Endovascular management of torcular dural sinus malformations in children: the role of straight sinus occlusion

2020 ◽  
pp. neurintsurg-2020-016888
Author(s):  
Stanislas Smajda ◽  
Michael Söderman ◽  
Georg Dorfmüller ◽  
Nathalie Dorison ◽  
Marie-Claire Nghe ◽  
...  
Keyword(s):  
Vascular Malformations ◽  
Pediatric Population ◽  
Transarterial Embolization ◽  
Venous System ◽  
High Rate ◽  
Dural Sinus ◽  
Clinical Prognosis ◽  
Deep Venous System ◽  
Straight Sinus ◽  
Arteriovenous Shunts

BackgroundTorcular dural sinus malformations (tDSMs) with arteriovenous shunts are rare congenital intracranial vascular malformations that carry a high rate of neurologic impairment and death in the neonatal, infant and young pediatric population. Their impact on brain venous drainage, especially the deep venous system, is one of the key factors in the clinical prognosis and natural history of the disease. We describe our therapeutic strategy for tDSMs, disconnecting the reflux into the deep venous system by performing an endovascular straight sinus occlusion.MethodsAmong all children with dural sinus malformations seen between 2002 and 2020, we retrospectively reviewed those with tDSM in whom straight sinus occlusion had been performed.ResultsOur databank included nine patients with tDSM that were embolized. Mean age at the clinical onset was 8.9±9.6 months (min–max=0–31). Five patients presented a significant reflux in the straight sinus on digital subtraction angiography. Those patients were initially clinically worse (mean modified Rankin Scale (mRS) 3.8) than those who did not present with reflux (mean mRS 2.25), this reflux being responsible for intraventricular hemorrhage in three patients. The reflux was suppressed by transarterial embolization in one patient and by transvenous straight sinus occlusion in four patients. Staged endovascular treatment resulted in a complete cure in six patients without complications, and clinical improvement in all patients.ConclusionStraight sinus occlusion is a feasible technique that needs to be considered in the treatment strategy for tDSM with deep venous reflux in order to avoid or minimize brain damage.

scholarly journals Malformations of the Fetal Dural Sinuses

2009 ◽  
Vol 36 (1) ◽  
pp. 72-77 ◽  
Author(s):  
Matthew McInnes ◽  
Katherine Fong ◽  
Andrea Grin ◽  
Karel ter Brugge ◽  
Susan Blaser ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Gestational Age ◽  
Vascular Malformations ◽  
In Utero ◽  
Developmental Trajectory ◽  
Dural Sinus ◽  
Vein Of Galen ◽  
Dural Sinuses ◽  
Arteriovenous Shunts ◽  
Dural Sinus Malformation

Background:Dural sinus malformation (DSM) is a term used to describe congenital vascular malformations characterized by massive dilation of one or more dural sinuses: these dilatations are typically associated with arteriovenous shunts. Such malformations can present antenatally but their early natural history and anatomy is poorly defined.Methods:We reviewed five years of autopsy experience and retrieved three primary vascular malformations of the fetal dural sinuses with ultrasound, magnetic resonance imaging (MRI) and post-mortem correlation.Results:Fetal ultrasound and MRI obtained between 19 and 23 weeks gestational age demonstrated in all cases dilation of the dural sinuses. In two cases vascular thromboses were present in either the dilated dural sinus (one of three) or the associated arteriovenous fistula (one of three). All cases were autopsied at 22-23 weeks gestational age. In one there was imaging and autopsy evidence of remodeling of the dural sinuses associated with a pial arteriovenous fistula. In two cases, no arteriovenous malformation was identified on initial imaging, but only became evident at autopsy. One case showed morphological overlap with vein of Galen aneurysmal malformation, with a midline arteriovenous shunt and vein of Galen ectasia. The other demonstrated a perisylvian dural arteriovenous fistula.Conclusion:In utero thrombosis of feeding vascular malformations or of the dural sinus malformation may be prominent. The early in utero developmental trajectory of dural sinus malformation (DSM) is poorly defined and deserves further study.

