Evolving Role of Digital Subtraction Angiography in Neurosurgical Practice

Neurosurgery ◽  
1982 ◽  
Vol 11 (3) ◽  
pp. 430-438 ◽  
Author(s):  
Thomas A. Duff ◽  
Patrick A. Turski ◽  
Joseph F. Sackett ◽  
Charles M. Strother ◽  
Andrew B. Crummy
Keyword(s):  
Digital Subtraction Angiography ◽  
Digital Processing ◽  
Initial Assessment ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Pathological Conditions ◽  
Vascular Bypass ◽  
Intracranial Vasculature

Abstract Advances in digital subtraction angiography (DSA) have allowed the evaluation of a number of pathological conditions involving the extra-and intracranial vasculature. In addition to its role in diagnosis. DSA has been used for the postoperative assessment of endarterectomy, aneurysm clipping, and vascular bypass and for the follow-up of arteriovenous fistulas or malformations. This paper describes the theory and anticipated improvements in the digital processing of radiological information and presents our initial assessment of its clinical utility.

Intra-Operative Digital Angiography as a Control of the in Situ Saphenous Vein By-Pass Grafts

1988 ◽  
Vol 29 (6) ◽  
pp. 645-648 ◽  
Author(s):  
M. Kehler ◽  
U. Albrechtsson ◽  
A. Alwmark ◽  
H. Lárusdottír ◽  
E. Ribbe ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Saphenous Vein ◽  
Digital Angiography ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas

Forty-two patients undergoing in situ saphenous vein by-pass grafting procedures, in two patients bilaterally, were examined intra-operatively with digital subtraction angiography. In 19 (43%) of the examinations the graft and the anastomoses appeared adequate. In 8 cases (18%) significant abnormalities were found, including stenoses (11 %), deficient anastomoses (5%) and graft kinking (2%). Remaining arteriovenous fistulas were found in 17 patients (39%). In most cases immediate correction was possible avoiding later re-operation. At follow up 11 of the 44 grafts were occluded, 10 of these during the first five months and of these five during the first week.

scholarly journals Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

2021 ◽  
Author(s):  
Serge Marbacher ◽  
Matthias Halter ◽  
Deborah R Vogt ◽  
Jenny C Kienzler ◽  
Christian T J Magyar ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Diagnostic Yield ◽  
Three Dimensional ◽  
P Value ◽  
Digital Subtraction ◽  
Patient Demographics ◽  
Included Patient ◽  
2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

L'angiografia digitale nello studio dei tumori endocranici

1997 ◽  
Vol 10 (2_suppl) ◽  
pp. 149-150
Author(s):  
G. Fabris ◽  
I. Aprile ◽  
E. Biasizzo ◽  
M.C. De Colle ◽  
A. Lavaroni ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Intracranial Tumors ◽  
Diagnostic Role ◽  
Nello Studio

The development of Computed Tomography and Magnetic Resonance has reduced the diagnostic role of Digital Subtraction Angiography (DSA) in the neuroradiological evaluation of intracranial tumors. DSA is currently an important pre-surgical examination, able to offer important information regarding the type and the entity of neoplastic vascularization. Moreover the development of endo-vascular interventional practices (pre-surgical embolization of meningiomas and endo-arterious chemotherapy of gliomas) has widened the applications of angiography.

Role of diagnostic imaging in diagnosis by Covid-19

2020 ◽  
Author(s):  
Coda Marco ◽  
Sica Federica ◽  
Finelli Mirko ◽  
Ungaro Gaetano ◽  
Sica Alfonso Marco
Keyword(s):  
Differential Diagnosis ◽  
Lung Parenchyma ◽  
Chest Ct ◽  
Initial Assessment ◽  
X Rays ◽  
Radiological Imaging ◽  
Laboratory Examinations ◽  
Clinical Conditions

The diagnosis from Covid-19 provides the set of several examinations such as: clinical examinations, laboratory examinations, radiographic examinations. Using radiological imaging, RX and chest CT, it is possible to evaluate the impairment of lung function and thanks to this aspect it is possible to define the severity and clinical conditions of the patient. In this way, it allows timely therapeutic intervention especially if the patient shows a mild condition in such a way as to avoid the onset of further complications. Chest X-rays allow both an initial assessment of patients and the possibility to perform a differential diagnosis towards other possible causes of lung parenchyma involvement. The CT scan, which highlights the peculiar characteristics of COVID pneumonia, is performed both as diagnostic confirmation and in the patient’s follow-up.

