Angiographic disappearance of multiple dural arteriovenous malformations

1984 ◽  
Vol 60 (6) ◽  
pp. 1275-1278 ◽  
Author(s):  
Kazuo Kataoka ◽  
Mamoru Taneda
Keyword(s):  
Arteriovenous Malformations ◽  
Obstructive Hydrocephalus ◽  
Transverse Sinus ◽  
Occipital Artery ◽  
Content Type ◽  
Presenting Symptoms ◽  
Sagittal Sinus ◽  
One Year ◽  
The Right

✓ Angiographic disappearance of two dural arteriovenous malformations (AVM's) in different locations in one case is reported. One of the AVM's involved the right transverse sinus, and the other involved the superior sagittal sinus. The patient's presenting symptoms were due to obstructive hydrocephalus resulting from a small intraventricular hemorrhage that was diagnosed by computerized tomography on admission. The symptoms cleared 25 hours after the ictus in conjunction with improvement of hydrocephalus. The AVM involving the right transverse sinus was supplied by the occipital artery, but ligation of that artery was not successful in eliminating the anomaly. One year later, follow-up angiography revealed disappearance of both dural AVM's.

Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery

1994 ◽  
Vol 81 (6) ◽  
pp. 851-859 ◽  
Author(s):  
Adam I. Lewis ◽  
Thomas A. Tomsick ◽  
John M. Tew
Keyword(s):  
Arteriovenous Malformations ◽  
Obstructive Hydrocephalus ◽  
Transarterial Embolization ◽  
Treatment Protocol ◽  
Venous Aneurysm ◽  
Occipital Artery ◽  
Vein Of Galen Aneurysm ◽  
Content Type ◽  
Stereotactic Radiation ◽  
Dural Avm

✓ The clinical, anatomical, and radiological features of nine cases of tentorial dural arteriovenous malformations (AVM's) are presented, and 45 reported cases are reviewed. Unlike dural AVM's of the transverse sigmoid and cavernous sinuses that usually have a benign natural history, dural AVM's of the tentorium typically present with hemorrhage or progressive neurological deficit. In this series, patients ranged in age from 52 to 72 years and included five men and four women. These patients presented with subarachnoid hemorrhage, parenchymal hemorrhage, brainstem dysfunction, cerebellar signs, and obstructive hydrocephalus. Malformations were fed principally by the meningohypophyseal trunk, branches of the middle meningeal artery, and the occipital artery. Venous drainage was uniform through the cortical veins (predominantly the mesencephalic, petrosal, and cerebellar veins). Eight of the nine patients had an associated venous aneurysm(s); two had more than one venous aneurysm, and two patients had a vein of Galen aneurysm associated with the tentorial dural AVM. Eight of nine patients improved after treatment, including four patients with complete obliteration of the dural AVM. Based on our experience, we have developed a treatment protocol for tentorial dural AVM's that uses transarterial embolization followed by direct microsurgery or stereotactic radiation. These therapies, applied in a staged manner, have proven safe and relatively effective for the treatment of dural AVM's.

Arteriovenous malformations of the transverse dural sinus

1976 ◽  
Vol 45 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Andreas Kühner ◽  
Arno Krastel ◽  
Wolfgang Stoll
Keyword(s):  
Successful Treatment ◽  
Arteriovenous Malformations ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Occipital Artery ◽  
Adequate Treatment ◽  
Content Type ◽  
Meningeal Arteries ◽  
Tinnitus Aurium ◽  
Fine Print

✓ Clinical, radioanatomical, and therapeutic aspects of dural arteriovenous malformations in the region of the transverse sinus are discussed on the basis of seven personal observations and the analysis of 72 reported cases. Common symptoms are headache and troublesome tinnitus aurium. More serious neurological deficiencies may occur as a result of disturbance in cerebral hemodynamics. A complete neuroradiological investigation is essential for adequate treatment. Most frequent arterial feeders are the occipital, tentorial, and middle meningeal arteries. Ligation of the occipital artery is not sufficient in most cases. Operative isolation of the transverse sinus by craniotomy and dural section is considered by far the most successful treatment and should be performed whenever ligations fail or are not indicated.

