scholarly journals Variations and management for patients with craniocervical junction arteriovenous fistulas: Comparison of dural, radicular, and epidural arteriovenous fistulas

2021 ◽  
Vol 12 ◽  
pp. 411
Author(s):  
Shunji Matsubara ◽  
Hiroyuki Toi ◽  
Hiroki Takai ◽  
Yuko Miyazaki ◽  
Keita Kinoshita ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Elective Surgery ◽  
Vascular Diseases ◽  
Craniocervical Junction ◽  
Vascular Lesions ◽  
Imaging Studies ◽  
Venous Reflux ◽  
Arteriovenous Fistulas ◽  
Asymptomatic Patients

Background: Craniocervical junction arteriovenous fistulas (CCJAVFs) are known to be rare, but variations and clinical behaviors remain controversial. Methods: A total of 11 CCJAVF patients (M: F=9:2, age 54–77 years) were investigated. Based on the radiological and intraoperative findings, they were categorized into three types: dural AVF (DAVF), radicular AVF (RAVF), and epidural AVF (EDAVF). Results: There were four symptomatic patients (subarachnoid hemorrhage in two, myelopathy in one, and tinnitus in one) and seven asymptomatic patients in whom coincidental CCJAVFs were discovered on imaging studies for other vascular diseases (arteriovenous malformation in one, intracranial DAVF in two, ruptured cerebral aneurysm in two, and carotid artery stenosis in two). Of these 11 patients, 2 (18.2%) had multiple CCJAVFs. Of 14 lesions, the diagnoses were DAVF in 5, RAVF in 3, and EDAVF in 6 (C1–C2 level ratio =5:0, 2:1, 3:3). Patients with DAVF/RAVF in four lesions with intradural venous reflux underwent surgery, although an RAVF remained in one lesion after embolization/radiation. Since all six EDAVFs, two DAVFs, and one RAVF had neither feeder aneurysms nor significant symptoms, no treatment was provided; of these nine lesions, one DAVF and one RAVF remained unchanged, whereas six EDAVFs showed spontaneous obliteration within a year. Unfortunately, however, one DAVF bled before elective surgery. Conclusion: CCJAVFs have many variations of shunting site, angioarchitecture, and multiplicity, and they were frequently associated with coincidental vascular lesions. For symptomatic DAVF/RAVF lesions with intradural drainage, surgery is preferred, whereas asymptomatic EDAVFs without dangerous drainage may obliterate during their natural course.

scholarly journals Ruptured Thoracolumbar Perimedullary Arteriovenous Fistula during Pregnancy Complicated by Cerebral Subarachnoid Hemorrhage and Brainstem Hematoma: A Case Report

2020 ◽  
Vol 10 (8) ◽  
pp. 561
Author(s):  
Jan Sroubek ◽  
Ladislava Janouskova ◽  
Jan Klener
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Correct Diagnosis ◽  
Pregnant Patient ◽  
Vascular Lesions ◽  
Partial Recovery ◽  
Presumptive Diagnosis ◽  
Arteriovenous Fistulas ◽  
Spine Mri ◽  
Symptoms And Signs

Intradural spinal arteriovenous fistulas (sAVF) are spinal vascular lesions that usually manifest due to myelopathy or local symptoms caused by venous congestion and ischemia. In addition, perimedullary arteriovenous fistulas (PMAVF) in particular may rupture and cause subarachnoid or intramedullary hemorrhage along with relevant symptoms. Subarachnoid hemorrhage (SAH) can propagate into cranial space with clinically dominant symptoms and signs of typical aneurysmal intracranial SAH. The standard workup for cerebral SAH, after excluding an intracranial source of hemorrhage, is usually limited to a cervical spine MRI; therefore, thoracolumbar sources of hemorrhage can be missed, or their diagnosis may be delayed. Here we present a case of a pregnant patient who presented with cerebral SAH. The source of hemorrhage was not initially identified, leading to a presumptive diagnosis of benign pretruncal non-aneurysmal SAH. The correct diagnosis of spinal thoracolumbar PMAVF was revealed 2.5 months later due to the progression of local symptoms. While the diagnosis was being refined and endovascular treatment was being planned (but delayed due to pregnancy), there was a recurrence of intraconal hemorrhage followed by brainstem hemorrhage. This led to significant clinical deterioration. The PMAVF was then treated microsurgically and the patient experienced partial recovery.

