RECONSTRUCTIVE TREATMENT USING A STENT GRAFT FOR A DURAL ARTERIOVENOUS FISTULA OF THE TRANSVERSE SINUS IN THE CASE OF HYPOPLASIA OF THE CONTRALATERAL VENOUS SINUSES

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E994-E996 ◽  
Author(s):  
Beom Jin Choi ◽  
Tae Hong Lee ◽  
Chang Won Kim ◽  
Chang Hwa Choi
Keyword(s):  
Stent Graft ◽  
Coil Embolization ◽  
Transarterial Embolization ◽  
Transverse Sinus ◽  
Balloon Occlusion ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Venous Sinuses ◽  
Balloon Occlusion Test ◽  
The Right

Abstract OBJECTIVE Transvenous coil embolization for transverse sinus (TS) and sigmoid sinus dural arteriovenous fistulae (DAVFs) is now recognized as one of the most effective treatment modalities. However, in the case of hypoplasia of the contralateral venous sinuses and internal jugular vein, complete occlusion of the ipsilateral sinus may cause fatal consequences. We describe a case of combined intravenous graft stent placement and transarterial coil embolization for DAVFs that involved the dominant right TS in a patient with hypoplasia of the contralateral venous sinuses. CLINICAL PRESENTATION A 50-year-old man presented with headache, left hand tremor, and pulsatile right tinnitus. A cerebral angiogram demonstrated a right TS DAVF that was supplied by tentorial branches of both internal carotid arteries, multiple branches of the right external carotid artery, and branches of the left occipital artery. Unfortunately, left TS and sigmoid sinus hypoplasia were observed. INTERVENTION A right TS balloon occlusion test revealed contrast stagnation of the cortical veins and of the right TS and superior sagittal sinus. In this case, the use of transvenous stent graft placement with or without transarterial embolization is safer and more effective than sacrifice of the right TS. We therefore performed balloon-expandable stent graft deployment at the right TS, and the remnant DAVF flow between the stent graft and venous sinus was treated with transarterial coil embolization. Postprocedural angiograms showed patent right TS outflow with disappearance of retrograde cortical venous drainage as well as complete eradication of the fistulous connections. CONCLUSION In a DAVF involving the dominant TS or sigmoid sinus in a patient with hypoplasia of the contralateral venous sinuses and an intolerable balloon occlusion test for the ipsilateral venous sinuses, the complete occlusion of the diseased venous sinus may cause hazardous consequences. In this situation, the use of a stent graft with or without transarterial embolization to preserve venous sinus flow can be an effective treatment.

Gradual dilatation of an occluded transverse sinus associated with dural arteriovenous fistula after balloon angioplasty with sinus packing: A case report

2021 ◽  
pp. 197140092110415
Author(s):  
Takuya Osuki ◽  
Hiroyuki Ikeda ◽  
Tomoko Hayashi ◽  
Silsu Park ◽  
Minami Uezato ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Balloon Angioplasty ◽  
Dural Arteriovenous Fistula ◽  
Executive Dysfunction ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Shunt Flow ◽  
Symptomatic Epilepsy ◽  
The Right

Background There is no consensus as to whether balloon angioplasty alone or stent placement is effective for sinus occlusion associated with dural arteriovenous fistula (DAVF). Herein, we first report a case of transverse sinus occlusion associated with DAVF in which gradual sinus dilatation was observed after balloon angioplasty with embolization of the affected sinus with shunt flow. Case presentation A 69-year-old man presented with executive dysfunction. Magnetic resonance imaging revealed left transverse sinus–sigmoid sinus DAVF with occlusion of the left jugular vein and right transverse sinus. Before endovascular treatment, the patient had symptomatic epilepsy and subarachnoid hemorrhage. Retrograde leptomeningeal venous drainage disappeared with packing of the left transverse sinus–sigmoid sinus. Subsequently, balloon angioplasty of the right occluded transverse sinus was performed to maintain the normal venous drainage and remaining shunt outflow. Dilatation of the right transverse sinus was poor immediately after surgery. However, angiography after 10 days and 6 months revealed gradual dilatation of the right transverse sinus. Conclusion Sinus occlusion, which is thought to be caused by sinus hypertension associated with DAVF rather than chronic organized thrombosis or thrombophilia, may dilate over time after balloon angioplasty and shunt flow reduction if occluded sinus is necessary for facilitating normal venous drainage.

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

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.

