An analysis of the anatomic route of the hypoglossal nerve within the hypoglossal canal using dynamic computed tomography angiography in patients with anterior condylar arteriovenous fistulas

Evaluation of the venous system may be useful in stroke prognostication and patient selection for acute intervention strategies. We report a novel phenomenon, delayed-late venous phase cortical vein filling, observed on dynamic computed tomography angiography obtained using multidetector computed tomography scanner, in acute ischemic stroke patients. The aim of this study was to examine the frequency of delayed-late venous phase cortical vein filling and assess its association to baseline collateral status. Dynamic computed tomography angiography images of acute ischemic stroke patients, being assessed for reperfusion therapy, were prospectively studied. Delayed-late venous phase cortical vein filling was defined by late venous phase opacification of cortical veins despite contrast clearance from contralateral cortical veins on dynamic computed tomography angiography. Time to peak of maximum arterial enhancement was recorded. A total of 117 patients (mean age = 70.6 ± 13.3 years; males = 48%) with hemispheric ischemic stroke who underwent acute dynamic computed tomography angiography were included in the study. Overall, 56 (48%) demonstrated delayed-late venous phase cortical vein filling. Poor collateralization (OR = 13.50; 95% CI = (4.2, 43); p ≤ 0.0001) and longer time to peak of maximum arterial enhancement (OR = 3.2; 95% CI = (1.96, 5.3); p ≤ 0.0001) were positively associated with delayed-late venous phase cortical vein filling. Delayed-late venous phase cortical vein filling was independently associated with poor baseline collateral status (75% vs. 15%, p ≤ 0.0001; OR = 14.38; 95% CI = (4.33, 47.8); p ≤ 0.0001). Delayed-late venous phase cortical vein filling is frequently seen in patients with acute ischemic stroke and is associated with poor baseline collateralization.

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Through-Plane Movement at Multiple Aortic Levels on Dynamic Computed Tomography Angiography Is Limited in Patients With an Abdominal Aortic Aneurysm

Journal of Endovascular Therapy ◽

10.1177/1526602815601402 ◽

2015 ◽

Vol 22 (5) ◽

pp. 765-769 ◽

Cited By ~ 2

Author(s):

Jeroen C. de Jonge ◽

Herman J.A. Zandvoort ◽

Evert-Jan P.A. Vonken ◽

Frans L. Moll ◽

Joost A. van Herwaarden

Keyword(s):

Computed Tomography ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Computed Tomography Angiography ◽

Dynamic Computed Tomography ◽

Abdominal Aortic

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Alternative route to a hypoglossal canal dural arteriovenous fistula in case of failed jugular vein approach

Interventional Neuroradiology ◽

10.1177/1591019920961199 ◽

2020 ◽

pp. 159101992096119

Author(s):

Rasmus Holmboe Dahl ◽

Alessandra Biondi ◽

Fortunato Di Caterino ◽

Giovanni Vitale ◽

Lars Poulsgaard ◽

...

Keyword(s):

Nerve Palsy ◽

Hypoglossal Nerve ◽

Jugular Vein ◽

Complete Regression ◽

Unsuccessful Attempt ◽

Hypoglossal Nerve Palsy ◽

Hypoglossal Canal ◽

Arteriovenous Fistulas ◽

Vein Access ◽

Alternative Routes

Hypoglossal canal dural arteriovenous fistulas (HC-DAVF) involve the anterior condylar vein (ACV) and anterior condylar confluence (ACC). They often present with tinnitus, bruit, and hypoglossal nerve palsy. The most common treatment in HC-DAVFs is transvenous embolization using coils and the most direct transvenous route is the trans-internal jugular vein access. When this approach is not feasible, a treatment attempt is possible through alternative routes. We report 2 patients with DAVFs involving the anterior condylar confluence. The first patient presented with pulsatile tinnitus and hypoglossal nerve palsy, and was treated by a standard transjugular approach. The second patient presented with pulse-synchronous bruit. Following an unsuccessful attempt of the transjugular approach, the fistulous point was reached via the deep cervical vein and complete occlusion was achieved by coil deployment. Both patients had complete regression of symptoms. Endovascular therapy is the elective treatment for HC-DAVFs and the transjugular approach is the most commonly used. The deep cervical vein (DCV) can be an alternative transvenous route when the transjugular approach fails.

