Chapter 32: Anterior Fossa, Superior Sagittal Sinus, and Convexity Dural Arteriovenous Malformations

2009 ◽  
Keyword(s):  
Arteriovenous Malformations ◽  
Superior Sagittal Sinus ◽  
Sagittal Sinus ◽  
Anterior Fossa

scholarly journals Analysis of the best therapeutic alternative for intracranial dural arteriovenous malformations

2005 ◽  
Vol 63 (3a) ◽  
pp. 605-613 ◽  
Author(s):  
César de Paula Lucas ◽  
Mirto N. Prandini ◽  
José Guilherme Mendes Pereira Caldas
Keyword(s):  
Cavernous Sinus ◽  
Arteriovenous Malformations ◽  
Superior Sagittal Sinus ◽  
Sigmoid Sinus ◽  
Combined Method ◽  
Therapeutic Success ◽  
Therapeutic Alternative ◽  
Sagittal Sinus ◽  
Anterior Fossa ◽  
Transvenous Approach

The material for this research consisted of 93 patients with dural arteriovenous malformations (DAVMs) who were studied retrospectively with regards to therapeutic success and failure, who had undergone either neurosurgery, or embolization or a combination of both methods and whose disease was located in the cavernous sinus, the superior sagittal sinus, the transverse-sigmoid sinus of the anterior fossa and the tentorium. Thus, it was possible to arrive at the following conclusions: treatment of the DAVMs must be indicated, jointly, by an interventionist neuroradiologist and a neurosurgeon; DAVMs of the transverse-sigmoid sinus were better treated when a combination of both methods was used; DAVMs of the tentorium were also better treated with a combined method; the endovascular method ensured only a 50% chance of therapeutic success for DAVMs of the superior sagittal sinus; DAVMs of the cavernous sinus are better treated when the endovascular method was used with a transvenous approach, relative to the transarterial approach.

Anatomical Variations in the Location of Veins Draining Into the Anterior Superior Sagittal Sinus: Implications for the Transbasal Approach

2019 ◽  
Author(s):  
Hamid Borghei-Razavi ◽  
Alankrita Raghavan ◽  
Aldo Eguiluz-Melendez ◽  
Krishna Joshi ◽  
Juan C Fernandez-Miranda ◽  
...  
Keyword(s):  
Superior Sagittal Sinus ◽  
Clinical Importance ◽  
Anatomical Variations ◽  
Sagittal Sinus ◽  
Skull Base Approach ◽  
Anterior Fossa ◽  
Cranial Fossa ◽  
The Mean ◽  
Level 1 ◽  
Subfrontal Approach

Abstract BACKGROUND Many approaches are used for midline anterior cranial fossa meningioma resection. In the subfrontal approach, the anterior superior sagittal sinus (SSS) is commonly ligated to release the anterior falx. The transbasal approach allows access to the origin of the anterior SSS, allowing for maximum venous preservation. OBJECTIVE To investigate variations in the first and second veins draining into the SSS. METHODS We performed stepwise dissections for a transbasal level 1 approach on 8 anatomic specimens. We visualized the first and second veins draining into the sinus and measured the distance from the foramen cecum to these veins. We also measured the orbital bar height to determine the length of sagittal sinus that could be preserved with orbital bar removal. RESULTS The distance between the foramen cecum and the first vein ranged from 4 to 36 mm while the distance to the second vein ranged from 6 to 48 mm. The mean orbital bar height was 26.4 mm. Based on these measurements, with a traditional bicoronal craniotomy without orbital bar removal, 81% of first veins and 58% of second veins would be sacrificed. CONCLUSION A supraorbital bar or nasofrontal osteotomy, part of the transbasal skull base approach, is helpful to preserve the first and second veins when ligating the anterior SSS. Based on this study, it may be difficult to preserve these veins without orbital bar removal. Preservation of these veins may be of clinical importance when approaching midline anterior fossa pathologies.

