Dural arteriovenous fistulas masquerading as dural sinus thrombosis

2009 ◽  
Vol 110 (3) ◽  
pp. 514-517 ◽  
Author(s):  
Scott Simon ◽  
Tom Yao ◽  
Arthur J. Ulm ◽  
Benjamin P. Rosenbaum ◽  
Robert A. Mericle
Keyword(s):  
Sinus Thrombosis ◽  
Noninvasive Imaging ◽  
Anticoagulation Therapy ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Venous Flow ◽  
Arteriovenous Fistulas ◽  
Imaging Results ◽  
Dural Arteriovenous Fistulas

The authors report dural sinus thrombosis diagnosed in 2 patients based on noninvasive imaging results, which were revealed to be dural arteriovenous fistulas (DAVFs) diagnosed using digital subtraction (DS) angiography. The first patient was a 63-year-old man who presented with headaches. Magnetic resonance venography was performed and suggested dural sinus thrombosis of the left transverse sinus and jugular vein. He was administered warfarin anticoagulation therapy but then suffered multiple intracranial hemorrhages. A DS angiogram was requested for a possible dural sinus thrombectomy, but the DS angiogram revealed a DAVF. The patient underwent serial liquid embolization with complete obliteration of the DAVF. The second patient, an 11-year-old boy, also presented with headaches and was diagnosed with dural sinus thrombosis on MR imaging. A DS angiogram was also requested for a possible thrombectomy and revealed a DAVF. This patient underwent serial liquid embolization and eventual operative resection. These reports emphasize that different venous flow abnormalities can appear similar on noninvasive imaging and that proper diagnosis is critical to avoid contraindicated therapies.

Transverse Sinus Thrombosis after Posterior Fossa Surgery for Cerebellar Tumor Treated by Endovascular Thrombectomy

2007 ◽  
Vol 20 (5) ◽  
pp. 562-565
Author(s):  
A. Della Puppa ◽  
L. Tosatto ◽  
P. Amistà ◽  
M. Munari ◽  
R. Scienza
Keyword(s):  
Posterior Fossa ◽  
Sinus Thrombosis ◽  
Rare Complication ◽  
Anticoagulation Therapy ◽  
Young Male ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Posterior Fossa Surgery ◽  
Cerebellar Tumor ◽  
Dural Sinus Thrombosis

Dural sinus thrombosis is a rare complication after posterior fossa surgery, particularly in cerebellar tumour surgery. The authors describe the case of a young male patient who presented a postoperative neurological deterioration due to transverse sinus thrombosis after surgery for cerebellar medulloblastoma. He was treated by mechanical clot thrombectomy using an endovascular catch system technique without anticoagulation therapy. Final angiographic recanalization was obtained. This kind of endoluminal mechanical revascularization is an efficacious method to treat dural sinus thrombosis during perioperative time but speed in diagnosis is crucial for clinical outcome.

scholarly journals Selective Transvenous Embolization for Dural Arteriovenous Fistulas with the Aid of Superselective Venograms of Fistulous Drainages and Involved Sinuses

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 43-50 ◽  
Author(s):  
M. Nakamura ◽  
Y. Nakamura ◽  
A. Fujita ◽  
E. Kohmura
Keyword(s):  
Developmental Process ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Transvenous Embolization ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Arteriovenous Shunts ◽  
Dural Arteriovenous Fistulas ◽  
Sinus Drainage