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Intraoperative cone-beam computed tomography contributes to avoiding hypoglossal nerve palsy during transvenous embolization for dural arteriovenous fistula of the anterior condylar confluence

Interventional Neuroradiology ◽

10.1177/1591019916654141 ◽

2016 ◽

Vol 22 (5) ◽

pp. 584-589 ◽

Cited By ~ 8

Author(s):

Akitake Okamura ◽

Mitsuo Nakaoka ◽

Naohiko Ohbayashi ◽

Kaita Yahara ◽

Shinya Nabika

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Nerve Palsy ◽

Dural Arteriovenous Fistula ◽

Hypoglossal Nerve ◽

Cone Beam Ct ◽

Cone Beam ◽

Transvenous Embolization ◽

Hypoglossal Nerve Palsy ◽

Hypoglossal Canal

Background Dural arteriovenous fistula of the anterior condylar confluence (ACC-DAVF) is a rare subtype of DAVFs that occurs around the hypoglossal canal. Transvenous embolization (TVE) with coils has been performed for most ACC-DAVFs with a high clinical cure rate. However, some reports call attention to hypoglossal nerve palsy associated with TVE due to coil mass compression of the hypoglossal nerve caused by coil deviation from the ACC to the anterior condylar vein (ACV). Herein, we report a case of ACC-DAVF in which an intraoperative cone-beam computed tomography (CT) contributed to avoiding hypoglossal nerve palsy. Case presentation A 74-year-old man presented with left pulse-synchronous tinnitus. An angiography detected left ACC-DAVF mainly supplied by the left ascending pharyngeal artery and mainly drained through the ACV. The two fistulous points were medial side of the ACC and the venous pouch just cranial of the ACC. We performed TVE detecting the fistulous points by contralateral external carotid angiography (ECAG). The diseased venous pouch and ACC were packed with seven coils but a slight remnant of the DAVF was recognized. Because a cone-beam CT revealed that the coil mass was localized in the lateral lower clivus osseous without deviation to the hypoglossal canal, we finished TVE to avoid hypoglossal nerve palsy. Postoperatively, no complication was observed. No recurrence of symptoms or imaging findings were detected during a five-month follow-up period. Conclusion An intraoperative cone-beam CT contributed to avoiding hypoglossal nerve palsy by estimating the relationship between the coil mass and the hypoglossal canal during TVE of ACC-DAVF.

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Quantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair: A feasibility study

PLoS ONE ◽

10.1371/journal.pone.0245134 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245134

Author(s):

Georg Apfaltrer ◽

Francesco Lavra ◽

U. Joseph Schoepf ◽

Marco Scarabello ◽

Ricardo Yamada ◽

...

Keyword(s):

Computed Tomography ◽

Quantitative Analysis ◽

Abdominal Aorta ◽

Endovascular Repair ◽

Computed Tomography Angiography ◽

Aortic Aneurysms ◽

Wilcoxon Test ◽

Complete Agreement ◽

Dynamic Computed Tomography ◽

Diagnostic Confidence

Objectives To assess the feasibility of quantitative analysis of dynamic computed tomography angiography (dCTA) for the detection of endoleaks in patients who underwent endovascular repair of abdominal aortic aneurysms (EVAR). Material and methods Twenty patients scheduled for contrast-enhanced CT angiography (CTA) of the abdominal aorta post-EVAR were prospectively enrolled. All patients received a standard triphasic CTA protocol, followed by an additional dCTA. The dCTA acquisition enabled reconstruction of color-coded maps depicting blood perfusion and a dCTA dataset of the aneurysm sac. Observers assessed the dCTA and dynamic CT perfusion (dCTP) images for the detection of endoleaks, establishing diagnostic confidence based on a modified 5-point Likert scale. An index was calculated for the ratio between the endoleak and aneurysm sac using blood flow for dCTP and Hounsfield units (HU) for dCTA. The Wilcoxon test compared the endoleak index and the diagnostic confidence of the observers. Results In total, 19 patients (18 males, median age 74 years [70.5–75.7]) were included for analysis. Nine endoleaks were detected in 7 patients using triphasic CTA as the reference standard. There was complete agreement for endoleak detection between the two techniques on a per-patient basis. Both dCTA and dCTP identified an additional endoleak in one patient. The diagnostic confidence using dCTP for detection of endoleaks was not significantly superior to dCTA (5.0 [5–5] vs. 4.5 [4–5], respectively; p = 0.11); however, dCTP demonstrated superior diagnostic confidence for endoleak exclusion compared to dCTA (1.0 [1–1] vs 1.5 [1.5–1.5], respectively; p <0.01). Moreover, the dCTP endoleak index was significantly higher than the dCTA index (18.5 [10.8–20.5] vs. 3.5 [5–2.7], respectively; p = 0.02). Conclusions Quantitative analysis of dCTP imaging can aid in the detection of endoleaks and demonstrates a higher endoleak detection rate than triphasic CTA, as well as a strong correlation with visual assessment of dCTA images.

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