Abstract 1122‐000122: The Role of the Venous System in Infarct Burden in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Shail S Thanki ◽  
Elliot Pressman ◽  
Shail S Thanki ◽  
John D Mayfield ◽  
Maximilian J Rabil ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
False Negative ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Post Stroke ◽  
Number Of Patients ◽  
Ct Head

Introduction : Acute ischemic stroke (AIS) is a leading cause of disability internationally. Most therapies focus on intra‐arterial treatment to improve post‐stroke deficits and neurologic status. However, if a relationship between venous anatomy and post‐stroke deficits or infarct size can be shown, then venous augmentation strategies represent a possibility for future interventions as an adjunct to intra‐arterial treatment. Methods : We retrospectively reviewed all ischemic infarcts at our institution that underwent thrombectomy from January 2018 – October 2020. From these, we selected cases that were demonstrated as M1 occlusions on intra‐procedural angiogram and those who had a CT Head obtained within six hours of the patient’s last known normal (LKN). Patients without a CT Head or CT Angiogram of their head were excluded. Using axial and sagittal reconstructed views of 0.9mm slices, cross‐sectional area measurements were taken of the superior sagittal sinus 1cm above the Torcula, in three locations of the ipsilateral and contralateral transverse sinus, in three locations of the ipsilateral and contralateral sigmoid sinus, and of the ipsilateral and contralateral internal jugular vein (IJV) at the external surface of the skull. For the transverse and sigmoid sinuses, the three measurements were averaged together. These measurements were then compared against patient’s Alberta Stroke Program Early CT Score (ASPECTS). Results : 77 patients were identified in the study period. Average ASPECTS was 8.9, ranging from 5–10. There were three patients included with ASPECTS < 6. Average ipsilateral transverse sinus area was 34.4mm ± 3.34, average ipsilateral sigmoid sinus area was 32.8mm ± 2.74, average ipsilateral IJV area was 46.9 mm ± 5.00. Correlation tests to identify relationships between venous sinus area and ASPECTS was unremarkable (ipsilateral transverse sinus p = 0.574, ipsilateral sigmoid sinus p = 0.548, ipsilateral IJV p = 0.798). When assessed as a ratio of ipsilateral venous sinus area to contralateral sinus area to assess correlation with ASPECTS, results were unremarkable (transverse sinus p = 0.891, sigmoid sinus p = 0.292, IJV p = 0.499). Conclusions : Venous sinus size was not found to be predictive or associated with predominantly favorable ASPECTS for strokes found within six hours. We believe this may be due to our cohort lacking significant numbers of patients with low ASPECTS, yielding a false negative result. We are currently expanding this project to include a comparable number of patients with ASPECTS < 6 to determine the role of venous collateral system in infarct progression.

scholarly journals Persistent Enlarged Occipital Sinus with Absent Unilateral Transverse Sinus

2019 ◽  
Vol 10 (03) ◽  
pp. 519-521
Author(s):  
Guru Dutta Satyarthee ◽  
Luis Rafael Moscote-Salazar ◽  
Amit Agrawal
Keyword(s):  
Rare Condition ◽  
Surgical Excision ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Occipital Sinus ◽  
Suboccipital Craniotomy ◽  
Acoustic Schwannoma ◽  
The Right ◽  
Dural Opening ◽  
Selection Of

AbstractThe occipital sinus may occasionally remain patent, but the incidence is extremely low and observed in less than 10% of cases. A persistent patent occipital sinus (POS) may be associated with other venous sinus abnormality. The absence of transverse sinus in association with POS is an extremely rare condition and not reported yet. The neuroradiologist, neurosurgeons, otolaryngologist, and neurologist must be aware of the possible existence of POS and other associated venous sinus anomaly, as its warrants very crucial modification of surgical planning, selection of appropriate approaches, and, additionally, may also critically limit the extent of surgical exposure of target, and may hinder intended extent of surgical excision of tumor and associated possibility of injury to POS, which may produce catastrophic hemorrhage, brain swelling, and neurosurgical morbidity. The authors report a 35-year-old male who underwent suboccipital craniotomy for right-side giant acoustic schwannoma. Following the raising bone flap, a markedly prominent, turgid, occipital sinus was observed, not placed exactly in the midline but deviated to the right side, causing further restraining of dural opening. Surgical nuances and intraoperative difficulty encountered along with pertinent literature is reviewed briefly.