For the treatment of transvenous embolization (TVE) of dural arteriovenous fistulas (DAVFs) the sites of arteriovenous shunts, fistulous drainage, and the pathological changes inside the affected sinuses were explored in detail by means of preoperative arteriograms, superselective arteriograms, and superselective venograms. Out of 42 adult patients with DAVFs involving a total of 63 sinuses, three distinctive findings were identified as essential for indication of selective TVE for DAVFs. The first is extra-sinus fistulous drainage, which is embolizable fistulous drainage, remote from the major dural sinus, that flows into the sinus lumen. The second is intramural fistulous drainage, which is embolizable fistulous drainage located within the dural leafs of the involved sinus and separate from the major sinus lumen. The third consists of several lumens inside the affected sinuses, which suggests a variety of histological changes in the developmental process of sinus thrombosis and DAVFs. The extra-sinus drainage was occluded in three torcular heroplili fistulas and three transverse sinus fistulas. The intramural fistulous drainage was eliminated in three superior sagittal sinus fistulas. Several lumens inside the affected sinuses were encountered in 17 posterior fossa fistulas (68%) and 10 cavernous sinus fistulas (34%). These distinctive findings were recognized in 52% of the DAVFs. Out of various modalities for treatment of DAVFs, TVE has been the method of choice for the treatment of diffuse DAVFs. The TVE of DAVFs do not correspond to simple sinus occlusion, but imply selective occlusion of fistulous drainages and sinus lumens. The recognition of these three distinctive types of fistulous drainages have clinical impact in that it helps to completely occlude all the fistulous components of fistulas as well as preserve or restore the normal venous outflow through the involved sinus.

Percutaneous transvenous embolization of a dural arteriovenous fistula through a mastoid emissary vein

2006 ◽  
Vol 105 (4) ◽  
pp. 636-639 ◽  
Author(s):  
Dennis J. Rivet ◽  
James K. Goddard ◽  
Keith M. Rich ◽  
Colin P. Derdeyn
Keyword(s):  
Endovascular Treatment ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Type Ii ◽  
Emissary Vein ◽  
Arteriovenous Fistulas ◽  
Mastoid Emissary Vein ◽  
Vein Access ◽  
Dural Arteriovenous Fistulas ◽  
Gain Access

✓ Definitive endovascular treatment of dural arteriovenous fistulas (DAVFs) requires obliteration of the site of the fistula: either the diseased dural sinus or the pial vein. Access to this site is often limited by occlusion of the sinus proximal and distal to the segment containing the fistula. The authors describe a technique in which the mastoid emissary vein is used to gain access to a Borden–Shucart Type II DAVF in the transverse–sigmoid sinus. Recognition of this route of access, if present, may facilitate endovascular treatment of these lesions. Access to the transverse sinus via this approach can be straightforward and may be underused.

scholarly journals Multiple Dural Arteriovenous Fistulas

2002 ◽  
Vol 8 (2) ◽  
pp. 183-191 ◽  
Author(s):  
A.J.P. Goddard ◽  
M.S. Khangure
Keyword(s):  
De Novo ◽  
Disease Process ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
External Carotid ◽  
Unique Case ◽  
Arteriovenous Fistulas ◽  
Type Iv ◽  
Dural Arteriovenous Fistulas

Dural arteriovenous fistulas are most probably acquired lesions. However, they have been rarely encountered de novo. We present a unique case of a 71-year-old woman who initially presented with right-sided dural arteriovenous fistula (DAVF), which spontaneously resolved after diagnostic arteriography. She later developed asymptomatic occlusion of the left transverse sinus. Five years after her initial presentation she developed left-sided pulse-synchronous tinnitus. MRA and catheter angiography showed a complex type IV DAVF between the left transverse sinus and multiple dural branches arising from both left and right external carotid arteries. The left transverse sinus was isolated from the torcula herophili, with stenosis of the sigmoid sinus. Extensive cortical venous drainage was demonstrated. Endovascular cure was effected by polyvinyl alcohol particle and absolute alcohol occlusion of the dominant dural supply, and transvenous coil occlusion of the left transverse sinus. The patient's symptoms resolved almost immediately. This unique case demonstrates that dural sinus occlusion and DAVFs may co-exist, but there may not be a causal relationship. It is likely that both DAVFs and sinus occlusion are manifestations of the same disease process characterised by a pro-thrombotic state and secondary angiogenesis. It is important to recognise that changes in symptomatology, even long after apparent disappearance of a lesion may indicate recurrence, and careful follow up is advocated.

Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy

1999 ◽  
Vol 91 (2) ◽  
pp. 192-197 ◽  
Author(s):  
Glenn L. Keiper ◽  
Jonathan D. Sherman ◽  
Thomas A. Tomsick ◽  
John M. Tew
Keyword(s):  
Sinus Thrombosis ◽  
Pseudotumor Cerebri ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Posterior Fossa Surgery ◽  
Dural Sinus Thrombosis ◽  
Mr Venography ◽  
Content Type ◽  
Suboccipital Craniotomy ◽  
Fine Print

Object. The goal of this study was to document the hazards associated with pseudotumor cerebri resulting from transverse sinus thrombosis after tumor resection. Dural sinus thrombosis is a rare and potentially serious complication of suboccipital craniotomy and translabyrinthine craniectomy. Pseudotumor cerebri may occur when venous hypertension develops secondary to outflow obstruction. Previous research indicates that occlusion of a single transverse sinus is well tolerated when the contralateral sinus remains patent.Methods. The authors report the results in five of a total of 107 patients who underwent suboccipital craniotomy or translabyrinthine craniectomy for resection of a tumor. Postoperatively, these patients developed headache, visual obscuration, and florid papilledema as a result of increased intracranial pressure (ICP). In each patient, the transverse sinus on the treated side was thrombosed; patency of the contralateral sinus was confirmed on magnetic resonance (MR) imaging. Four patients required lumboperitoneal or ventriculoperitoneal shunts and one required medical treatment for increased ICP. All five patients regained their baseline neurological function after treatment. Techniques used to avoid thrombosis during surgery are discussed.Conclusions. First, the status of the transverse and sigmoid sinuses should be documented using MR venography before patients undergo posterior fossa surgery. Second, thrombosis of a transverse or sigmoid sinus may not be tolerated even if the sinus is nondominant; vision-threatening pseudotumor cerebri may result. Third, MR venography is a reliable, noninvasive means of evaluating the venous sinuses. Fourth, if the diagnosis is made shortly after thrombosis, then direct endovascular thrombolysis with urokinase may be a therapeutic option. If the presentation is delayed, then ophthalmological complications of pseudotumor cerebri can be avoided by administration of a combination of acetazolamide, dexamethasone, lumbar puncture, and possibly lumboperitoneal shunt placement.

Transcranial approach for venous embolization of dural arteriovenous fistulas

2002 ◽  
Vol 97 (2) ◽  
pp. 280-286 ◽  
Author(s):  
Emmanuel Houdart ◽  
Jean-Pierre Saint-maurice ◽  
René Chapot ◽  
Adam Ditchfield ◽  
Alexandre Blanquet ◽  
...  
Keyword(s):  
Operating Room ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
First Case ◽  
Transcranial Approach ◽  
Fine Print

Object. Transvenous embolization is effective in the treatment of an intracranial dural arteriovenous fistula (DAVF). Access to the fistula via the internal jugular vein (IJV) may be limited by associated dural sinus thrombosis; a transcranial approach has been developed for venous embolization in such a situation. The authors report their experiences with the use of a transcranial approach for venous embolization of DAVFs. Methods. Ten patients with DAVFs underwent craniectomy and embolization procedures in which direct sinus puncture was performed. The DAVFs were located inside the dura mater that constituted the walls of the transverse sinus in five cases, the superior sagittal sinus in four cases, and the superior petrosal sinus in one case. All DAVFs drained directly into a sinus with secondary reflux into leptomeningeal veins. In all cases, the fistula could not be accessed from the IJVs. Craniectomy was performed in an operating room and, in seven cases, subsequent enlargement of the craniectomy was required. Sinus catheterization was performed after the patient had been transferred to the angiography room. The DAVFs were embolized using coils only in five patients, glue only in two patients, and both coils and glue in three patients. Angiographic confirmation that embolization of the fistula was successful was obtained in all cases. A transient complication occurred during the first case after sinus catheterization was attempted in the operating room. Conclusions. The transcranial approach allows straightforward access to DAVFs located on superficial dural sinuses that are inaccessible from the IJVs. The effectiveness of this approach is similar to that of the standard retrograde venous approach. The correct location and adequate extent of the craniectomy are essential for success to be achieved using this technique.