Combined transvenous and transarterial embolization of a tentorial—incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus

2003 ◽  
Vol 99 (3) ◽  
pp. 579-583 ◽  
Author(s):  
Neil A. Troffkin ◽  
Cole Blease Graham ◽  
Turgut Berkmen ◽  
Ajay K. Wakhloo
Keyword(s):  
Stent Placement ◽  
Clinical Course ◽  
Transarterial Embolization ◽  
Dural Sinus ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Straight Sinus ◽  
Venous Outflow Obstruction ◽  
Aggressive Clinical Course ◽  
Dural Avm

✓ Dural arteriovenous malformations (AVMs) involving the tentoria—incisura are associated with an aggressive clinical course characterized by subarachnoid and intracranial hemorrhage (ICH). In these lesions, venous outflow obstruction precipitates leptomeningeal venous drainage, resulting in the arterialization of pial veins and the formation of venous aneurysms, both of which are prone to hemorrhage. Stenotic lesions of the dural sinuses also contribute to the development of retrograde leptomeningeal drainage, which is responsible for the aggressive clinical course of the dural AVM. Endovascular approaches are successful in the treatment of these lesions and of any potential venous outflow obstruction caused by stenosis of a dural sinus. The authors report on a patient with a tentorial—incisural dural AVM and an accompanying stenotic venous sinus. A combined transvenous and transarterial embolization procedure was performed, resulting in complete obliteration of the dural AVM, followed by primary stent placement across a stenotic segment of the straight sinus and normalization of venous outflow. The authors conclude that dural AVMs can be treated safely by using a combined transarterial and transvenous approach and that an extensive search for venous outflow obstruction often reveals stenosis of a draining sinus. Consideration should be given to primary stent placement in the stenotic sinus to protect against ICH.

Cervical spine dural arteriovenous fistula presenting with congestive myelopathy of the conus

2009 ◽  
Vol 11 (4) ◽  
pp. 427-431 ◽  
Author(s):  
Sasikhan Geibprasert ◽  
Sirintara Pongpech ◽  
Pakorn Jiarakongmun ◽  
Timo Krings
Keyword(s):  
Cervical Spine ◽  
Clinical Symptoms ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Conus Medullaris ◽  
Imaging Findings ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Arteriovenous Shunts ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (DAVFs) are the spinal vascular malformations that are encountered most often, and they are usually encountered in the lower thoracic region. Cervical spine DAVFs are exceedingly rare and may be difficult to differentiate from radicular arteriovenous malformations, epidural arteriovenous shunts, or perimedullary AVFs. Typical angiographic findings in spinal DAVFs include a slow-flow shunt with converging feeding vessels from radiculomeningeal arteries draining via a radicular vein centripetally into perimedullary veins. The MR imaging findings such as spinal cord edema and perimedullary dilated vessels may be used to direct the spinal angiography that is needed to localize and classify the shunt. When the shunt is distant from the pathological imaging findings, the diagnosis may be difficult to establish, especially when the shunt is present at an atypical location such as the cervical spine. The authors present the case of a 51-year-old man presenting with lower thoracic and conus medullaris congestive edema due to a cervical spine DAVF that was located at the C-5 level. Transarterial embolization with N-butyl cyanoacrylate closed the proximal vein and completely obliterated the fistula. Clinical and imaging follow-up confirmed occlusion of the fistula, with improvement in clinical symptoms.

scholarly journals Therapeutic progress in pediatric intracranial dural arteriovenous shunts: A review

2016 ◽  
Vol 22 (5) ◽  
pp. 548-556 ◽  
Author(s):  
Jinlu Yu ◽  
Xianli Lv ◽  
Youxiang Li ◽  
Zhongxue Wu
Keyword(s):  
Imaging Techniques ◽  
Transarterial Embolization ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Venous Drainage ◽  
Dural Sinus ◽  
Adult Type ◽  
Appropriate Treatment ◽  
Arteriovenous Shunts ◽  
Dural Arteriovenous Shunts

Pediatric dural arteriovenous shunts (dAVSs) are a rare form of vascular disease: Fewer than 100 cases are reported in PubMed and the understanding of pediatric dAVS is limited. For this study, we searched in PubMed, reviewed and summarized the literature related to pediatric dAVSs. Our review revealed that pediatric dAVSs have an unfavorable natural history: If left untreated, the majority of pediatric dAVSs deteriorate. In a widely accepted classification scheme developed by Lasjaunias et al., pediatric dAVSs are divided into three types: Dural sinus malformation (DMS) with dAVS, infantile dAVS (IDAVS) and adult-type dAVS (ADAVS). In general, the clinical manifestations of dAVS can be summarized as having symptoms due to high-flow arteriovenous shunts, symptoms from retrograde venous drainage, symptoms from cavernous sinus involvement and hydrocephalus, among other signs and symptoms. The pediatric dAVSs may be identified with several imaging techniques; however, the gold standard is digital subtraction angiography (DSA), which indicates unique anatomical details and hemodynamic features. Effectively treating pediatric dAVS is difficult and the prognosis is often unsatisfactory. Transarterial embolization with liquid embolic agents and coils is the treatment of choice for the safe stabilization and/or improvement of the symptoms of pediatric dAVS. In some cases, transumbilical arterial and transvenous approaches have been effective, and surgical resection is also an effective alternative in some cases. Nevertheless, pediatric dAVS can have an unsatisfactory prognosis, even when timely and appropriate treatment is administered; however, with the development of embolization materials and techniques, the potential for improved treatments and prognoses is increasing.