Endovascular treatment of unruptured ophthalmic artery aneurysms: clinical usefulness of the balloon occlusion test in predicting vision outcomes after coil embolization

2015 ◽  
Vol 8 (7) ◽  
pp. 696-701 ◽  
Author(s):  
Byungjun Kim ◽  
Pyoung Jeon ◽  
Keonha Kim ◽  
Narae Yang ◽  
Sungtae Kim ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Collateral Circulation ◽  
Ophthalmic Artery ◽  
Balloon Occlusion ◽  
Endovascular Coiling ◽  
External Carotid ◽  
Occlusion Test ◽  
Balloon Occlusion Test ◽  
Retrograde Filling

BackgroundEndovascular coil embolization for ophthalmic artery (OphA) aneurysms has the latent risk of occlusion of the OphA during the procedure, which can lead to loss of vision. We report clinical and angiographic results of endovascular treatment of OphA aneurysms together with the efficacy of the balloon occlusion test (BOT).MethodsFrom August 2005 to December 2013, 31 consecutive patients with 33 OphA aneurysms were treated in our institution. The patients were classified into two groups according to the location of the OphA within the aneurysmal sac. The BOT was performed in 28 patients using a hypercompliant balloon before endovascular coiling. Collateral circulation between the external carotid artery and the OphA was examined and visual function tests were performed before and after treatment. Patient demographics, angiographic and clinical outcomes were reviewed.ResultsAmong the 28 patients who underwent the BOT, intact collateral circulation was demonstrated in 26 (92.9%) patients and complete occlusion of the OphA was obtained in three patients after coiling. Retrograde filling of the OphA with choroidoretinal blush was observed on post-procedural angiography and no specific visual symptoms were reported during the follow-up period. Complete embolization was achieved in 30 lesions (96.8%) and only five patients (16.1%) had minor recanalization.ConclusionsEndovascular treatment of OphA aneurysms can be performed safely and effectively in conjunction with BOT. The BOT may give useful information to predict visual outcome in patients whose OphA is likely to be threatened by the coiling procedure and to determine the optimal treatment strategy.

scholarly journals A peculiar case of dural venous sinuses with resulting atypical bony markings in posterior cranial fossa

2017 ◽  
Vol 5 (6) ◽  
pp. 2830
Author(s):  
Gitanjali Khorwal ◽  
Sunita Kalra
Keyword(s):  
Right Hemisphere ◽  
Superior Sagittal Sinus ◽  
Transverse Sinus ◽  
Posterior Cranial Fossa ◽  
Undergraduate Medical Students ◽  
Venous Sinuses ◽  
Sagittal Sinus ◽  
Cranial Fossa ◽  
The Right ◽  
Dural Venous Sinuses

A paramedian or midline suboccipital approach for craniotomies and craniectomies is commonly employed for decompression or tumour resections from posterior cranial fossa. The reference for midline is taken as the line joining the nasion and inion on the surface of the skull which is the estimated position of superior sagittal sinus. In the interior, the internal occipital protuberance is the site of confluence of sinuses which presents a spectrum of variations. An unusual pattern of drainage of dural venous sinuses was observed at the site of customary confluence during routine dissection of head region for undergraduate medical students in a sixty-year-old female cadaver. The superior sagittal sinus continued as right transverse sinus as usual but it was connected to the left transverse sinus through a venous channel. There was no appreciable confluence of sinuses at this site. A prominent and atypical cerebellar process emerged from right hemisphere of cerebellum and projected between right transverse sinus and the venous channel connecting right and left transverse sinuses. In the posterior cranial fossa, the internal occipital crest was present on the left of midline separated from internal occipital protuberance. Another small ridge was present to the right of midline. A triangular fossa thus formed on the right side of internal occipital crest was occupied by the unusual prominent process emerging from the right hemisphere of cerebellum.Pre-operative assessment of dural venous sinuses is imperative before any surgical intervention especially around the confluence of the sinuses.

scholarly journals Dynamic nature of intracranial venous sinuses in idiopathic intracranial hypertension

2019 ◽  
Vol 26 (1) ◽  
pp. 118-120 ◽  
Author(s):  
Patrick Nicholson ◽  
Stéphanie Lenck ◽  
Walter Kucharczyk ◽  
Vitor Mendes-Pereira
Keyword(s):  
Case Report ◽  
Intracranial Hypertension ◽  
Medical Therapy ◽  
Idiopathic Intracranial Hypertension ◽  
Complete Resolution ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Dynamic Nature ◽  
Venous Sinuses ◽  
Transverse Sinuses

There is increasing interest in venous sinus stenting in patients with idiopathic intracranial hypertension who are refractory to medical therapy. Often the transverse sinus stenoses are bilateral, however, and there is no clear evidence for whether we should stent one or both sides in these patients. Our practice is to first stent one side, and in this brief case report, we demonstrate complete resolution of the contralateral stenosis in one such patient who underwent stenting. Her symptoms also completely resolved, and so this case highlights the dynamic fluctuant nature of the transverse sinuses.

