Treatment Strategy of a Patient With a Brain Arteriovenous Malformation and Cranial Dural Fistula: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (5) ◽  
pp. 636-636 ◽  
Author(s):  
Mithun G Sattur ◽  
Karl R Abi-Aad ◽  
Fucheng Tian ◽  
Matthew E Welz ◽  
Barrett Anderies ◽  
...  
Keyword(s):  
Informed Consent ◽  
Arteriovenous Malformation ◽  
Vascular Malformations ◽  
High Grade ◽  
Venous Reflux ◽  
Dural Fistula ◽  
Cortical Venous Reflux ◽  
Intraoperative Planning ◽  
The Right ◽  
Angiographic Result

Abstract We present the case of a 56-yr-old right-handed male, after informed consent was obtained, who presented with acute confusion and agitation, on the background of a remote history of an uncomplicated resection of a left parietal grade 2 glioma. Imaging revealed a large, acute right temporal intracerebral hemorrhage (ICH). Standard vascular workup for the cause of the ICH included catheter angiography. No direct cause of the hemorrhage was revealed; however, a high grade parasagittal dural arteriovenous fistula (DAVF) with cortical venous reflux was noted close to the prior craniotomy site. The venous reflux was towards the left hemisphere, but it was hypothesized that similar reflux on the right side may have been present and was not presently evident due to thrombosis. The DAVF was embolized by endovascular means, followed by evacuation of the hematoma. Follow-up angiogram 7 mo later revealed a high-flow, right superior temporal cortical arteriovenous malformation (AVM). The DAVF unfortunately had also progressed. Endovascular occlusion of both lesions was attempted but was not successful. Subsequently, microsurgical resection for both the vascular malformations was performed with careful pre- and intraoperative planning to obtain a successful clinical and angiographic result. In this video, we summarize diagnostic and therapeutic nuances that have broad implications for the workup of ICH and the strategic management of a unique scenario involving a brain AVM and high-grade cranial dural fistula in the same patient. Prior to each procedure, informed consent was obtained from the patient, which includes consent for publication.

Surgical Disconnection of the Cortical Venous Reflux for High-Grade Intracranial Dural Arteriovenous Fistulas

2015 ◽  
Vol 83 (4) ◽  
pp. 652-656 ◽  
Author(s):  
Rafid Al-Mahfoudh ◽  
Ramez Kirollos ◽  
Paul Mitchell ◽  
Maggie Lee ◽  
Hans Nahser ◽  
...  
Keyword(s):  
High Grade ◽  
Venous Reflux ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Reflux

Benign astrocytoma associated with arteriovenous malformation

1971 ◽  
Vol 35 (2) ◽  
pp. 229-233 ◽  
Author(s):  
Reid R. Heffner ◽  
Robert S. Porro ◽  
Michael D. F. Deck
Keyword(s):  
Nervous System ◽  
Arteriovenous Malformation ◽  
Frontal Lobe ◽  
Vascular Malformations ◽  
Pathological Features ◽  
Primary Tumors ◽  
Content Type ◽  
Multiple Primary ◽  
The Right ◽  
Fine Print

✓ An arteriovenous malformation associated with an underlying benign astrocytoma of the right frontal lobe is reported and the radiological and pathological features discussed. Previous reports of multiple primary tumors of the nervous system are reviewed and the few cases of vascular malformations associated with gliomas noted.

Multiple spinal and cranial dural arteriovenous fistulas

2011 ◽  
Vol 15 (1) ◽  
pp. 113-116 ◽  
Author(s):  
Jai Jai Shiva Shankar ◽  
Timo Krings ◽  
Keyword(s):  
Superior Sagittal Sinus ◽  
Anterior Part ◽  
Posterior Part ◽  
Transverse Sinus ◽  
Venous Reflux ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Reflux ◽  
The Right

