High flow arteriovenous malformation with transverse-sigmoid sinus stenosis and congestive venopathy mimicking DAVF

AbstractCongenital arteriovenous malformations are rare causes of congestive cardiac failure in neonates. The most common sites are in the head and liver, but other sites include the thorax, the abdomen and the limbs. The onset of failure is usually not in the immediate neonatal period, but later on in life, albeit that lesions such as the arteriovenous malformation of the vein of Galen, and other arteriovenous malformations in different locations which produce high flow can present early. We describe here the first case, to the best of our knowledge, of prenatal detection of an intrathoracic arteriovenous malformation producing neonatal cardiac failure, which was successfully treated by surgery postnatally.

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Abstract 1122‐000232: The Importance of Performing Venous Pressure Measurements Following Venous Sinus Stenting for Idiopathic Intracranial Hypertension

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000232 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Yazan Radaideh

Keyword(s):

Pressure Gradient ◽

Intracranial Hypertension ◽

Stent Placement ◽

Idiopathic Intracranial Hypertension ◽

Venous Pressure ◽

Sigmoid Sinus ◽

Venous Sinus ◽

Pressure Measurements ◽

Sinus Stenosis ◽

The Right

Introduction : Although venous sinus stenting is an established treatment for medically refractory idiopathic intracranial hypertension, a subset of patients shows little or no improvement of symptoms after stenting. While this could be related to a number of factors, failure to sufficiently address the pressure gradient is one that can be recognized during the treatment procedure. We describe two patients who had a persistent venous pressure gradient after stent placement. Once identified, a second stent was placed with subsequent resolution of the pressure gradient. Methods : This retrospective chart review identified patients at a single institution who underwent venous sinus stenting and required immediate placement of a second venous sinus stent for a persistent pressure gradient. Results : Two patients with refractory idiopathic intracranial hypertension underwent cerebral angiography with venous manometry. In the first patient, unilateral venous sinus stenosis was present with a maximum pressure of 50 mmHg, which only decreased to 30 mmHg after placement of a right transverse‐sigmoid sinus stent. Subsequent manometry revealed a persistent gradient between the superior sagittal sinus and the right transverse sinus, which resolved after placement of a second stent in this location. In the second patient, bilateral stenosis was observed at the transverse‐sigmoid sinus junction; the maximum venous pressure was 40 mmHg, and a gradient of 30 mmHg was measured at the right transverse‐sigmoid junction, where a venous sinus stent was placed. Venous sinus pressure measurements performed immediately after the stent placement demonstrated a persistent pressure gradient of 20 mmHg in the contralateral transverse‐sigmoid sinus junction, which resolved after contralateral stent placement. Both patients showed sustained improvement in their symptoms at 1 year follow up. Conclusions : In some patients with idiopathic intracranial hypertension and venous sinus stenosis, a single stent may not sufficiently reduce the pressure gradient. A second stent may be required; however, this is only detectable with post‐stent pressure measurements. Performing manometry after stent placement should be routinely performed in order to detect persistent venous pressure gradient.

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Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_13_18 ◽

2018 ◽

Vol 51 (02) ◽

pp. 222-230

Author(s):

Parvathi Ravula ◽

Srikanth Rangachari ◽

Rammurti Susarla ◽

Laxman Sambari ◽

Srinivas Saraswathi Jammula

Keyword(s):

Arteriovenous Malformation ◽

Curative Resection ◽

High Flow ◽

External Carotid ◽

Primary Reconstruction ◽

Free Fibula Flap ◽

Definitive Therapy ◽

Free Fibula ◽

Life Threatening ◽

Selective Embolisation

ABSTRACT Background: High flow arteriovenous malformation (AVM) of the mandible is rare, but it can present as a life-threatening emergency with severe intraoral bleeding for the first time. The gold standard of treatment for an AVM of the mandible is selective embolisation combined with resection and subsequent reconstructions. With the advent of advanced multidisciplinary techniques aimed at definitive therapy, surgical resection and primary reconstruction can provide an ideal anatomical and functional cure. There are no previous reports on primary resection and reconstruction for life-threatening haemorrhage from high flow AVM of the mandible. Aim: We discuss our approach aimed at definitive therapy in life-threatening intraoral bleeding from large high flow AVM of the mandible. Subjects and Methods: Four patients were managed for life-threatening intraoral bleeding during 2015–2017. Compression was applied over the bleeding point before the airway could be secured by endotracheal tube. Under general anaesthesia, the external carotid artery (ECA) was temporarily occluded using an umbilical tape loop ligature to control the bleeding. Emergency selective embolisation was done, followed by curative resection and primary mandible reconstruction using free fibula flap. Outcome assessed. Results: Temporary occlusion of the ECA successfully controlled the bleeding immediately and facilitated selective embolisation and definitive therapy. All the four cases were successfully reconstructed with a good outcome. There was no recurrence during the follow-up period. Conclusion: In life-threatening intraoral bleeding from large high flow AVM of the mandible, emergency selective embolisation followed by curative resection and primary reconstruction is safe in achieving an ideal cure.