scholarly journals Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm

2019 ◽  
Vol 26 (2) ◽  
pp. 170-177
Author(s):  
Keisuke Yoshida ◽  
Shinsuke Sato ◽  
Tatsuya Inoue ◽  
Bikei Ryu ◽  
Shogo Shima ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Craniocervical Junction ◽  
Transvenous Embolization ◽  
Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Transvenous Approach

Arteriovenous fistulas at the craniocervical junction are rare vascular malformations with frequent hemorrhagic presentations, which may have a concurrent pial feeder aneurysm. A 65-year-old man presented with subarachnoid hemorrhage and angiography showed an epidural arteriovenous fistula at the C-2 level with an anterior spinal feeder aneurysm without perimedullary venous drainage. Transarterial coil embolization of the ruptured aneurysm and partial Onyx embolization of the shunt led to thrombosis of the aneurysm. However, three years later angiography showed an increased shunt flow and recurrence of the aneurysm. Transvenous embolization of the shunt using coils and Onyx yielded complete obliteration of the shunt, thus leading to occlusion of the aneurysm. This case demonstrates that partial transarterial embolization of arteriovenous fistula leaves a risk of rebleeding, whereas complete obliteration of the shunt with a transvenous approach can lead to disappearance of the flow-related aneurysm without embolization of the aneurysm itself.

scholarly journals Unusual Aneurysms of the Distal Internal Carotid Artery

1998 ◽  
Vol 25 (3) ◽  
pp. 202-208 ◽  
Author(s):  
Gary J. Redekop ◽  
Barrie Woodhurst
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Operative Management ◽  
Vascular Lesions ◽  
Parent Vessel ◽  
Distal Internal Carotid Artery ◽  
Carotid Aneurysms

ABSTRACT:Background:Supraclinoid carotid aneurysms have traditionally been classified according to their relation to the major carotid branches, but considerable variation exists with respect to site of origin, projection, and relationship to the skull base. Distal internal carotid aneurysms with a superior or medial projection are uncommon vascular lesions, with an unusually high incidence of operative complications.Methods:Surgical experience with five patients suffering from subarachnoid hemorrhage due to ruptured aneurysms of the dorsomedial wall of the distal internal carotid artery is presented, with emphasis on their angiographic appearance, anatomical features, and operative management.Results:All five patients underwent surgical clipping. Intra-operative rupture occurred in two cases, with avulsion of the aneurysm from the internal carotid artery in both. A third patient experienced recurrent subarachnoid hemorrhage three days after uneventful surgery, due to the clip shearing off of the parent vessel.Conclusions:Distal internal carotid aneurysms do not conform to the usual principles of aneurysm formation and are unique in their dorsomedial location unrelated to an arterial bifurcation. Although their anatomy is straightforward and exposure is not restricted by bone or dural structures of the skull base, they possess extremely fragile necks which make surgical management particularly hazardous.

scholarly journals Surgical treatment of previously embolized craniocervical junction dural arteriovenous fistula

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V2
Author(s):  
Thomas J. Sorenson ◽  
Lucio De Maria ◽  
Leonardo Rangel-Castilla ◽  
Giuseppe Lanzino
Keyword(s):  
Surgical Treatment ◽  
Natural History ◽  
Dural Arteriovenous Fistula ◽  
Craniocervical Junction ◽  
Vascular Lesions ◽  
Previous Attempt ◽  
Endovascular Techniques ◽  
Arteriovenous Fistulas ◽  
Suboccipital Craniotomy ◽  
Dural Arteriovenous Fistulas

Craniocervical junction dural arteriovenous fistulas (dAVFs) are rare vascular lesions with a potentially dangerous natural history due to the onset of neurological deficit secondary to intracranial hemorrhage or myelopathy due to venous congestion. Despite advances in endovascular techniques, many dAVFs located in this area continue to require surgical treatment as embolization is often not feasible or safe. In this video, the authors illustrate a patient with a symptomatic craniocervical junction dAVF who had undergone attempted Onyx embolization at another institution. Because of persistent filling of the fistula and worsening myelopathy after the previous attempt, the patient was referred to the authors’ clinic for definitive surgical treatment. The video illustrates the typical location of the early draining vein in most craniocervical junction dAVFs immediately below the emergence of the vertebral artery from the dura. The patient underwent successful definitive clip ligation of the fistula, which was exposed through a lateral suboccipital craniotomy.The video can be found here: https://youtu.be/Bvg6VKLgwO0.