Synchronous multiplicity of cranial and spinal dural arteriovenous fistulas (DAVFs) is known but uncommon. The authors report on a patient with the unusual finding of multiple cranial and multiple separate spinal DAVFs. The patient initially presented with vague visual symptoms in 2004. A cranial DAVF was identified along the left transverse sinus with cortical venous reflux and another DAVF was identified along the posterior part of the superior sagittal sinus with no cortical venous reflux. The first DAVF was treated both endovascularly and surgically and the second was left untreated. The follow-up angiogram showed multiple spinal DAVFs at the levels of C-1, C-2, and C-6 on the left side and at the C-3 level on the right side along with another cranial DAVF along the anterior part of the superior sagittal sinus with cortical venous reflux. A retrospective analysis of the digital subtraction angiogram and MR images suggested that the cervical spinal DAVFs were already present in 2004 (6 years previously). Multiple DAVFs, although rare, do exist and it is important to look for any evidence of their presence when evaluating patients with symptoms suggestive of arteriovenous fistulas.

A Challenging Case of A Myeloid Sarcoma Misdiagnosed as High Grade B-Cell Lymphoma

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S97-S97
Author(s):  
A Herrmann ◽  
B Mai ◽  
S Elzamly ◽  
A Wahed ◽  
A Nguyen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Myeloid Sarcoma ◽  
Proliferation Index ◽  
High Grade ◽  
Cell Markers ◽  
Thoracolumbar Region ◽  
The Right

Abstract Introduction/Objective A 46-year-old female presented with severe back pain associated with progressive bilateral lower extremity weakness and paresthesia, urinary retention, and constipation. Computed tomography revealed a retroperitoneal mass encasing the right psoas muscle, obstructing the right kidney, and extending to the thoracolumbar region resulting in severe spinal compression. An epidural tumor resection was subsequently performed at an outside hospital. Methods Histological sections showed sheets of blastoid neoplastic cells with intermediate to large nuclei, irregular membranes, fine chromatin, and prominent nucleoli. Immunohistochemical stains showed that these cells were positive for CD43, CD79a (weak, focal), BCL2, C-MYC, and PAX5 (weak, focal) and negative for CD10, CD20, CD30, ALK1, BCL6, MUM1, and Tdt. The Ki-67 proliferation index was 75-80%. With this immunophenotype, this patient was diagnosed with a high grade B-cell lymphoma and transferred to our institution for further work-up. On review of the slides, further immunohistochemical testing was requested which revealed positivity for CD117 and myeloperoxidase (MPO). Results The overall morphological and immunophenotypical features are most compatible with myeloid sarcoma (MS) with aberrant expression of B-cell markers and this patient’s diagnosis was amended. Interestingly, the patient’s bone marrow examination only showed 2% myeloblasts with left shifted granulocytosis and concurrent fluorescence in situ hybridization (FISH) studies were negative. Conclusion A literature review showed that 40-50% of MS are misdiagnosed as lymphoma. MS can frequently stain with B-cell or T-cell markers, as seen in this case, which makes it challenging for an accurate diagnosis and sub- classification. In addition, our case is interesting in that there was only extramedullary presentation without bone marrow involvement. Typically, MS develops after the diagnosis of acute myeloid leukemia (AML) with an incidence of 3–5% after AML. It can also manifest de novo in healthy patients, who then go on to develop AML months to years later. Therefore, this patient will require close follow-up.

Informed Consent in the Military: Fighting a Losing Battle Against the Anthrax Vaccine

2002 ◽  
Vol 28 (2-3) ◽  
pp. 325-343
Author(s):  
Ruth K. Miller
Keyword(s):  
Informed Consent ◽  
Service Member ◽  
Individual Choice ◽  
Civilian Life ◽  
Medical Treatments ◽  
Employment History ◽  
Receive Treatment ◽  
The Right ◽  
The Military ◽  
To Receive

In civilian life, an individual has the right to refuse medical treatment in almost any circumstance. While a patient who refuses treatment may face adverse consequences such as prolonged illness, our society recognizes the importance of individual choice in health matters. Members of the military, however, enjoy no such right. Service members are required to submit to certain medical treatments as a part of their employment contract. Refusing such treatments is disobeying an order, and the service member then faces the prospect of a dishonorable or “other than honorable” discharge, and even imprisonment. Disobeying an order to receive treatment can thus result in the equivalent of a felony conviction on the individual's employment history forever.