Management and outcome of spontaneous cerebral venous sinus thrombosis in a 5-year consecutive single-institution cohort

2016 ◽  
Vol 9 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Darrin J Lee ◽  
Arjang Ahmadpour ◽  
Tamar Binyamin ◽  
Brian C Dahlin ◽  
Kiarash Shahlaie ◽  
...  
Keyword(s):  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Anticoagulation Therapy ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Dural Sinus ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
The Impact

BackgroundCerebral venous sinus thrombosis (CVST) is an uncommon form of stroke with a variable presentation, ranging from headaches, to coma and death. Although the American Stroke Association has developed guidelines for the treatment of CVST, data are sparse on the outcome after treatment with anticoagulation, thrombolysis, and thrombectomy.MethodsIn this retrospective review, we describe the 5-year UC Davis experience with spontaneous CVST.ResultsForty-one patients (mean age 37.5±23.1, range 0–96 years; 29 female) were identified with CVST. The majority of cases involved the transverse sinus (75.6%), sigmoid sinus (58.5%), and superior sagittal sinus (29.3%). The most common form of treatment was anticoagulation or antiplatelet therapy (n=35), while six patients were managed by observation alone. The overall 1-year modified Rankin score (mRS) was 1.4±1.5. Male patients and patients with a poor admission mRS had a worse outcome. Outcome was unaffected by hypercoagulable state, number of dural sinuses involved, the presence of intracranial hemorrhage, or seizures. Two patients who underwent anticoagulation therapy also required endovascular thrombectomy; both patients had a 1-year mRS of ≤2. Two patients underwent direct open surgical canalization of the superior sagittal sinus with varying outcomes (mRS 2 vs mRS 6).ConclusionsIn our series, the majority (92.9%) of patients with spontaneous dural sinus thrombosis had a favorable clinical outcome as defined by a mRS ≤2. Further prospective studies are needed to study the impact of anticoagulation on the clinical course of the disease.

Dural Sinus Thrombosis Complicating Subclavian Vein Catheterization: Treatment With Local Thrombolysis

PEDIATRICS ◽  
1995 ◽  
Vol 95 (1) ◽  
pp. 138-140
Author(s):  
Bassam M. Gebara ◽  
Mark G. Goetting ◽  
Ay-Ming Wang
Keyword(s):  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Jugular Vein Thrombosis ◽  
Vein Thrombosis ◽  
Vein Catheterization

Local venous thrombosis is a known complication of subclavian vein catheterization.1,2 The clot can extend to the noncatheterized ipsilateral internal jugular vein.3,4 It is usually asymptomatic, however, signs of venous congestion can occur. Dural sinus thrombosis has been reported in association with retrograd catheterization of the internal jugular vein,5 but not the subclavian vein. We report a case of symptomatic right sigmoid sinus, transverse sinus, and bilateral internal jugular vein thrombosis without subclavian vein thrombosis in an infant few hours after placement of right subclavian vein catheter. CASE REPORT A 9-week-old girl was seen in the emergency room for lethargy, cyanosis, and apnea.

