Angiographic Detection and Characterization of “Cryptic Venous Anomalies” Associated With Spinal Cord Cavernous Malformations Using Flat-Panel Catheter Angiotomography

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. ons125-ons132 ◽  
Author(s):  
Monica S. Pearl ◽  
James X. Chen ◽  
Lydia Gregg ◽  
Diego San Millàn ◽  
Allan Belzberg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Digital Subtraction Angiography ◽  
Surgical Complication ◽  
Digital Subtraction ◽  
Flat Panel ◽  
Data Set ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Venous Anomalies

BACKGROUND: Spinal cord cavernous malformations (CMs) are associated with 2 types of angiographically occult “cryptic venous anomalies,” which differ in location with respect to the spinal cord. The anatomic distinction between superficial and intramedullary is important in that the latter heighten the risks of CM resection. OBJECTIVE: To report the observations of both types of cryptic venous anomalies documented during spinal digital subtraction angiography enhanced with flat-panel catheter angiotomography (FPCA). METHODS: Spinal digital subtraction angiography enhanced with FPCA was performed in 2 adult patients with magnetic resonance imaging--documented intramedullary spinal cord CMs and prominent, nonspecific flow voids at the same levels. FPCA was obtained by selective injection of left T4 (case 1) and left T9 (case 2) with 5F Cobra 2 catheters (Terumo, Japan) during a 20-second rotational acquisition. Thirty milliliters of a 75% saline and 25% contrast solution (Omnipaque 300; GE) was administered. The rotational data set was reconstructed on a dedicated workstation (Leonardo; Siemens, Erlangen, Germany) through the use of regular and high-resolution matrixes, 0.4- and 0.1-mm voxel size, respectively. RESULTS: Spinal digital subtraction angiography was unremarkable in both cases. In case 1, FPCA findings indicated an atypical network of prominent posterior perimedullary veins. In case 2, FPCA identified radially oriented channels forming a caput medusae pattern collecting into an enlarged intramedullary vein. CONCLUSION: The unique ability of FPCA to image the spinal venous system enables the angiographic detection and characterization of abnormal spinal veins associated with CMs. Differentiating between the types of associated cryptic venous malformations may aid in surgical planning because the intramedullary type is associated with a higher risk of surgical complication.

Development and evaluation of a digital subtraction angiography system using a large-area flat panel detector

2003 ◽  
Author(s):  
Shigeyuki Ikeda ◽  
Katsumi Suzuki ◽  
Ken Ishikawa ◽  
Richard E. Colbeth ◽  
Chris Webb ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Large Area ◽  
Flat Panel ◽  
Flat Panel Detector

scholarly journals Intramedullary Cavernous Malformation of the Spinal Cord in Two Dogs

2007 ◽  
Vol 44 (4) ◽  
pp. 528-532 ◽  
Author(s):  
E. MacKillop ◽  
N. J. Olby ◽  
K. E. Linder ◽  
T. T. Brown
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Postmortem Examination ◽  
Spinal Cord Lesion ◽  
Intraparenchymal Hemorrhage ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Vascular Channels ◽  
Thin Walled ◽  
Cord Lesion

Intramedullary cavernous malformations (CVMs) of the spinal cord were diagnosed in 2 adult dogs that presented for paraparesis. An intramedullary spinal cord lesion was identified on a myelogram in the first dog, and expansion of the vertebral canal was evident on radiographs in the second. Extensive intraparenchymal hemorrhage was found on gross postmortem examination in both dogs, and a distinct lobulated intramedullary mass was evident in the second dog. Microscopically, both lesions were composed of dilated, thin-walled vascular channels with little-to-no intervening neural parenchyma. Both dogs had evidence of channel thrombosis along with perilesional hemorrhage and hemosiderin accumulation. The second dog had additional degenerative changes, including thickened fibrous channel walls with hyalinization, foci of mineralization, and occasional tongues of entrapped gliotic neuropil. CVMs appear to be an uncommon cause of both acute and chronic spinal cord disease in the dog.

scholarly journals Paraplegia after contrast media application: a transient or devastating rare complication? Case report

2016 ◽  
Vol 24 (5) ◽  
pp. 806-809 ◽  
Author(s):  
Dorothee Mielke ◽  
Kai Kallenberg ◽  
Marius Hartmann ◽  
Veit Rohde
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Contrast Media ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Dural Arteriovenous Fistula ◽  
Rare Complication ◽  
Digital Subtraction ◽  
Spinal Dural Arteriovenous Fistula ◽  
The Individual

The authors report the case of a 76-year-old man with a spinal dural arteriovenous fistula. The patient suffered from sudden repeated reversible paraplegia after spinal digital subtraction angiography as well as CT angiography. Neurotoxicity of contrast media (CM) is the most probable cause for this repeated short-lasting paraplegia. Intolerance to toxicity of CM to the vulnerable spinal cord is rare, and probably depends on the individual patient. This phenomenon is transient and can occur after both intraarterial and intravenous CM application.