scholarly journals Esthetic and Functional Improvement of Asymmetric Lower Limb Overgrowth in a Proteus Syndrome Patient: a Combined Surgical Technique

2021 ◽  
Author(s):  
Francesca Riccardi ◽  
Simone Catapano ◽  
Giuseppe Cottone ◽  
Dino Zilio ◽  
Luca Vaienti
Keyword(s):  
Adipose Tissue ◽  
Lower Limb ◽  
Vascular Malformations ◽  
Functional Improvement ◽  
Proteus Syndrome ◽  
Phosphatase And Tensin Homolog ◽  
Tensin Homolog ◽  
Genetic Mosaicism ◽  
Phosphoinositide 3 Kinase ◽  
The Right

AbstractProteus syndrome is a rare, sporadic, congenital syndrome that causes asymmetric and disproportionate overgrowth of limbs, connective tissue nevi, epidermal nevi, alteration of adipose tissue, and vascular malformations. Genetic mosaicism, such as activating mutations involving protein kinase AKT1, phosphoinositide 3 kinase (PI3-K), and phosphatase and tensin homolog (PTEN), may be important causes of Proteus syndrome. However, many patients have no evidence of mutations in these genes. Currently, the diagnosis is clinical and based on phenotypic features. This article reports a case of Proteus syndrome in a 14-year-old female patient who presented with linear epidermal nevi, viscera anomalies, and adipose tissue dysregulation. She showed an asymmetric progressive overgrowth of the right lower limb after birth bringing relevant functional and esthetic consequences. Therefore, she asked a plastic surgery consultation and a surgical treatment with a combined technique was planned. With our approach, we were able to reduce leg diameter and improve joint mobility reliably and safely with satisfying esthetic results.

scholarly journals Spontaneous Thrombosis of an Orbital Arteriovenous Malformation Revealing Hereditary Haemorrhagic Telangiectasia (Rendu-Osler-Weber Disease)

2011 ◽  
Vol 17 (4) ◽  
pp. 466-471 ◽  
Author(s):  
C. Van Went ◽  
A. Ozanne ◽  
G. Saliou ◽  
G. Dethorey ◽  
I. De Monchy ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Arteriovenous Malformation ◽  
Genetic Disorder ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Spontaneous Thrombosis ◽  
Vein Thrombosis ◽  
Recurrent Epistaxis ◽  
The Right ◽  
Central Retinal Vein

Hereditary Haemorrhagic Telangiectasia (HHT) is a genetic disorder responsible for cutaneous or mucosal telangiectasia and arteriovenous malformations (AVMs). The most frequent locations are lung and brain. In contrast, orbital AVMs are very rare. We describe a case of symptomatic orbital arteriovenous malformation due to spontaneous thrombosis. A 65-year-old woman was referred for chronic right eye proptosis associated with dilation of conjunctival vessels with a jellyfish pattern. Right visual acuity was 20/40 and intraocular pressure was 40 mmHg. Personal and familial history of recurrent epistaxis, associated with multiple telangiectasia within lips and palate, led to the diagnosis of HHT. Magnetic resonance imaging (MRI) completed with cerebral angiography found a giant and occluded AVM within the right orbit. Other AVMs were also found in brain and chest, confirming the diagnosis. Antiglaucomatous eyedrops were added to reduce intraocular pressure and a steroid therapy was begun. Two months later, visual acuity decreased in the right eye, due to a central retinal vein thrombosis. In conclusion, Most brain or pulmonary AVM can be treated by embolization. By contrast, this treatment in case of orbital location can lead to central retinal artery and/or central retinal vein occlusion, which may also appear as a spontaneous complication of the orbital AVM. Therapeutic management of orbital AVM is thus not standardized, and the balance between spontaneous and iatrogenic risk of visual loss has to be taken into account.

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