Neonatal giant dural sinus ectasia: a multimodality imaging approach

2021 ◽  
Vol 14 (9) ◽  
pp. e242439
Author(s):  
Ralph Rommualdo Abareta Zuniega ◽  
Julian Alejandro Santos ◽  
Romelito Jose Galvan Galsim ◽  
Jonathan Saputil Elevazo
Keyword(s):  
Multimodality Imaging ◽  
Case Reports ◽  
Case Series ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Cardiac Insufficiency ◽  
Dural Sinus ◽  
Dural Sinuses ◽  
Sagittal Sinus ◽  
Dural Venous Sinus

Dural venous sinus ectasia is a rare anomaly characterised by the formation of a large vascular lake within the leaves of the dural sinuses, usually associated with thrombosis. These lesions can cause brain compression, cardiac insufficiency and disseminated intravascular coagulation, which may lead to poor prognosis. We present the case of a neonate who presented with an intracranial mass on prenatal ultrasound. Postnatal transcranial ultrasonography, cranial CT and cranial MRI demonstrated a large lesion predominantly occupying the dural sinus confluence, extending into the sagittal sinus, straight sinus and right transverse sinus. The left marginal sinus remains unfused and patent. Concomitant arteriovenous malformations were evident in the median interhemispheric fissure and the left Sylvian fissure. There are several published case reports and case series describing malformations of the dural sinuses in perinatal and neonatal patients in recent years, but this case is unique in that: (1) there is the presence of a vascular malformation concomitant to the dural sinus ectasia and (2) it highlights the importance of imaging in clinching the diagnosis of giant dural venous sinus ectasia, as it is often misdiagnosed as more common conditions such as extra-axial intracranial haemorrhage.

Abstract TP329: Venous Collateral Drainage Patterns Predict Clinical Worsening in Dural Venous Sinus Thrombosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sunil A Sheth ◽  
Harry Trieu ◽  
David S Liebeskind ◽  
Jeffrey L Saver ◽  
Viktor Szeder ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Complete Recovery ◽  
Transverse Sinus ◽  
Venous Hypertension ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
Dural Venous Sinus ◽  
Dural Venous Sinus Thrombosis ◽  
Clinical Worsening

Background: Dural venous sinus thrombosis (DVST) is an increasingly recognized cause of a wide array of neurological symptoms, with outcomes that range from complete recovery to death. Approximately 23% of patients with DVST will worsen after initial presentation, as a result of restricted venous outflow and venous hypertension, but early identification of this subset is challenging. A venous collateral scale (VCS) that grades alternative drainage routes may improve prediction of clinical deterioration. Methods: From our institutional database, we identified patients with documented DVST on dedicated venous imaging (MR, CT or catheter angiography) from January 2010 to July 2016. Patients were excluded for thrombosis related to arteriovenous fistulae. The VCS (Table) was created and scores were determined from cerebrovascular venous imaging at presentation by two reviewers blinded to subsequent imaging and clinical data. Results: Among 28 patients that met criteria, median age was 42 (IQR 24-57) and 50% (14/28) were female. Presentation symptoms included intracranial hemorrhage in 40% (11/28) and headache without hemorrhage in 18% (5/28). Transverse sinus occlusion was present in 68% (19/28), and superior sagittal sinus occlusion in 39% (11/28). 82% (23/28) of patients were treated with anticoagulation, and 18% (5/28) with endovascular thrombectomy. New hemorrhage or expansion of initial hemorrhage occurred in 21% (6/28). In-hospital mortality occurred in 18% (5/28). VCS was 0 in 18% (5/28), 1 in 39% (11/28), and 2 in 46% (12/28). Lower VCS was significantly associated with development of new hemorrhage or expansion of initial hemorrhage (62% vs. 0%, VCS 0-1 vs. 2, p<0.01). VCS demonstrated excellent discrimination for in-hospital clinical worsening (C-statistic 0.85). Conclusions: The type and quality of venous collaterals influence outcome in DVST. VCS helps identify patients who are likely to deteriorate and may need additional early interventions.