Multiple cerebral arteriovenous malformations associated to rostral hypoplasia of the superior sagittal sinus: a case report

2020 ◽  
Vol 64 (3) ◽  
Author(s):  
Ramon Torné ◽  
Felipe A. Molina Jaque ◽  
Ana Rodríguez-Hernández ◽  
Fuat Arikan ◽  
Diego López Bermeo ◽  
...  
Keyword(s):  
Case Report ◽  
Arteriovenous Malformations ◽  
Superior Sagittal Sinus ◽  
Cerebral Arteriovenous Malformations ◽  
Sagittal Sinus

Endoarterial Management of Dural Arteriovenous Malformations with Isolated Sinus Using Onyx-18: Technical Case Report

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONSE293-ONSE294 ◽  
Author(s):  
César de Paula Lucas ◽  
Charbel Mounayer ◽  
Laurent Spelle ◽  
Michel Piotin ◽  
Marco T. Rezende ◽  
...  
Keyword(s):  
Clinical Cure ◽  
Arteriovenous Malformations ◽  
Superior Sagittal Sinus ◽  
Transarterial Embolization ◽  
Sigmoid Sinus ◽  
Embolic Agent ◽  
Ethylene Vinyl Alcohol ◽  
Sagittal Sinus ◽  
Surgical Exposure ◽  
Meningeal Artery

Abstract Objective: Anatomic and clinical cure of dural arteriovenous malformations (DAVM) with isolated sinus is difficult to achieve by endovascular means without previous surgical exposure. We propose a new management technique using a new liquid embolic agent (ethylene-vinyl alcohol copolymer [Onyx-18]; ev3 Inc., Plymouth, MN) via an endoarterial approach that would avoid surgical craniotomy. Background: Data of three consecutive patients with a DAVM with isolated sinus treated at our department between January 2005 and June 2005 are described. Procedures performed under general anesthesia consist of an arterial approach whereby a microcatheter is navigated via a meningeal feeder to the DAVM. Onyx-18, which diffuses under aqueous conditions, is then delivered, mechanically filling the isolated sinus and ultimately treating it. Results: The patients included two men and one woman aged 69, 71, and 64 years, respectively. All patients were classified as Merland Type IV. Two patients presented with DAVMs involving the transverse-sigmoid sinus, and one patient presented with a DAVM involving the superior sagittal sinus with an isolated venous collector. All three fistulae were treated with transarterial embolization, using Onyx-18, through the filling of the pathological sinus via the anterior meningeal artery branch of the ophthalmic artery (DAVM at the superior sagittal sinus), and the other two patients were treated by means of the petrosquamous branch of the middle meningeal artery (DAVM at the transverse-sigmoid sinus). Postoperative digital subtraction angiography confirmed the elimination of the DAVMs in all three patients. The follow-up study ranging from 3 to 12 months (average, 7.5 mo) revealed no recurrence, and all of the patients had clinical improvement and recovered to their full activities. Conclusion: DAVMs with isolated sinus and retrograde venous drainage to the cortical system are aggressive vascular lesions that can be treated by transarterial embolization using Onyx-18. This procedure allowed us to achieve an anatomic and clinical cure in the three patients consecutively treated without the need for surgical exposure of the compromised sinus.

Interhemispheric Approaches to Arteriovenous Malformations: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (5) ◽  
pp. 637-637
Author(s):  
Vijay Agarwal ◽  
Daniel L Barrow
Keyword(s):  
Cerebral Artery ◽  
Arteriovenous Malformations ◽  
Anterior Cerebral Artery ◽  
Superior Sagittal Sinus ◽  
Venous Drainage ◽  
Sagittal Sinus ◽  
Complete Obliteration ◽  
Future Risk ◽  
Risk Of Hemorrhage ◽  
Neurologically Intact

Abstract We present 2 illustrative cases of interhemispheric approaches to right sided arteriovenous malformations (AVMs). The first patient is a healthy 54-yr-old female who presented with left-sided hearing loss and pulsatile tinnitus, and was neurologically intact. Imaging demonstrated a right sided interhemispheric AVM, fed by the anterior cerebral artery with superficial venous drainage to the superior sagittal sinus. The AVM was thought to be asymptomatic and the patient chose to have her AVM treated surgically to eliminate future risk of hemorrhage. We elected to approach this lesion via a contralateral interhemispheric approach to avoid retraction of the right hemisphere. Intraoperative angiogram demonstrated complete obliteration of the malformation and the patient was neurologically intact postoperatively. The second patient is a 41-yr-old healthy male who presented with progressive bifrontal headaches and was also neurologically intact. Imaging revealed a right interhemispheric AVM fed by the anterior cerebral artery and with superficial venous drainage to the superior sagittal sinus. Although the patient's headaches may have been related, the patient's decision to undergo surgical resection was primarily to eliminate future risk of hemorrhage. The difference with this patient was that imaging revealed the presence of two draining veins on the left side that would potentially be injured via a contralateral approach. As a result, we elected to approach this lesion ipsilaterally. Intraoperative angiogram showed complete obliteration of the malformation with intact venous drainage, and the patient was neurologically intact postoperatively. Contralateral vs ipsilateral interhemispheric approaches are compared and contrasted.

