiles associated with transarterial endovascular treatment using Onyx for intracranial DAVF. METHODS: We analyzed data from our prospective clinical registry and conducted a systematic review of all previous transarterial embolization studies using Onyx published between January 2005 and December 2015 in MEDLINE and EMBASE...
June 17, 2017: Neurosurgery
Jiali Pu, Xiaoli Si, Rong Ye, Baorong Zhang
RATIONALE: A dural arteriovenous fistula (DAVF) refers to an abnormal direct connection between an intracranial artery and a dural venous sinus. A DAVF presenting with parkinsonism is rare, and is therefore easily misdiagnosed. Therefore, early consideration of DAVF in the differential diagnosis of reversible parkinsonism is necessary. PATIENT CONCERNS: We present the case of a 51-year-old male with progressive parkinsonism. DIAGNOSES: He was diagnosed as straight sinus occlusion...
December 2017: Medicine (Baltimore)
A Z Copelan, A Krishnan, H Marin, R Silbergleit
Medullary edema with enhancement is rarely reported at initial MR imaging in intracranial dural arteriovenous fistulas. We report a series of 5 patients with dural arteriovenous fistulas, all of whom demonstrated a characteristic pattern of central medullary edema and medullary enhancement at initial MR imaging. Cognard type V dural arteriovenous fistula, defined by drainage into the perimedullary veins and the veins surrounding the brain stem, is a rare yet well-described pathologic entity. Even more rarely reported, however, is its clinical presentation with predominantly bulbar symptoms and MR imaging findings of central medullary edema with enhancement...
February 2018: AJNR. American Journal of Neuroradiology
Luana Antunes Maranha Gatto, Fernando Saurin, Gelson Luis Koppe, Zeferino Demartini
Background: Dural arteriovenous fistulas (DAVF) are unusual intracranial vascular malformations consisting of anomalous connections between meningeal arteries and dural sinuses or the veins that pass through them. They have variable clinical presentation and prognosis, which depend on their location and venous hemodynamics. Treatment is based on the closure of the abnormal connections, which is usually conducted via arterial and/or transvenous endovascular techniques. Case Description: We present a male patient who complained of headaches and left-sided pulsatile tinnitus due to DAVF from the external carotid artery branches draining directly into the ipsilateral sigmoid sinus...
2017: Surgical Neurology International
Limin Dou, Wenhua Yu
Intracranial dural arteriovenous fistulas (DAVFs) are complex intracranial vascular malformations that may lead to hemorrhage. Although the precise mechanisms by which DAVFs occur remain unknown, dural angiogenesis may be a vital factor in its pathogenesis. Nuclear factor erythroid 2-related factor 2 (Nrf2) significantly influences angiogenesis; however, the association between DAVF and Nrf2 remains unclear. Therefore, the present study investigated whether DAVF alters the expression of Nrf2 in an experimental animal model of DAVF...
November 2017: Experimental and Therapeutic Medicine
Shriram Varadharajan, Arvinda Hanumanthapura Ramalingaiah, Jitender Saini, Arun Kumar Gupta, B Indira Devi, Ullas V Acharya
Precipitating hydrophobic injectable liquid (PHIL) is a newly available liquid embolic agent for endovascular therapy. It is nonadhesive and composed of a biocompatible polymer dissolved in dimethyl sulfoxide solvent and bonded covalently with iodine. In this report, the authors present their preliminary experience using PHIL in the treatment of intracranial vascular shunts. Between July 2015 and December 2015, 11 patients underwent endovascular embolization using the PHIL embolic agent. Five patients had arteriovenous malformations, 4 had dural arteriovenous fistulas, 1 patient had a carotid-cavernous fistula, and 1 patient had a pial arteriovenous fistula...
December 1, 2017: Journal of Neurosurgery
Yen-Heng Lin, Yu-Fen Wang, Hon-Man Liu, Chung-Wei Lee, Ya-Fang Chen, Hong-Jen Hsieh
PURPOSE: Computed tomography angiography (CTA) and magnetic resonance imaging/angiography (MRI/MRA) are used for the diagnosis of intracranial dural arteriovenous fistulas (DAVFs). The purpose of this study was to compare the diagnostic accuracy of CTA and magnetic resonance imaging/angiography (MRI/MRA) for detection of cortical venous reflux (CVR) in intracranial DAVFs. METHODS: The records of patients with angiography-confirmed intracranial DAVFs who also received CTA and MRI/MRA from January 2008 to July 2016 were reviewed...
January 2018: Neuroradiology
Federico Cagnazzo, Andrea Peluso, Riccardo Vannozzi, Waleed Brinjikji, Giuseppe Lanzino, Paolo Perrini
Arterial aneurysms are uncommon among patients with dural arteriovenous fistulae (DAVFs), and there is limited information available to guide treatment decisions in such cases. We performed a systematic review of the literature, including a case of a DAVF associated with a flow-related intraorbital ophthalmic artery (OA) aneurysm that we have recently managed. The purpose of our study was to clarify epidemiology, natural history, and management of these lesions. A total of 43 published cases of DAVF associated aneurysms were found in 26 studies on the topic...
November 25, 2017: Neurosurgical Review
Brent J Doolan, Iddo Paldor, Peter J Mitchell, Andrew P Morokoff
Intracranial dural arteriovenous fistulae (DAVF) are complex vascular malformations consisting of a pathological shunt located between meningeal arteries and drainage to dural venous sinuses and/or cerebral veins. We report an unusual anatomical variation, resulting in a DAVF forming between the superior sagittal sinus and an anomalous origin of the middle meningeal artery (MMA) arising from the left ophthalmic artery. We present an atypical case requiring mini-craniotomy for catheter access, as well as cannulation of extracranial arterial supply prior to embolization of a Cognard type IIa+b fistula...
November 11, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Mogwale S Motebejane, In Sup Choi
BACKGROUND: Dural arteriovenous fistulas (DAVFs) are usually seen in relation to the venous sinuses, but in certain rare instances fistulas may not drain directly into the venous sinuses but rather drain into the cortical veins. This rare form of DAVF may present with either intracranial hemorrhage or myelopathy. The mode of clinical presentation is influenced by the venous outflow into either intracranial drainage or caudally intraspinal drainage. OBJECTIVE: To evaluate the clinical presentations, angioarchitectural characteristics, and treatment of 12 patients who presented with DAVF in the region of the foramen magnum...
November 8, 2017: Operative Neurosurgery (Hagerstown, Md.)
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