Intramedullary spinal cord cavernous malformations: clinical features and risk of hemorrhage

2003 ◽  
Vol 26 (4) ◽  
pp. 253-256 ◽  
Author(s):  
Ibrahim Erol Sandalcioglu ◽  
Helmut Wiedemayer ◽  
Thomas Gasser ◽  
Siamek Asgari ◽  
Tobias Engelhorn ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Features ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Risk Of Hemorrhage

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

2014 ◽  
Vol 121 (3) ◽  
pp. 745-750 ◽  
Author(s):  
David A. Stidd ◽  
Joshua Wewel ◽  
Ali J. Ghods ◽  
Stephan Munich ◽  
Anthony Serici ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Vascular Anatomy ◽  
Water Soluble ◽  
Vascular Lesions ◽  
Digital Subtraction ◽  
Cerebrovascular Lesions ◽  
Data Set ◽  
Surface Anatomy ◽  
Neuronavigation System ◽  
Image Set

Object Cerebrovascular lesions can have complicated abnormal anatomy that is not completely characterized by CT or MR angiography. Although 3D rotational angiography provides superior spatial and temporal resolution, catheter angiograms are not easily registered to the patient, limiting the use of these images as a source for neuronavigation. However, 3D digital subtraction angiography (DSA) contains not only vascular anatomy but also facial surface anatomy data. The authors report a novel technique to register 3D DSA images by using only the surface anatomy contained within the data set without having to fuse the DSA image set to other imaging modalities or use fiducial markers. Methods A cadaver model was first created to assess the accuracy of neuronavigation based on 3D DSA images registered by facial surface anatomy. A 3D DSA scan was obtained of a formalin-fixed cadaver head, with acquisitions of mask and contrast runs. The right common carotid artery was injected prior to the contrast run with a 45% contrast solution diluted with water-soluble red liquid latex. One week later, the head was registered to a neuronavigation system loaded with the 3D DSA images acquired earlier using facial surface anatomy. A right pterional craniotomy was performed and 10 different vascular landmarks were identified and measured for accuracy using the neuronavigation system. Neuronavigation based only on 3D DSA was then used to guide an open clipping procedure for a patient who presented with a ruptured distal lenticulostriate aneurysm. Results The accuracy of the measurements for the cadaver model was 0.71 ± 0.25 mm (mean ± SE), which is superior to the 1.8–5 mm reported for neuronavigation. The 3D DSA–based navigation-assisted surgery for the distal lenticulostriate aneurysm aided in localization, resulting in a small craniotomy and minimal brain dissection. Conclusions This is the first example of frameless neuronavigation based on 3D catheter angiography registered by only the surface anatomy data contained within the 3D DSA image set. This is an easily applied technique that is beneficial for accurately locating vascular pathological entities and reducing the dissection burden of vascular lesions.

Characteristics and Long-Term Outcome of 20 Children With Intramedullary Spinal Cord Cavernous Malformations

Neurosurgery ◽  
2019 ◽  
Author(s):  
Jian Ren ◽  
Tao Hong ◽  
Gao Zeng ◽  
Chuan He ◽  
Xiaoyu Li ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pediatric Patients ◽  
Adult Patients ◽  
Consecutive Series ◽  
Long Term Outcomes ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Long Term Outcome ◽  
Disability Status

Abstract BACKGROUND No prior reports have focused on the natural history and long-term outcomes of intramedullary spinal cord cavernous malformations (ISCCMs) in children. OBJECTIVE To investigate the clinical characteristics and long-term outcomes of pediatric ISCCMs and identify the risk of hemorrhage. METHODS We retrospectively reviewed a series of 20 pediatric patients (<18 yr old) from a consecutive series of 254 patients with ISCCMs evaluated at a single institution. RESULTS Of the 20 pediatric patients, 9 (45.0%) presented with a severe neurological and disability status. The annual hemorrhagic rate in pediatric patients was 8.2%/patient/year. After initial overt hemorrhage events, the annual overt rehemorrhage rate increased to 30.7%/patient/year. In 234 adult patients, the respective rates were 2.8% and 7.4%. Thoracic or lumbar level lesions (P = .002, OR = 3.425, 95% CI = 1.588-7.387) and rehemorrhagic events (P = .005, OR = 3.209, 95% CI = 1.415-7.279) were more likely to follow an aggressive course. There were no significant differences in the sex distribution, location and size of lesions, types of symptoms, likelihood of a severe neurological and disability status, or immediate and long-term postoperative outcomes between pediatric and adult patients with ISCCMs CONCLUSION The annual overt hemorrhage rate and rehemorrhage rate of ISCCMs were higher in affected children than in affected adults. Surgical resection of pediatric ISCCMs remains the preferred therapeutic option and provides favorable outcomes.

