Diagnostic Accuracy of SWAN in the Diagnosis of Low-Flow Brain Vascular Malformations in Childhood

2021 ◽  
Author(s):  
Nazlı Gülsüm Akyel ◽  
Ayşe Gül Alımlı ◽  
Mesut Sivri ◽  
Havva Akmaz Ünlü ◽  
Mehmet Tiftik
Keyword(s):  
Diagnostic Accuracy ◽  
Vascular Malformations ◽  
False Negative ◽  
Vascular Anomaly ◽  
Low Flow ◽  
Developmental Venous Anomaly ◽  
Cavernous Malformations ◽  
Capillary Telangiectasia ◽  
Cerebral Vascular Malformations ◽  
Cerebral Vascular

Abstract Purpose The main objective of this study is to demonstrate the diagnostic accuracy of susceptibility-weighted angiography (SWAN) in the diagnosis of slow-flow cerebral vascular malformations, especially developmental venous anomaly (DVA). We also aimed to determine the prevalence of DVAs identified by SWAN at 1.5 T. Methods We retrospectively evaluated 1,760 axial SWAN images for the diagnosis of low-flow vascular anomaly. Among them were 305 patients who underwent contrast-enhanced examination due to different indications. Postcontrast images were analyzed by different radiologists who were blinded to patients. The presence of DVA and other features such as location, length, depth, and direction of drainage vein was evaluated. Results Twenty-six patients with DVA had both SWAN and postcontrast images. There were four false-negative patients with SWAN. The sensitivity of the SWAN sequence was 84.6%. In addition, totally 77 DVA (4.36%), 2 capillary telangiectasia (0.11%), and 2 cavernous malformations (0.11%) were detected in 1,760 patients. Conclusion SWAN is an effective method for the diagnosis of developmental venous anomalies and other low-flow cerebral vascular malformations. Especially in the pediatric age, susceptibility-weighted imaging sequences are useful to limit contrast use.

Unexpected Binding of Tozuleristide “Tumor Paint” to Cerebral Vascular Malformations: A Potentially Novel Application of Fluorescence-Guided Surgery

Neurosurgery ◽  
2021 ◽  
Author(s):  
Andrew J Kobets ◽  
David Nauen ◽  
Amy Lee ◽  
Alan R Cohen
Keyword(s):  
Near Infrared ◽  
Vascular Malformations ◽  
Cns Tumors ◽  
Matrix Metalloproteinase 2 ◽  
Cerebrovascular Lesions ◽  
Cavernous Malformations ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
Cerebral Vascular Malformations ◽  
Cerebral Vascular

Abstract BACKGROUND Fluorescence-guided surgery (FGS) is under investigation as a means to improve the extent of resection for primary central nervous system (CNS) tumors. Tozuleristide, known also as “Tumor Paint,” is an investigational tumor-targeting agent covalently conjugated to a derivative of the fluorescent dye indocyanine green. OBJECTIVE To report the finding of avid intraoperative fluorescence of tozuleristide on cerebral vascular malformations. METHODS Our institution is participating in a phase 2/3 study of intraoperative near-infrared fluorescence detection of pediatric primary CNS tumors in patients receiving intravenous tozuleristide and imaged with the Canvas system. Our site enrolled 2 patients with intracranial lesions, suspected preoperatively of possibly being gliomas that proved to be cavernous vascular malformations after resection. RESULTS Each lesion had a dark blue mulberry appearance and each fluoresced avidly with tozuleristide. Each was completely resected, and the patients recovered without deficit. Pathological assessment showed cavernous angioma for both cases. Tozuleristide fluorescence is postulated to result from binding to matrix metalloproteinase-2 and annexin A2, and literature review demonstrates expression of both these ligands on multiple cerebrovascular lesions, including cavernous malformations. CONCLUSION This finding deserves further investigation to determine if tozuleristide “Tumor Paint” may have a wider role in the identification of non-neoplastic intracranial pathologies.

The Juxtaposition of a Capillary Telangiectasia, Cavernous Malformation, and Developmental Venous Anomaly in the Brainstem of a Single Patient: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1246-1250 ◽  
Author(s):  
Richard E. Clatterbuck ◽  
İlhan Elmacı ◽  
Daniele Rigamonti
Keyword(s):  
Cavernous Malformation ◽  
Vascular Malformations ◽  
Magnetic Resonance Imaging Examination ◽  
Developmental Venous Anomaly ◽  
Venous Malformations ◽  
Venous Anomaly ◽  
Single Patient ◽  
Cavernous Malformations ◽  
Swallowing Problems ◽  
Capillary Telangiectasia