Abstract 1122‐000107: Charles Bonnet Syndrome Secondary to Massive Dural Arteriovenous Fistula Disguised as Extensive Venous Sinus Thrombosis

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Ahmad A Ballout ◽  
Timothy G White ◽  
Athos Patsalides
Keyword(s):  
Digital Subtraction Angiography ◽  
Sinus Thrombosis ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
High Grade ◽  
Retrograde Flow ◽  
Digital Subtraction ◽  
Venous Sinus Thrombosis ◽  
Charles Bonnet Syndrome

Introduction : Charles Bonnet Syndrome is characterized by visual hallucinations that can occur following severe visual insult, rarely due to dural arteriovenous fistulas (DAVF) or cerebral venous sinus thrombosis (CVST). Prompt differentiation between DAVF and CVST is important since treatments may differ and inadequate treatment may result in blindness. We highlight a patient who presented with Charles Bonnet Syndrome initially misdiagnosed with CVST by MR venography and later correctly diagnosed with a massive DAVF with superimposed CVST by digital subtraction angiography and underwent DAVF embolization with complete resolution. Methods : Case Report. Results : A 78 year‐old man with hypertension and hyperlipidemia presented with three weeks of bilateral vision loss associated with formed hallucinations exacerbated by dark rooms. Neurological exam revealed decreased visual acuity of 20/400 and grade five papilledema bilaterally. Non‐Contrast (TOF) MR venogram revealed lack of flow in the superior sagittal sinus (SSS), straight sinus (SS) and deep venous system, and partial flow of the left transverse and sigmoid sinus and left jugular vein. MR brain without gadolinium was unremarkable. Cerebral angiography revealed a high‐grade DAVF predominantly supplied by the occipital branch of the left external carotid artery [Figure 1; A‐C], with retrograde flow into the left sigmoid, transverse, superior sagittal, and straight sinuses, as well as retrograde flow into the right vein of Trolard [Figure 1; A‐D]. The left distal sigmoid sinus and left jugular bulb were occluded. The left transverse and proximal left sigmoid venous sinuses were compartmentalized from non‐occlusive thrombus, while the SSS and bilateral transverse sinuses where patent [Figure 1; A, B]. Embolization using coils and onyx was performed with complete occlusion of the left transverse and sigmoid sinuses, the points of main drainage of the fistula, as there was no single trans arterial pedicle suitable for embolization. Postembolization angiography demonstrated a Cognard Grade 1 fistula with some residual fistulous shunting of the occipital artery to the torcula. Follow up angiogram at six weeks showed interval occlusion of the residual shunt. He had minimal improvement in his vision at three months of follow up. Conclusions : This case highlights a patient with Charles Bonnet Syndrome due to a high flow DAVF. The MR venogram failed to capture the DAVF since the retrograde flow was interpreted as thrombosis on MRV. DAVF and CVST have a complex cause‐effect relationship, since thrombosis may open up venous channels that can lead to a fistula and sluggish blood flow from a fistula may stimulate thrombus formation. Treatments between CVST and DAVF differ since high grade DAVF often require endovascular embolization and anticoagulation may increase the risk of intracerebral hemorrhage in a subset of patients. Digital subtraction angiography and/or contrast enhanced MRV should be considered in cases of suspected extensive thrombosis to help differentiate between thrombosis and DAVF.