Genesis of a dural arteriovenous malformation in a rat model

1995 ◽  
Vol 83 (3) ◽  
pp. 539-545 ◽  
Author(s):  
James M. Herman ◽  
Robert F. Spetzler ◽  
Joshua B. Bederson ◽  
James M. Kurbat ◽  
Joseph M. Zabramski
Keyword(s):  
Carotid Artery ◽  
Jugular Vein ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
External Jugular Vein ◽  
Content Type ◽  
Sagittal Sinus ◽  
Sinus Wall ◽  
The Right ◽  
Fine Print

✓ A rat model was developed to determine the role of sinus thrombosis and elevated sinus pressures in the pathogenesis of dural arteriovenous malformations (AVMs) Five protocols were tested to compare various sinus pressures and thrombosis of a sinus: 1) Control I, sham operation (five animals); 2) Control II, occlusion of the right common carotid artery, the right external jugular vein, and the vein draining the left transverse sinus, as well as thrombosis of the sagittal sinus (10 animals); 3) arteriovenous fistula (AVF) I, anastomosis of the right common carotid artery to the external jugular vein causing retrograde flow through the transverse sinus (10 animals); 4) AVF II, anastomosis (as described in AVF I) and thrombosis of the sagittal sinus (12 animals); 5) AVF III, anastomosis (as described in AVF I) as well as thrombosis of the sagittal sinus and occlusion of the vein draining the transverse sinus on the left (12 animals). Mean arterial and sagittal sinus pressures were monitored and cerebral angiograms were obtained intraoperatively and again 90 days later. Afterward, the animals were sacrificed and their brains and dura were examined histologically. Formation of a fistula resulted in a significant (p < 0.05) threefold increase in sagittal sinus pressure in the AVF II group and a significant (p < 0.05) sixfold increase in the AVF III group. Seven dural AVMs (three in the AVF II group and four in the AVF III group) were demonstrated angiographically and histologically. The seven malformations were located adjacent to a thrombosed sagittal sinus. All lesions were within the dura and sinus wall with direct thrombus—sinus wall connections demonstrated in four of the malformations. The other three lesions displayed arteriovenous connections within the sinus wall and dura. These data suggest the importance of not only sinus thrombosis but also sinus hypertension in the development of a dural AVM.

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 96-101 ◽  
Author(s):  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Maximum Diameter ◽  
Content Type ◽  
Complete Occlusion ◽  
Factors Associated ◽  
Martin Grade ◽  
Fine Print

Object. The authors sought to evaluate the effects of gamma knife radiosurgery (GKS) on cerebral arteriovenous malformations (AVMs) and the factors associated with complete occlusion. Methods. A total of 301 radiosurgical procedures for 277 cerebral AVMs were performed between December 1988 and December 1999. Two hundred seventy-eight lesions in 254 patients who were treated with GKS from May 1992 to December 1999 were analyzed. Several clinical and radiological parameters were evaluated. Conclusions. The total obliteration rate for the cases with an adequate radiological follow up of more than 2 years was 78.9%. In multivariate analysis, maximum diameter, angiographically delineated shape of the AVM nidus, and the number of draining veins significantly influenced the result of radiosurgery. In addition, margin radiation dose, Spetzler—Martin grade, and the flow pattern of the AVM nidus also had some influence on the outcome. In addition to the size, topography, and radiosurgical parameters of AVMs, it would seem to be necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

A new rat model of chronic cerebral hypoperfusion associated with arteriovenous malformations

2002 ◽  
Vol 97 (5) ◽  
pp. 1198-1202 ◽  
Author(s):  
Jian Hai ◽  
Meixiu Ding ◽  
Zhilin Guo ◽  
Bingyu Wang
Keyword(s):  
Electron Microscopy ◽  
Animal Model ◽  
Arteriovenous Malformations ◽  
Perfusion Pressure ◽  
Chronic Cerebral Hypoperfusion ◽  
Cerebral Hypoperfusion ◽  
Model Group ◽  
Content Type ◽  
The Right ◽  
Fine Print