ABSTRACT OBJECTIVE AND IMPORTANCE Capillary telangiectasias, cavernous malformations, and developmental venous anomalies are all vascular malformations that occur on the capillary-venous side of the cerebral circulation. The associations of capillary telangiectasias with venous malformations, cavernous malformations with venous malformations, and capillary telangiectasias with cavernous malformations have all been described; however, the association of all three lesions in a single patient is extremely rare. CLINICAL PRESENTATION A 52 year-old Caucasian woman presented to our clinic with an extended history of confusion, distorted visual perceptions, photophobia, neck pain, swallowing problems, and poor balance. The patient's examination was remarkable for difficulty concentrating, mild rotatory nystagmus, subtle decreased sensation over the left side of the face and body, and brisk reflexes. Review of the patient's magnetic resonance imaging examination demonstrated a cavernous malformation, a capillary telangiectasia, and a developmental venous anomaly located adjacent to one another in the brainstem. INTERVENTION Given the patient's complex constellation of symptoms and relatively mild neurological findings, it was difficult to ascribe any one of them to a specific vascular malformation. Conservative management of this patient's vascular malformations was decided upon. CONCLUSION Juxtaposition of these three different vascular lesions in the brainstem of an otherwise normal individual suggests a relationship among them. Although there are several theories that link similar associations through physiological mechanisms such as venous hypertension, we propose that a developmental event disrupting local capillary-venous pattern formation is a plausible alternative.

Neurosurgical Issues in Pregnancy

2017 ◽  
Vol 37 (06) ◽  
pp. 689-693 ◽  
Author(s):  
Anil Can ◽  
Rose Du
Keyword(s):  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Vascular Malformations ◽  
Significant Risk ◽  
Unborn Child ◽  
Cavernous Malformations ◽  
Life Threatening ◽  
Ruptured Intracranial Aneurysms ◽  
Cerebral Vascular Malformations ◽  
Cerebral Vascular

AbstractAlthough rare, intracranial hemorrhage due to rupture of cerebral vascular malformations or intracranial aneurysms during pregnancy is a potentially devastating and life-threatening disorder, posing a diagnostic and therapeutic challenge to a multidisciplinary team of neurosurgeons, neurologists, obstetricians, and anesthesiologists. Despite the significant risk of morbidity and mortality affecting both the mother and the unborn child, knowledge of the natural history, epidemiology, and appropriate management of cerebral vascular malformations and intracranial aneurysms in pregnant women is limited. Although emergent neurosurgical concerns usually outweigh obstetric considerations, and treatment of these disorders is generally similar in pregnant and nonpregnant women, any necessary and feasible modifications to protect the unborn child should be made. This article reviews the management of ruptured intracranial aneurysms and cerebral vascular malformations, including arteriovenous malformations, cavernous malformations, and moyamoya disease, in women during pregnancy, partus, and puerperium.

Cerebral vascular malformations in hereditary hemorrhagic telangiectasia

2014 ◽  
Vol 120 (1) ◽  
pp. 87-92 ◽  
Author(s):  
M. Neil Woodall ◽  
Melissa McGettigan ◽  
Ramon Figueroa ◽  
James R. Gossage ◽  
Cargill H. Alleyne
Keyword(s):  
Hereditary Hemorrhagic Telangiectasia ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Cerebral Aneurysms ◽  
Developmental Venous Anomalies ◽  
Capillary Telangiectasia ◽  
The Brain ◽  
Single Modality ◽  
Cerebral Vascular Malformations ◽  
Cerebral Vascular

Object Hereditary hemorrhagic telangiectasia (HHT) is a hereditary disorder characterized by mucocutaneous telangiectasias, frequent nosebleeds, and visceral arteriovenous malformations (AVMs). Few reports have outlined the prevalence of the various cerebral vascular malformations found in patients with HHT. The authors set out to define the prevalence of cerebral vascular malformations in a population of HHT patients who underwent imaging with 3-T imaging (MRI/MR angiography [MRA]) of the brain. Methods A retrospective review of prospectively collected data was carried out using a database of 372 HHT patients who were seen and examined at the Georgia Regents University HHT Center and screened with 3-T MRI/MRA. Data were tabulated for numbers and types of vascular malformations in this population. Results Arteriovenous malformations were identified in 7.7%, developmental venous anomalies in 4.3%, and cerebral aneurysms in 2.4% of HHT patients. The HHT AVMs tended to be supratentorial, small, and cortical in this series, findings consistent with other recent studies in the literature. An arteriovenous fistula, cavernous malformation, and capillary telangiectasia were identified in 0.5%, 1%, and 1.9% of HHT patients, respectively. Conclusions Few studies have investigated the prevalence of the various vascular malformations found in HHT patients screened with 3-T MRI/MRA of the brain. Hereditary hemorrhagic telangiectasia AVMs are more likely to be multiple and have a tendency toward small size and cortical location. As such, they are often treated using a single-modality therapy.

scholarly journals Functional and topographical considerations in the surgical management of cerebral vascular malformations

2000 ◽  
Vol 2 (3) ◽  
pp. 321-330
Keyword(s):  
Magnetic Resonance ◽  
Vascular Malformations ◽  
Venous Drainage ◽  
Preoperative Embolization ◽  
Surgical Morbidity ◽  
Conventional Angiography ◽  
Cavernous Malformations ◽  
Positron Emission ◽  
Cerebral Vascular Malformations ◽  
Cerebral Vascular