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Sigmoid Sinus Patency following Vestibular Schwannoma Resection via Retrosigmoid versus Translabyrinthine Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1713773 ◽

2020 ◽

Author(s):

Andrea Ziegler ◽

Nadeem El-Kouri ◽

Zaneta Dymon ◽

David Serrano ◽

Mariah Bashir ◽

...

Keyword(s):

Acoustic Neuroma ◽

Treatment Options ◽

Middle Cranial Fossa ◽

Sigmoid Sinus ◽

Surgical Approaches ◽

Stereotactic Radiation ◽

Acoustic Neuromas ◽

Significant Difference ◽

Sinus Stenosis ◽

Dural Venous Sinus

Abstract Introduction The treatment options for acoustic neuromas are observation with serial imaging, stereotactic radiation, or surgical resection. The most common surgical approaches are the translabyrinthine (TL), the retrosigmoid (RS), and the middle cranial fossa. During the TL approach the sigmoid sinus is decompressed with bipolar cautery to allow greater medial exposure. It is unknown if this causes any long-term narrowing or thrombus of the sigmoid sinus. Methods We performed a retrospective review of patients who underwent acoustic neuroma resection to determine if patients undergoing a TL approach for acoustic neuroma resection develop radiographic evidence of sigmoid sinus stenosis or thrombosis compared with patients undergoing a RS approach. Results A total of 128 patients were included in this study, 56 patients underwent a TL approach and 72 patients underwent a RS approach. We compared the preoperative and postoperative diameter of the ipsilateral and contralateral sigmoid sinus at proximal, midpoint, and distal locations on magnetic resonance imaging examinations. There was no significant difference between the preoperative and postoperative diameter of the ipsilateral or contralateral sigmoid sinus based on surgical approach. Conclusion Decompression of the sigmoid sinus during the TL approach does not have a significant postoperative effect on the dural venous sinus patency.

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Pattern and severity of transverse sinus stenosis in patients with pulsatile tinnitus associated with sigmoid sinus wall anomalies

The Laryngoscope ◽

10.1002/lary.28168 ◽

2020 ◽

Vol 130 (4) ◽

pp. 1028-1033 ◽

Cited By ~ 4

Author(s):

Daniel Hewes ◽

Robert Morales ◽

Prashant Raghavan ◽

David J. Eisenman

Keyword(s):

Transverse Sinus ◽

Sigmoid Sinus ◽

Pulsatile Tinnitus ◽

Sinus Wall ◽

Sinus Stenosis

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Quantifying the Cerebral Hemodynamics of Dural Arteriovenous Fistula in Transverse Sigmoid Sinus Complicated by Sinus Stenosis: A Retrospective Cohort Study

American Journal of Neuroradiology ◽

10.3174/ajnr.a4960 ◽

2016 ◽

Vol 38 (1) ◽

pp. 132-138 ◽

Cited By ~ 8

Author(s):

W.-Y. Guo ◽

C.-C.J. Lee ◽

C.-J. Lin ◽

H.-C. Yang ◽

H.-M. Wu ◽

...

Keyword(s):

Cohort Study ◽

Arteriovenous Fistula ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Dural Arteriovenous Fistula ◽

Cerebral Hemodynamics ◽

Sigmoid Sinus ◽

Sinus Stenosis

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Dual Pathologies: Pial Arteriovenous Fistula in Combination with an Arteriovenous Malformation

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1698398 ◽

2020 ◽

Vol 81 (02) ◽

pp. 185-187

Author(s):

Gianpaolo Jannelli ◽

Holger Joswig ◽

Gianmarco Bernava ◽

Torstein R. Meling ◽

Philippe Bijlenga

Keyword(s):

Arteriovenous Malformation ◽

Arteriovenous Fistula ◽

Operating Room ◽

Preoperative Planning ◽

Structural Characteristics ◽

Sigmoid Sinus ◽

Direct Connection ◽

Digital Subtraction ◽

Hybrid Operating Room ◽

Pial Arteriovenous Fistula

Abstract Background A pial arteriovenous fistula (PAVF) is a rare neurovascular pathology consisting of a direct connection between one or more arterial feeders and a single venous channel. A PAVF was previously considered a subtype of an arteriovenous malformation (AVM). In the current literature these are distinguished as two independent entities with different clinical, physiopathologic, and structural characteristics. We report a case of a surgically treated 37-year-old woman with an extremely rare combination of an unruptured PAVF and AVM. Patient The AVM was mainly supplied by feeders of the middle cerebral artery and drained into the sigmoid sinus via an abnormally dilated and tortuous vein. Following its resection, intraoperative digital subtraction angiography (DSA) in the hybrid operating room revealed the presence of a PAVF that had not been noted during the preoperative planning. Hence the PAVF was completely disconnected as confirmed by DSA again. Conclusion This is the second reported case of an AVM-associated PAVF. Without the intraoperative DSA in the hybrid operating room, this unusual complex cerebrovascular entity would likely have been missed.

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