Single-center experience with the new generation Derivo Embolization Device in ruptured dissecting and blister aneurysms

2019 ◽  
Vol 61 (1) ◽  
pp. 37-46 ◽  
Author(s):  
Marius Georg Kaschner ◽  
Athanasios Petridis ◽  
Bernd Turowski
Keyword(s):  
Digital Subtraction Angiography ◽  
Flow Diverter ◽  
High Morbidity ◽  
Digital Subtraction ◽  
Related Complication ◽  
Single Center Experience ◽  
Flow Diverter Stent ◽  
Aneurysm Occlusion ◽  
New Generation

Background Treatment of ruptured dissecting and blister aneurysms is technically challenging with potentially high morbidity and mortality. The Derivo Embolisation Device (Derivo) is a flow diverter stent designed for the treatment of intracranial aneurysms. Purpose To assess the safety and feasibility of the Derivo in the treatment of ruptured dissecting and blister aneurysms. Material and Methods We retrospectively analyzed all patients with ruptured dissecting and blister aneurysms treated with the Derivo between February 2016 and July 2018. Procedural details, complications, morbidity within 30 days, and angiographic aneurysm occlusion rates, initially and after six months, were assessed. Results In 10 patients 11 ruptured dissecting and blister aneurysms were treated with 12 Derivos as monotherapy. No aneurysm rebleeding was observed at follow-up. One treatment-related complication occurred including a coil perforation of an additionally treated aneurysm. One patient died due to brain edema. Initial digital subtraction angiography revealed complete (O’Kelly–Marotta [OKM] classification D) and favorable (OKM D+C) occlusion rate in three aneurysms. Six-month follow-up for digital subtraction angiography and clinical evaluation was available in 6/9 patients with complete (OKM D) occlusion in all aneurysms (6/6). Favorable (modified Rankin Scale [mRS] ≤ 2) and moderate (mRS 3) clinical outcome after a mean follow-up of 10 months was observed in six and two patients, respectively. Conclusion Endovascular treatment with the Derivo in ruptured dissecting and blister aneurysms revealed a sufficient initial division of aneurysms from the circulation without rebleeding. The Derivo is associated with high procedural and clinical short-term safety.

scholarly journals Acute Brainstem Dysfunction Caused by Cavernous Sinus Dural Arteriovenous Fistula

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Yuwa Oka ◽  
Kenichi Komatsu ◽  
Soichiro Abe ◽  
Naoya Yoshimoto ◽  
Junya Taki ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Inflammatory Diseases ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Ocular Symptoms ◽  
Brainstem Dysfunction

Symptoms of cavernous sinus dural arteriovenous fistula depend on the drainage patterns and are very diverse. Among these, brainstem dysfunction is a rare but serious complication. Here, we describe a case with isolated and rapidly progressive brainstem dysfunction due to cavernous sinus dural arteriovenous fistula. An 80-year-old woman presented with a 2-day history of progressive gait disturbance. Neurological examination revealed mild confusion, dysarthria, and left hemiparesis. Magnetic resonance imaging (MRI) revealed pontine swelling without evidence of infarction. Magnetic resonance angiography suggested a faint abnormality near the cavernous sinus. Dural arteriovenous fistula was suspected, and digital subtraction angiography was planned for the next day. Her condition had progressed to coma by the next morning. Pontine swelling worsened, and hyperintensity appeared on diffusion-weighted imaging. Digital subtraction angiography revealed a right-sided cavernous sinus dural arteriovenous fistula with venous reflux into the posterior fossa. Orbital or ocular symptoms had preceded brainstem symptoms in all nine previously reported cases, but brainstem symptoms were the only presentation in our case, making the diagnosis difficult. Some dural arteriovenous fistulas mimic inflammatory diseases when the clinical course is acute. Prompt diagnosis using enhanced computed tomography or MRI and emergent treatment are needed to avoid permanent sequelae.

scholarly journals Arteriovenous shunting and early cortical venous filling in subacute cerebral infarction: An old angiographic finding revisited

2002 ◽  
Vol 6 (3) ◽  
pp. 32-33
Author(s):  
Ian C. Duncan
Keyword(s):  
Cerebral Infarction ◽  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Angiographic Finding ◽  
Arteriovenous Shunting ◽  
Venous Filling ◽  
Sectional Imaging

Demonstrated in this report is an example of arteriovenous shunting and early venous filling in an area of cerebral infarction recorded on digital subtraction angiography. This angiographic appearance is largely of historical interest given the current use of sectional imaging (CT and MR) and altered role of angiography in the imaging of stroke, but should nevertheless still be considered amongst the differential causes of cerebral arteriovenous shunting.

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