Management and outcome of spontaneous cerebral venous sinus thrombosis in a 5-year consecutive single-institution cohort

2016 ◽  
Vol 9 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Darrin J Lee ◽  
Arjang Ahmadpour ◽  
Tamar Binyamin ◽  
Brian C Dahlin ◽  
Kiarash Shahlaie ◽  
...  
Keyword(s):  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Anticoagulation Therapy ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Dural Sinus ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
The Impact

BackgroundCerebral venous sinus thrombosis (CVST) is an uncommon form of stroke with a variable presentation, ranging from headaches, to coma and death. Although the American Stroke Association has developed guidelines for the treatment of CVST, data are sparse on the outcome after treatment with anticoagulation, thrombolysis, and thrombectomy.MethodsIn this retrospective review, we describe the 5-year UC Davis experience with spontaneous CVST.ResultsForty-one patients (mean age 37.5±23.1, range 0–96 years; 29 female) were identified with CVST. The majority of cases involved the transverse sinus (75.6%), sigmoid sinus (58.5%), and superior sagittal sinus (29.3%). The most common form of treatment was anticoagulation or antiplatelet therapy (n=35), while six patients were managed by observation alone. The overall 1-year modified Rankin score (mRS) was 1.4±1.5. Male patients and patients with a poor admission mRS had a worse outcome. Outcome was unaffected by hypercoagulable state, number of dural sinuses involved, the presence of intracranial hemorrhage, or seizures. Two patients who underwent anticoagulation therapy also required endovascular thrombectomy; both patients had a 1-year mRS of ≤2. Two patients underwent direct open surgical canalization of the superior sagittal sinus with varying outcomes (mRS 2 vs mRS 6).ConclusionsIn our series, the majority (92.9%) of patients with spontaneous dural sinus thrombosis had a favorable clinical outcome as defined by a mRS ≤2. Further prospective studies are needed to study the impact of anticoagulation on the clinical course of the disease.

scholarly journals Contralateral approach to transverse-sigmoid sinus stenting

2020 ◽  
Vol 26 (5) ◽  
pp. 658-663
Author(s):  
Weston Gordon ◽  
Michael Abraham
Keyword(s):  
Case Series ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Dural Sinus ◽  
Presenting Symptoms ◽  
Antegrade Approach ◽  
Alternative Approach ◽  
Mean Pressure ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

Introduction Endovascular dural venous sinus stenting (DVSS) has emerged as a safe and effective therapy for idiopathic intracranial hypertension (IIH) in patients with transverse-sinus stenosis associated with an elevated mean pressure gradient (MPG). The typical antegrade approach, jugular to sigmoid to transverse, is not always technically feasible due to the degree of stenosis and other anatomic factors. To this point, there has been no reported cases of contralateral DVSS. We describe four cases of DVSS from a contralateral transverse-sigmoid sinus approach. Methods We describe 4 patients presenting with symptoms of IIH between 2019 and 2020 who we treated with contralateral transverse-sigmoid sinus stenting. Cases were reviewed for clinical data including initial presenting symptoms, devices used, other attempted IIH treatments, and follow up symptoms. Results Four female patients were identified and treated under general endotracheal anesthesia. Stenoses measured 72%, 78%, 67%, and 70% with MPGs across the transverse-sigmoid sinus of 19, 16, 9 and 13 mmHg, respectively. Post-stenting MPGs were 1, 0, 1 and 1 mmHg, respectively. Three patients had complete resolution of symptoms and 1 had partial resolution. No complications occurred. Conclusions This case series demonstrates successful transverse-sigmoid sinus stenting from the contralateral dural sinus and provides an alternative approach to DVSS in patients with IIH.