Direct Endovascular Thrombolytic Therapy for Dural Sinus Thrombosis

Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 135-142 ◽  
Author(s):  
Stanley L. Barnwell ◽  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Grant B. Hieshima
Keyword(s):  
Sinus Thrombosis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Transverse Sinus ◽  
Clinical Findings ◽  
Dural Sinus ◽  
Clot Lysis ◽  
Dural Sinus Thrombosis ◽  
Patients Âgés ◽  
Cranial Nerve Palsies

Abstract Three patients, ages 51 to 71 years, sought treatment for symptomatic dural sinus thrombosis with occlusion and were treated by direct sinus perfusion with urokinase. All three patients had a dural arteriovenous fistula; one involved the inferior petrosal sinus and two involved the transverse sinus. Clinical findings included papilledema, diminished visual acuity, decreased mentation, and cranial nerve palsies. Diagnosis was made by cerebral arteriography and confirmed by sinus venography. All three patients were treated by a transjugular direct infusion of urokinase. In one patient, a transfemoral venous approach used initially was discontinued because of an infection. The period of continuous infusion for thrombolysis ranged between 4 and 10 days. In two patients, the clinical signs and symptoms improved with angiographic evidence of clot lysis and dural sinus recanalization. Angiography indicated that one patient had a partial resolution of a clot in the torcular herophili and transverse sinus but showed no clinical improvement. These preliminary results suggest that transjugular local infusion of thrombolytic agents can be an effective treatment for symptomatic, thrombosed dural sinuses. This selective lysis avoids thrombolytic effects that could aggravate or produce systemic hemorrhagic complications.

THROMBOPHILIC ABNORMALITIES AMONG PATIENTS WITH CRANIAL DURAL ARTERIOVENOUS FISTULAS

Neurosurgery ◽  
2007 ◽  
Vol 61 (2) ◽  
pp. 262-269 ◽  
Author(s):  
Takashi Izumi ◽  
Shigeru Miyachi ◽  
Ken-ichi Hattori ◽  
Hiroshi Iizuka ◽  
Yukimi Nakane ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Anticardiolipin Antibody ◽  
University Hospital ◽  
Fistula Formation ◽  
Dural Sinus ◽  
Arteriovenous Fistulas ◽  
Unruptured Intracranial Aneurysms ◽  
Dural Arteriovenous Fistulas ◽  
The Mean ◽  
D Dimer

Abstract OBJECTIVE Dural sinus thrombosis often accompanies or precedes the development of dural arteriovenous fistulas (DAVFs). Because thrombophilic abnormalities can contribute to sinus thrombosis, we investigated the prevalence of such abnormalities and of venous sinus thrombosis in patients with DAVFs. METHODS Thrombophilic factors were measured in 18 patients with DAVFs treated with embolization at our university hospital. Control data were obtained from patients with unruptured intracranial aneurysms. In addition to sinus occlusion, we investigated prothrombin time, activated thromboplastin time, platelet count, and fibrinogen, platelet, antithrombin III, protein C, protein S, anticardiolipin antibody, anti-cardiolipin β2-glycoprotein-I complex antibody, and D-dimer levels. RESULTS Of the 18 patients with DAVFs, 16 had abnormal D-dimer levels, whereas the mean values for other thrombophilic factors were nearly normal. D-dimer levels were significantly higher in preoperative DAVF patients than in controls. Interestingly, the mean value of D-dimer was higher in patients with sinus occlusion than in those without it (3.33 versus 1.19). D-dimer levels rose after embolization in eight out of 10 serially tested patients, but, on average, the change was not significant. In clinically cured patients treated more than 3 months before, D-dimer was lower than in preoperative patients. CONCLUSION D-dimer is a very sensitive indicator of acute venous thrombosis, suggesting that elevations in patients with DAVFs are likely to reflect sinus thrombosis. D-dimer values decreased and nearly normalized in clinically cured patients during a long-term follow-up period, a finding consistent with completion of thrombosis and cure of the disease. To clarify the correlation between DAVF and sinus thrombosis from the aspect of etiology, we should thoroughly check the variation in the concentration of the thrombophilic factors in the patient with chronic sinus occlusion to know the variation in the fistula formation in the further study.

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