Surgical outcomes and natural history of intramedullary spinal cord cavernous malformations: a single-center series and meta-analysis of individual patient data

2014 ◽  
Vol 21 (4) ◽  
pp. 662-676 ◽  
Author(s):  
Jetan H. Badhiwala ◽  
Forough Farrokhyar ◽  
Waleed Alhazzani ◽  
Blake Yarascavitch ◽  
Mohammed Aref ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Individual Patient Data ◽  
Clinical Course ◽  
Meta Analysis ◽  
Single Center ◽  
Total Resection ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Neurological Outcomes ◽  
History Of

Object Information pertaining to the natural history of intramedullary spinal cord cavernous malformations (ISCCMs) and patient outcomes after surgery is scarce. To evaluate factors associated with favorable outcomes for patients with surgically and conservatively managed ISCCMs, the authors performed a systematic review and metaanalysis of the literature. In addition, they included their single-center series of ISCCMs. Methods The authors searched MEDLINE, EMBASE, CINAHL, Google Scholar, and The Cochrane Library for studies published through June 2013 that reported cases of ISCCMs. Data from all eligible studies were used to examine the epidemiology, clinical features, and neurological outcomes of patients with surgically managed and conservatively treated ISCCMs. To evaluate several variables as predictors of favorable neurological outcomes, the authors conducted a meta-analysis of individual patient data and performed univariate and multivariate logistic regression analyses. Variables included patient age, patient sex, lesion spinal level, lesion size, cerebral cavernomas, family history of cavernous malformations, clinical course, presenting symptoms, treatment strategy (operative or conservative), symptom duration, surgical approach, spinal location, and extent of resection. In addition, they performed a meta-analysis to determine a pooled estimate of the annual hemorrhage rate of ISCCMs. Results Eligibility criteria were met by 40 studies, totaling 632 patients, including the authors' institutional series of 24 patients. Mean patient age was 39.1 years (range 2–80 years), and the male-to-female ratio was 1.1:1. Spinal levels of cavernomas were cervical (38%), cervicothoracic (2.4%), thoracic (55.2%), thoracolumbar (0.6%), lumbar (2.1%), and conus medullaris (1.7%). Average cavernoma size was 9.2 mm. Associated cerebral cavernomas occurred in 16.5% of patients, and a family history of cavernous malformation was found for 11.9% of evaluated patients. Clinical course was acute with stepwise progression for 45.4% of patients and slowly progressive for 54.6%. Symptoms were motor (60.5%), sensory (57.8%), pain (33.8%), bladder and/or bowel (23.6%), respiratory distress (0.5%), or absent (asymptomatic; 0.9%). The calculated pooled annual rate of hemorrhage was 2.1% (95% CI 1.3%–3.3%). Most (89.9%) patients underwent resection, and 10.1% underwent conservative management (observation). Outcomes were better for those who underwent resection than for those who underwent conservative management (OR 2.79, 95% CI 1.46–5.33, p = 0.002). A positive correlation with improved neurological outcomes was found for resection within 3 months of symptom onset (OR 2.11, 95% CI 1.31–3.41, p = 0.002), hemilaminectomy approach (OR 3.20, 95% CI 1.16–8.86, p = 0.03), and gross-total resection (OR 3.61, 95% CI 1.24–10.52, p = 0.02). Better outcomes were predicted by an acute clinical course (OR 1.72, 95% CI 1.10–2.68, p = 0.02) and motor symptoms (OR 1.76, 95% CI 1.08–2.86, p = 0.02); poor neurological recovery was predicted by sensory symptoms (OR 0.58, 95% CI 0.35–0.98, p = 0.04). Rates of neurological improvement after resection were no higher for patients with superficial ISCCMs than for those with deep-seated ISCCMs (OR 1.36, 95% CI 0.71–2.60, p = 0.36). Conclusions Intramedullary spinal cord cavernous malformations tend to be clinically progressive. The authors' findings support an operative management plan for patients with a symptomatic ISCCM. Surgical goals include gross-total resection through a more minimally invasive hemilaminectomy approach within 3 months of presentation.

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