scholarly journals MRV BRAIN NORMALANATOMICAL VARIANTS IN INDIA POPULATION

2020 ◽  
pp. 59-62
Author(s):  
Vemireddy Sreechand Reddy ◽  
Apoorva. C ◽  
Ankamma Rao. D
Keyword(s):  
Sinus Thrombosis ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Mr Venography ◽  
Medical College ◽  
Sagittal Sinus ◽  
Dural Venous Sinus

Introduction Knowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations Materials and Methods A retrospective study was conducted in NRI medical college in the Department of Radiodiagnosis for a duration of 3 years to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences. Results A total of (46 men, 54 women, age range 12 to 81 years), were included in the study. Most common indication for MR venography was headache (80%). Hypoplastic left transverse sinus was the most common anatomical variation in (25%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to females (13 versus 12). Most common variation of superior sagittal sinus (SSS) was hypoplastic anterior one third SSS ,. Conclusion Hypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders.

The Use of a Novel Perfusion-Based Human Cadaveric Model for Simulation of Dural Venous Sinus Injury and Repair

2020 ◽  
Vol 19 (3) ◽  
pp. E269-E274 ◽  
Author(s):  
Ben A Strickland ◽  
Kristine Ravina ◽  
Alexandra Kammen ◽  
Stephanie Chang ◽  
Martin Rutkowski ◽  
...  
Keyword(s):  
Venous Sinus ◽  
Dural Sinus ◽  
Management Skills ◽  
Confidence Levels ◽  
Sagittal Sinus ◽  
Dural Venous Sinus ◽  
Injury And Repair ◽  
Post Trial ◽  
And Control ◽  
Cadaveric Model

Abstract BACKGROUND Dural sinus injuries are potentially serious complications associated with acute blood loss. It is imperative that neurosurgery trainees are able to recognize and manage this challenging scenario. OBJECTIVE To assess the feasibility of a novel perfusion-based cadaveric simulation model to provide the fundamentals of dural sinus repair to neurosurgical trainees. METHODS A total of 10 perfusion-based human cadaveric models underwent superior sagittal sinus (SSS) laceration. Neurosurgery residents were instructed to achieve hemostasis by any method in the first trial and then repeated the trial after watching the instructional dural flap technique video. Trials were timed until hemostasis and control of the region of injury was achieved. Pre- and post-trial questionnaires were administered to assess trainee confidence levels. RESULTS The high-flow extravasation of the perfusion-based cadaveric model mimicked similar conditions and challenges encountered during acute SSS injury. Mean ± standard deviation time to hemostasis was 341.3 ± 65 s in the first trial and 196.9 ± 41.8 s in the second trial (P &lt; .0001). Mean trainee improvement time was 144.4 s (42.3%). Of the least-experienced trainees with longest repair times in the initial trial, a mean improvement time of 188.3 s (44.8%) was recorded. All participants reported increased confidence on post-trial questionnaires following the simulation (median pretrial confidence of 2 vs post-trial confidence of 4, P = .002). CONCLUSION A perfusion-based human cadaveric model accurately simulates acute dural venous sinus injury, affording neurosurgical trainees the opportunity to hone management skills in a simulated and realistic environment.

Intracranial venous pressures under conscious sedation and general anesthesia

2017 ◽  
Vol 9 (10) ◽  
pp. 986-989 ◽  
Author(s):  
Daniel M S Raper ◽  
Thomas J Buell ◽  
Ching-Jen Chen ◽  
Dale Ding ◽  
Robert M Starke ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Transverse Sinus ◽  
Jugular Bulb ◽  
Venous Sinus ◽  
Pressure Gradients ◽  
Sagittal Sinus ◽  
Venous Outflow Obstruction ◽  
The Mean ◽  
The Relationship ◽  
Sinus Pressure