Cerebral vascular malformations with potential surgical consequences mainly consist of arteriovenous malformations (AVM) and cavernous malformations. The standard preoperative workup of these lesions includes basic neuroradiological investigation, such as computed tomography, magnetic resonance imaging (MRI), and magnetic resonance angiography, and conventional angiography, to assess the exact neurotopographical relationships of the nidus, arterial feeding pedicles, and venous drainage. In cases where lesions are located near or within eloquent areas, precise documentation of the anatomy can be obtained using various functional tests including functional MRI, activated positron emission tomoqraphy, and magnetoencephalography (MEG), which may then be integrated into a neuronavigational system allowing for selective, image-guided surgery, thus potentially reducing surgical morbidity. Preoperative embolization may in certain cases improve the surqical excision by reducinq blood flow throuqh the AVM. Cavernous malformations may also be removed with minimally invasive and highly selective techniques.

Cavernomata and angiographically occult lesions

2019 ◽  
pp. 651-658
Author(s):  
Hiren Patel ◽  
Janneke van Beijnum
Keyword(s):  
Vascular Malformations ◽  
Genetic Disorder ◽  
Positive Family History ◽  
Intractable Epilepsy ◽  
Venous Drainage ◽  
Mass Effect ◽  
Developmental Venous Anomaly ◽  
Cavernous Malformations ◽  
Capillary Telangiectasia

Cerebral cavernous malformations (CCMs), known in addition as cavernomata or cavernous (haem)angiomata, are vascular malformations consisting of abnormally enlarged capillary cavities without intervening parenchyma (see section on capillary telangiectasia, this chapter) or arterial feeders with venous drainage (see arteriovenous malformations, Chapter 50). About 10–20% of CCMs are associated with a developmental venous anomaly (DVA), which is an extreme variation of the normal venous anatomy. CCMs can occur as result of an underlying genetic disorder, and genetic analysis is recommended in patients with a positive family history or multiple lesions. A conservative approach for asymptomatic CCMs seems justified in the large majority of cases and follow-up imaging is only needed if patients become symptomatic. Indications for surgical treatment are multiples haemorrhages, CCMs with mass effect causing symptoms, and patients with intractable epilepsy with an identified epileptogenic focus. Stereotactic radiosurgery can be considered in exceptional cases with a very high surgical risk.

scholarly journals Developmental Venous Anomaly with Adjacent Parenchymal Abnormality Masquerading as Glioma-A Unique Case Report

2021 ◽  
pp. 1-9
Author(s):  
Amna Alvi ◽  
Rabail Raza ◽  
Fatima Mubarak ◽  
Asma Alvi
Keyword(s):  
Vascular Malformations ◽  
Common Type ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Invasive Procedures ◽  
Unique Case ◽  
Cavernous Malformations ◽  
Underlying Pathophysiology ◽  
Cerebral Vascular Malformations ◽  
Parenchymal Abnormality

Developmental venous anomaly (DVA)/ Cerebral Venous Angioma is the most common type of cerebral vascular malformations, mostly an incidental benign finding. But there are documented associated complications like parenchymal signal abnormalities, thrombosis, cavernous malformations and parenchymal atrophy. In this report, we present a unique case of cerebral DVA with cortical changes mimicking the Glioma. Altered haemodynamics in DVA is the underlying pathophysiology for these changes. Correct MRI interpretation, by an expert neuroradiologist, can establish the diagnosis of DVA and its related changes. Therefore, it can reduce the morbidity and mortality by preventing the unnecessary invasive procedures like biopsy for diagnosis.

Cavernous Malformations and Capillary Telangiectasia: A Spectrum within a Single Pathological Entity

Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Daniele Rigamonti ◽  
Peter C. Johnson ◽  
Robert F. Spetzler ◽  
Mark N. Hadley ◽  
Burton P. Drayer
Keyword(s):  
Vascular Malformation ◽  
Vascular Malformations ◽  
Convincing Evidence ◽  
Cavernous Malformations ◽  
Multiple Lesions ◽  
Autopsy Data ◽  
Cerebral Capillary ◽  
Transitional Forms ◽  
Capillary Telangiectasia ◽  
Cerebral Vascular Malformations

Abstract Cerebral vascular malformations have traditionally been divided into four categories: arteriovenous, venous, cavernous, and capillary telangiectases. A controversy exists about separating the latter two lesions into separate entities. Critics claim the distinction is arbitrary but have been unable to present convincing evidence linking the two types of lesions. We have reviewed the histories of 20 patients with cavernous malformations and have analyzed the clinical, radiographic, and surgical-autopsy data associated with these lesions. In some patients, multiple lesions, including cavernous malformations, capillary telangiectases, and transitional forms between the two, were identified. Based on this analysis, we conclude that capillary telangiectasia and cavernous malformations represent two pathological extremes within the same vascular malformation category and propose grouping them as a single cerebral entity called cerebral capillary malformations.

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