A Case of Partially Thrombosed Giant Basilar Aneurysm Successfully Treated by Coil Embolization Followed by Proximal Clipping

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 85-88
Author(s):  
H. Manabe ◽  
S. Fujita ◽  
M. Kimura ◽  
T. Hatayama ◽  
S. Suzuki
Keyword(s):  
Basilar Artery ◽  
Coil Embolization ◽  
Balloon Occlusion ◽  
Collateral Flow ◽  
Anterior Circulation ◽  
Occlusion Test ◽  
Balloon Occlusion Test

A case of unclippable partially thrombosed giant basilar artery (BA) aneurysm was treated successfully by intra-aneurysmal GDC embolization followed by proximal BA occlusion. Balloon occlusion test of the BA showed a good opacification of the aneurysm angiographically through plentiful collateral flow from anterior circulation. This combination may prevent coil compaction and will promote intra-aneurysmal thrombosis.

scholarly journals Cranial venous sinus dominance: what to expect? Analysis of 100 cerebral angiographies

2017 ◽  
Vol 75 (5) ◽  
pp. 295-300 ◽  
Author(s):  
Matheus Augusto Pinto Kitamura ◽  
Leonardo Ferraz Costa ◽  
Danilo Otávio de Araújo Silva ◽  
Laécio Leitão Batista ◽  
Maurus Marques de Almeida Holanda ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Superior Sagittal Sinus ◽  
Jugular Vein ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Venous Sinuses ◽  
Sagittal Sinus ◽  
Cranial Venous Sinuses ◽  
And Gender ◽  
Dominance Pattern

ABSTRACT We report an analysis of the cranial venous sinuses circulation, emphasizing morphological and angiographic characteristics. Methods Data of 100 cerebral angiographies were retrospectively analyzed (p = 0.05). Results Mean age was 56.3 years, 62% female and 38% male. Measurements and dominance are shown in the Tables. There was no association between age or gender and dominance. Right parasagittal division of the superior sagittal sinus was associated with right dominance of the transverse sinus, sigmoid sinus and internal jugular vein; and left parasagittal division of the superior sagittal sinus was associated with left dominance of the transverse sinus, sigmoid sinus and internal jugular vein. Conclusion A dominance pattern of cranial venous sinuses was found. Age and gender did not influence this pattern. Angiographic findings, such as division of the superior sagittal sinus, were associated with a pattern of cranial venous dominance. We hope this article can add information and assist in preoperative venous analysis for neurosurgeons and neuroradiologists.

Traumatic Bilateral Carotid-Cavernous Fistulas Treated with Detachable Balloon

1996 ◽  
Vol 37 (1P1) ◽  
pp. 46-48 ◽  
Author(s):  
J. K. Kim ◽  
J. J. Seo ◽  
Y. H. Kim ◽  
H. K. Kang ◽  
J. H. Lee
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Venous Drainage ◽  
Balloon Occlusion ◽  
Detachable Balloon ◽  
Balloon Occlusion Test ◽  
Bilateral Carotid ◽  
The Right ◽  
Carotid Cavernous Fistulas

A 29-year-old male developed ptosis and progressive pulsating protrusion of the right eye, accompanied by conjunctival injection and tinnitus following a bicycle accident. MR angiography revealed dilation of both superior ophthalmic veins and facial veins. Right internal carotid angiography demonstrated right carotid-cavernous fistula (CCF) at the C3 portion of the right internal carotid artery with abnormal venous drainage. After right carotid balloon occlusion test had been performed, a detachable balloon was introduced into the right CCF while preserving the lumen of the right internal carotid artery. A left CCF, which was detected after closure of the right CCF, was also closed with a detachable balloon. Follow-up carotid angiographies showed complete closure of both CCFs and no abnormal venous drainage. After 1 year no abnormal physical manifestations, or abnormal neurologic signs or symptoms were present.

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