IntroductionVenous outflow obstruction has been implicated in the pathophysiology of a subset of patients with idiopathic intracranial hypertension (IIH), and venous sinus stenting (VSS) has emerged as an effective treatment. However, the effect of anesthesia on venous sinus pressure measurements is unpredictable. A more thorough understanding of the effect of the level of anesthesia on intracranial venous pressures might help to better define patients who might benefit most from stent placement.ObjectiveTo compare, in a retrospective cohort study, intracranial venous pressures measured under conscious (CS) sedation versus general anesthesia (GA) and to assess the relationship between anesthetic-dependent venous pressures and outcomes after VSS.MethodsWe performed a retrospective review of a prospectively maintained database to identify patients undergoing angiographic evaluation and VSS for intracranial venous stenosis. Mean venous pressures (MVPs) and trans-stenosis pressure gradients obtained under CS were compared with those measured under GA.ResultsThe maximal MVP was significantly lower under GA (19.8 mm Hg) than CS (21.9 mm Hg; p=0.029). The MVPs in the superior sagittal sinus, torcula, and transverse sinus were lower under GA, but were significantly higher in the sigmoid sinus and jugular bulb under GA (p<0.001). The mean trans-stenosis pressure gradient was also significantly lower under GA (8.6 mm Hg) than CS (12.1 mm Hg; p<0.001). Patients with a larger difference between maximum MVP under GA versus CS were more likely to have normalization of the MVP after VSS (p=0.0008).ConclusionsIntracranial venous pressures are markedly affected by GA. In order to obtain an accurate measurement of MVPs and trans-stenosis gradients, patients undergoing investigation for IIH should undergo cerebral angiography and venous manometry under CS, which provides more reliable data for outcomes after VSS.

scholarly journals Traumatic injury of dural venous sinus as cause of epidural hematoma: importance of recognition and adequate surgical planning

2021 ◽  
Vol 47 (1) ◽  
pp. 40-43
Author(s):  
Guilherme Brasileiro de Aguiar ◽  
Leonardo Henrique da Silva Rodrigues ◽  
Paulo Adolfo Wessel Xander ◽  
Tiago Marques Avelar ◽  
Guilherme Henrique Ferreira da Costa ◽  
...  
Keyword(s):  
Epidural Hematoma ◽  
Traumatic Injury ◽  
Middle Meningeal Artery ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Cranial Trauma ◽  
Level Of Consciousness ◽  
Dural Venous Sinus ◽  
The Many ◽  
Acute Epidural Hematoma

Background: Although most traumatic epidural hematomas are secondary to arterial injuries, particularly rupture of the middle meningeal artery, around 9.7% of cases are associated with dural venous sinus injury, leading to poorer prognosis and greater complications. We report a case of a patient presenting cranial trauma with bone fracture and laceration of the transverse sinus producing epidural hematoma, and discuss the main aspects of this condition. Case description: A 47-year-old man struck by a motorcycle was admitted to the Emergency Room with a score of 15 on the Glasgow Coma Scale, evolving over 5 hours with reduced level of consciousness. A cranial CT scan was performed disclosing right parieto- occipital hyperdensity, consistent with acute epidural hematoma, and a parieto-occipital fracture line crossing the path of the ipsilateral transverse sinus. Parietal craniotomy was performed to drain the hematoma, revealing a venous sinus injury requiring immediate repair. Conclusions: This case and discussion highlight the many details and technical specificities to be taken into account by neurosurgeons when encountering intracranial hematoma caused by traumatic injury of the dural venous sinus, and which are pivotal in determining the efficacy of the treatment approach and prognosis of the patient.