Superior sagittal sinus thrombosis induced by thyrotoxicosis

2001 ◽  
Vol 94 (1) ◽  
pp. 130-132 ◽  
Author(s):  
Cheng-Shyuan Rau ◽  
Chun-Chung Lui ◽  
Cheng-Loong Liang ◽  
Han-Jung Chen ◽  
Yeh-Lin Kuo ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Venous Blood ◽  
Fibrinogen Concentration ◽  
Venous Blood Flow ◽  
Content Type ◽  
Sagittal Sinus ◽  
Low Protein ◽  
Diffuse Goiter

✓ There is a wide variety of disorders associated with thrombosis of the superior sagittal sinus (SSS), including infectious disease, noninfectious conditions such as vasculitis and hypercoagulable states, and complications arising from pregnancy or use of oral contraceptive medications. Despite these well-defined associations, approximately 25% of the cases remain idiopathic. In this article the authors describe a patient who was found to have SSS thrombosis while experiencing a thyrotoxic phase of Graves disease. The patient presented with intracerebral hemorrhage, subarachnoid hemorrhage, seizure, coma, a raised fibrinogen concentration, low protein C activity, and atrial fibrillations. Thrombolysis was successfully performed despite the coexistence of thrombosis and intracranial hemorrhage. Patients with thyrotoxicosis and a diffuse goiter may be predisposed to the development of SSS thrombosis, as a result of hypercoagulation and stasis of local venous blood flow. In the present case, a patient in whom thrombosis coexisted with intracranial hemorrhage was successfully treated using thrombolytic therapy.

scholarly journals Dural Arteriovenous Fistula within Superior Sagittal Sinus Wall with Direct Cortical Venous Drainage: A Systematic Literature Review

2021 ◽  
Author(s):  
Rajendra Chavan ◽  
Shreya Sethi ◽  
Harsha Sahu ◽  
Neeraj Rao ◽  
Shivani Agarwal
Keyword(s):  
Literature Review ◽  
Treatment Option ◽  
Systematic Literature Review ◽  
Superior Sagittal Sinus ◽  
English Literature ◽  
Venous Drainage ◽  
Sagittal Sinus ◽  
Complete Obliteration ◽  
Cortical Venous Drainage ◽  
Special Subgroup

AbstractDural arteriovenous fistulas (DAVFs) located within superior sagittal sinus (SSS) wall with direct cortical venous drainage are rare. They are also known as variant DAVF (vDAVF) and form a special subgroup of DAVFs. Their chance of presenting with aggressive features is high compared with transverse sigmoid sinus fistula. They drain directly into cortical veins (Borden type 3, Cognard type III and IV). A systematic English literature review of SSS vDAVF was made. Systematic literature review revealed a total of 31 published cases. These were commonly seen in male population, (24 males, 77.41%, 24/31). Average age of patients was 54 years. A total of 24 patients (77.41%, 24/31) had aggressive clinical presentations with 13 patients (41.93%, 13/31) having intracranial hemorrhages (ICH). Two patients had rebleeding (15.38%, 2/13). Middle portion of SSS was commonly involved (15 cases, 75%). A total of 25 (96.15%, 25/26) cases had patent SSS. Most of the fistulas were idiopathic (65.38%, 17/26), with trauma being a frequent etiological factor (26.92%, 7/26). Venous ectasia was seen in 19 patients (59.37%, 19/32). Middle meningeal arterial (MMA) supply was seen in all patients (100%, 26/26), with bilateral MMA supply in 21 cases (80.76%), and unilateral in 5 cases (19.23%). Twenty patients (62.50%, 20/32) received only endovascular treatment (EVT), while four patients had EVT followed by surgery (12.5%, 4/32). Transarterial route via MMA was the preferred treatment option (79.16%). Complete obliteration of fistulas was noted in all cases (100%, 30/30). No immediate complication was noted after EVT. As much as 92.30% patients showed good recovery. Thus, SSS vDAVF forms a special subgroup of DAVF, with aggressive presentation, and warrants urgent treatment. EVT is effective treatment option and can produce complete obliteration.

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