Adenosine-induced cardiac standstill for endovascular treatment of pediatric vein of Galen malformations

2018 ◽  
Vol 21 (4) ◽  
pp. 380-383 ◽  
Author(s):  
Nam K. Yoon ◽  
Jonathan P. Scoville ◽  
Philipp Taussky
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Transarterial Embolization ◽  
Endovascular Embolization ◽  
High Flow ◽  
High Morbidity ◽  
Vein Of Galen ◽  
Open Surgical Treatment

Vein of Galen malformations are congenital high-flow vascular malformations that often present with heart failure, hydrocephalus, developmental delay, and intracranial hemorrhage. Because open surgical treatment is associated with high morbidity and mortality, endovascular embolization is increasingly becoming the preferred method of intervention. However, embolization of these lesions can be difficult because of their high-flow nature. The use of adenosine-induced cardiac standstill for treatment of vein of Galen malformations has not been previously described in neonates. The authors describe 3 treatments in 2 patients that demonstrate that the use of adenosine is well tolerated and allows safe transarterial embolization of high-flow vein of Galen malformations in the pediatric population.

scholarly journals The Anastomotic Venous Circle of the Base of the Brain

2005 ◽  
Vol 11 (4) ◽  
pp. 325-332 ◽  
Author(s):  
S. Cullen ◽  
F. Demengie ◽  
A. Ozanne ◽  
H. Alvarez ◽  
Ph. Mercier ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Gross Anatomy ◽  
Venous Drainage ◽  
Venous System ◽  
Deep Venous System ◽  
Arteriovenous Shunts ◽  
Radiologic Imaging ◽  
The Right ◽  
The Brain ◽  
Neuroimaging Techniques

Adjacent to the arterial circle of Willis at the base of the brain, there is an anastomotic circle of veins linking the right and left halves of the cerebral deep venous system. This venous circle is formed by anterior and posterior transverse anastomotic channels (the anterior and posterior communicating veins), and paramedian longitudinal vessels (the basal veins of Rosenthal). This collateral venous network has received considerably less attention than its arterial counterpart, but is its functional homologue. Although inconstant, it can be seen readily with current neuroimaging techniques including three-dimensional digital subtraction venographic phase 3D arteriography (3D-DSV) and CT venography (CTV). The venous circle represents a route of contralateral venous drainage that may become important, particularly when segments of the basal vein are absent (with or without complex DVA), or in high flow states including arteriovenous shunts that access the deep venous system. We review the gross anatomy and provide examples of the radiologic imaging of this venous circle.

Sulfinpyrazone or Acetylsalicylic Acid to Prevent Postoperative Thrombus Formation in Arteriovenous Fistulas of Haemodialysis Patients

1979 ◽  
Author(s):  
F Albert ◽  
U Schmidt
Keyword(s):  
Side Effects ◽  
Acetylsalicylic Acid ◽  
Thrombus Formation ◽  
Significant Inhibition ◽  
High Rate ◽  
Controlled Clinical Trial ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Shunts ◽  
Gastrointestinal Side Effects ◽  
Antithrombotic Efficacy

The effect of sulfinpyrazone (200 mg three times a day) and acetylsalicylic acid (500 mg three times a day) on the incidence of thrombosis of arteriovenous shunts was investigated in a controlled clinical trial. In 36 patients with chronic renal failure scheduled to begin haemodialysis the same operating team constructed a subcutaneous fistula in the distal forearm. During the first six weeks after the operation the antithrombotic efficacy proved to be good for both substances. No differences of thrombotic events between the two treatment groups were statistically significant. But in contrast to acetylsalicylic acid sulfinpyrazone made no significant inhibition of platelet - aggregation; sulfinpyrazone probably will prevent the clot formation by prolonging the shortened platelet survival in uraemic patients. In a high rate of patients given acetylsalicylic acid (10 out of 17) there were local bleeding and gastrointestinal side effects. In consequence we should prefer sulfinpyrazone, because in the sulfinpyrazone group side effects were minimal and in none patient withdrawal from the study was necessitated.

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