Transcranial approach for venous embolization of dural arteriovenous fistulas

2002 ◽  
Vol 97 (2) ◽  
pp. 280-286 ◽  
Author(s):  
Emmanuel Houdart ◽  
Jean-Pierre Saint-maurice ◽  
René Chapot ◽  
Adam Ditchfield ◽  
Alexandre Blanquet ◽  
...  
Keyword(s):  
Operating Room ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
First Case ◽  
Transcranial Approach ◽  
Fine Print

Object. Transvenous embolization is effective in the treatment of an intracranial dural arteriovenous fistula (DAVF). Access to the fistula via the internal jugular vein (IJV) may be limited by associated dural sinus thrombosis; a transcranial approach has been developed for venous embolization in such a situation. The authors report their experiences with the use of a transcranial approach for venous embolization of DAVFs. Methods. Ten patients with DAVFs underwent craniectomy and embolization procedures in which direct sinus puncture was performed. The DAVFs were located inside the dura mater that constituted the walls of the transverse sinus in five cases, the superior sagittal sinus in four cases, and the superior petrosal sinus in one case. All DAVFs drained directly into a sinus with secondary reflux into leptomeningeal veins. In all cases, the fistula could not be accessed from the IJVs. Craniectomy was performed in an operating room and, in seven cases, subsequent enlargement of the craniectomy was required. Sinus catheterization was performed after the patient had been transferred to the angiography room. The DAVFs were embolized using coils only in five patients, glue only in two patients, and both coils and glue in three patients. Angiographic confirmation that embolization of the fistula was successful was obtained in all cases. A transient complication occurred during the first case after sinus catheterization was attempted in the operating room. Conclusions. The transcranial approach allows straightforward access to DAVFs located on superficial dural sinuses that are inaccessible from the IJVs. The effectiveness of this approach is similar to that of the standard retrograde venous approach. The correct location and adequate extent of the craniectomy are essential for success to be achieved using this technique.

scholarly journals Dural sinus obstruction following head injury: a diagnostic and clinical study

2016 ◽  
Vol 18 (3) ◽  
pp. 253-262 ◽  
Author(s):  
Mony Benifla ◽  
Uri Yoel ◽  
Israel Melamed ◽  
Vladimir Merkin ◽  
Avi Cohen ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Medical Center ◽  
Skull Fracture ◽  
Dural Sinus ◽  
Chi Square ◽  
Poor Outcome ◽  
Sagittal Sinus ◽  
Severity Of Injury ◽  
Noncontrast Ct ◽  
Dural Venous Sinus

OBJECTIVE The aim of this study is to describe the clinical characteristics of patients with skull fracture adjacent to a dural venous sinus (DVS) and evaluate the role of CT venography (CTV) in the diagnosis of the effect of this fracture on the involved DVS. METHODS The study comprised patients with vault or skull base fracture adjacent to a DVS who were admitted to 1 medical center during a 2-year period. The medical records were reviewed for the clinical and radiographic characteristics. All patients had undergone CTV to evaluate potential DVS pathology. The clinical and radiological findings of the patients with DVS pathology were compared with those of the patients with normal DVS. The groups were compared using the chi-square and t-tests for categorical and continuous data, respectively. The potential risk for poor outcome among the patients with DVS pathology was also investigated. RESULTS Of 434 patients with skull fractures, 41 (9.4%) had fractures adjacent to a DVS. DVS pathology was detected in 51% of patients (21 of 41 patients). For 9 (43%) patients, obstruction was extraluminal without thrombosis, and 12 (57%) patients had dural sinus thrombosis (DST). In patients with a positive-CTV scan, the severity of injury according to the Glasgow Coma Scale score at presentation was correlated with the presence of DST (p = 0.007). The sensitivity of noncontrast CT (NCCT) for DVS involvement was 38% among the patients with positive-CTV scans. For patients with DVS pathology, poor outcome was correlated with DST (intraluminal), rather than extraluminal obstruction without thrombosis (p = 0.02), and superior sagittal sinus (SSS) involvement (p = 0.05). CONCLUSIONS NCCT is not sensitive enough to detect DVS obstruction in patients with skull fracture adjacent to a DVS, and CTV should be performed in order to rule it out. A correlation was found between the severity of injury and the presence of DST, rather than extraluminal obstruction. The authors' findings suggest that DST and SSS involvement may be indicators of poor outcome in patients with skull fracture adjacent to DVS.

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