Extracranial internal carotid artery: anatomical variations in asymptomatic patients

2016 ◽  
Vol 38 (8) ◽  
pp. 893-902 ◽  
Author(s):  
Salvatore Cappabianca ◽  
Francesco Somma ◽  
Alberto Negro ◽  
Michele Rotondo ◽  
Assunta Scuotto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Anatomical Variations ◽  
Extracranial Internal Carotid Artery ◽  
Asymptomatic Patients

scholarly journals Overview of Neo-Vascular Lesions after Delivery or Miscarriage

2021 ◽  
Vol 10 (5) ◽  
pp. 1084
Author(s):  
Yuji Shiina
Keyword(s):  
Arteriovenous Malformations ◽  
Uterine Artery ◽  
Spontaneous Regression ◽  
Vascular Diseases ◽  
Vascular Lesions ◽  
Artery Pseudoaneurysm ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Uterine Artery Pseudoaneurysm ◽  
Retained Products

The concept of intrauterine neo-vascular lesions after pregnancy, initially called placental polyps, has changed gradually. Now, based on diagnostic imaging, such lesions are defined as retained products of conception (RPOC) with vascularization. The lesions appear after delivery or miscarriage, and they are accompanied by frequent abundant vascularization in the myometrium attached to the remnant. Many of these vascular lesions have been reported to resolve spontaneously within a few months. Acquired arteriovenous malformations (AVMs) must be considered in the differential diagnosis of RPOC with vascularization. AVMs are errors of morphogenesis. The lesions start to be constructed at the time of placenta formation. These lesions do not show spontaneous regression. Although these two lesions are recognized as neo-vascular lesions, neo-vascular lesions on imaging may represent conditions other than these two lesions (e.g., peritrophoblastic flow, uterine artery pseudoaneurysm, and villous-derived malignancies). Detecting vasculature at the placenta–myometrium interface and classifying vascular diseases according to hemodynamics in the remnant would facilitate the development of specific treatments.

scholarly journals Colocalization of Erythrocytes and Vascular Calcification in Human Atherosclerosis: A Systematic Histomorphometric Analysis

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e113-e124
Author(s):  
Elsa Wilma Böhm ◽  
Maria Pavlaki ◽  
Georgios Chalikias ◽  
Dimitrios Mikroulis ◽  
George S. Georgiadis ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Aortic Valve ◽  
Carotid Artery ◽  
Vascular Tissue ◽  
Osteoblastic Differentiation ◽  
Aortic Aneurysms ◽  
Vascular Lesions ◽  
Erythrocyte Membranes ◽  
Intraplaque Hemorrhage ◽  
Alizarin Red

Abstract Background Intimal calcification typically develops in advanced atherosclerosis, and microcalcification may promote plaque progression and instability. Conversely, intraplaque hemorrhage and erythrocyte extravasation may stimulate osteoblastic differentiation and intralesional calcium phosphate deposition. The presence of erythrocytes and their main cellular components (membranes, hemoglobin, and iron) and colocalization with calcification has never been systematically studied. Methods and Results We examined three types of diseased vascular tissue specimens, namely, degenerative aortic valve stenosis (n = 46), atherosclerotic carotid artery plaques (n = 9), and abdominal aortic aneurysms (n = 14). Biomaterial was obtained from symptomatic patients undergoing elective aortic valve replacement, carotid artery endatherectomy, or aortic aneurysm repair, respectively. Serial sections were stained using Masson–Goldner trichrome, Alizarin red S, and Perl's iron stain to visualize erythrocytes, extracelluar matrix and osteoid, calcium phosphate deposition, or the presence of iron and hemosiderin, respectively. Immunohistochemistry was employed to detect erythrocyte membranes (CD235a), hemoglobin or the hemoglobin scavenger receptor (CD163), endothelial cells (CD31), myofibroblasts (SMA), mesenchymal cells (osteopontin), or osteoblasts (periostin). Our analyses revealed a varying degree of intraplaque hemorrhage and that the majority of extravasated erythrocytes were lysed. Osteoid and calcifications also were frequently present, and erythrocyte membranes were significantly more prevalent in areas with calcification. Areas with extravasated erythrocytes frequently contained CD163-positive cells, although calcification also occurred in areas without CD163 immunosignals. Conclusion Our findings underline the presence of extravasated erythrocytes and their membranes in different types of vascular lesions, and their association with areas of calcification suggests an active role of erythrocytes in vascular disease processes.

Sign in / Sign up

Export Citation Format

Share Document