Object. A new experimental model of chronic cerebral hypoperfusion was developed to study the effects of systemic arterial shunting and obstruction of the primary vessel that drains intracranial venous blood on cerebral perfusion pressure (CPP), as well as cerebral pathological changes during restoration of normal perfusion pressure. Methods. Twenty-four Sprague—Dawley rats were randomly assigned to either a sham-operated group, an arteriovenous fistula (AVF) group, or a model group (eight rats each). The animal model was readied by creating a fistula through an end-to-side anastomosis between the right distal external jugular vein (EJV) and the ispilateral common carotid artery (CCA), followed by ligation of the left vein draining the transverse sinus and bilateral external carotid arteries. Systemic mean arterial pressure (MAP), draining vein pressure (DVP), and CPP were monitored and compared among the three groups preoperatively, immediately postoperatively, and again 90 days later. Following occlusion of the fistula after a 90-day interval, blood—brain barrier (BBB) disruption and water content in the right cortical tissues of the middle cerebral artery territory were confirmed and also quantified with transmission electron microscopy. Formation of a fistula resulted in significant decreases in MAP and CPP, and a significant increase in DVP in the AVF and model groups. Ninety days later, there were still significant increases in DVP and decreases in CPP in the model group compared with the other groups (p < 0.05). Damage to the BBB and brain edema were noted in animals in the model group during restoration of normal perfusion pressure by occlusion of the fistula. Electron microscopy studies revealed cerebral vasogenic edema and/or hemorrhage in various amounts, which correlated with absent astrocytic foot processes surrounding some cerebral capillaries. Conclusions. The results demonstrated that an end-to-side anastomosis between the distal EJV and CCA can induce a decrease in CPP, whereas a further chronic state of cerebral hypoperfusion may be caused by venous outflow restriction, which is associated with perfusion pressure breakthrough. This animal model conforms to the basic hemodynamic characteristics of human cerebral arteriovenous malformations.

Management of spinal dural arteriovenous malformations

1989 ◽  
Vol 70 (6) ◽  
pp. 832-836 ◽  
Author(s):  
Michael K. Morgan ◽  
W. Richard Marsh
Keyword(s):  
Arteriovenous Malformations ◽  
Primary Treatment ◽  
Endovascular Embolization ◽  
Content Type ◽  
Early Improvement ◽  
Time To Treatment Failure ◽  
Spinal Arteriovenous Malformations ◽  
Progressive Paraparesis ◽  
Dural Avm

✓ Dura-based spinal arteriovenous malformations (AVM's) are being diagnosed with increasing frequency. The optimal management of such lesions remains a topic of discussion. In an effort to guide this discussion, the authors review their experience with 17 cases of spinal dural AVM treated between January, 1984, and July, 1987. All patients presented with a slowly progressive paraparesis. The abnormalities were initially identified on myelography and confirmed by selective spinal angiography. Fourteen patients underwent endovascular embolization as a primary treatment, and a total of 18 embolization procedures were performed. After all but two of these, obliteration was confirmed at angiography. Patients' symptoms improved following 15 or these procedures but early improvement was not sustained in 10 instances; patients were unchanged after two procedures and worse after one. Follow-up angiography was performed at varying intervals after 15 of the 18 procedures, and recanalization of the previously obliterated spinal dural AVM was demonstrated in 13 instances. Eight patients ultimately underwent surgical treatment of their dura-based spinal AVM. No patient suffered deterioration of symptoms following operation. While embolization may allow angiographic obliteration of a spinal dural AVM and early clinical improvement, for the majority of patients these are not sustained. The average time to treatment failure was 5 months. Newer embolization materials will be necessary to effect permanent treatment in many of these patients.

scholarly journals Recovery from Transient Global Amnesia Following Restoration of Hippocampal and Fronto–Cingulate Perfusion

2010 ◽  
Vol 22 (3-4) ◽  
pp. 131-139 ◽  
Author(s):  
Paolo Caffarra ◽  
Letizia Concari ◽  
Simona Gardini ◽  
Sabrina Spaggiari ◽  
Francesca Dieci ◽  
...  
Keyword(s):  
Acute Phase ◽  
Neuropsychological Testing ◽  
Transient Global Amnesia ◽  
Normal Limits ◽  
Global Amnesia ◽  
One Year ◽  
The Right ◽  
Rcbf Spect ◽  
Subject Comparison

A patient who suffered a transient global amnesia (TGA) attack underwent regional cerebral blood flow (rCBF) SPECT imaging and neuropsychological testing in the acute phase, after one month and after one year. Neuropsychological testing in the acute phase showed a pattern of anterograde and retrograde amnesia, whereas memory was within age normal limits at follow up. SPECT data were analysed with a within subject comparison and also compared with those of a group of healthy controls. Within subject comparison between the one month follow up and the acute phase detected increases in rCBF in the hippocampus bilaterally; further rCBF increases in the right hippocampus were detected after one year. Compared to controls, significant hypoperfusion was found in the right precentral, cingulate and medial frontal gyri in the acute phase; after one month significant hypoperfusion was detected in the right precentral and cingulate gyri and the left postcentral gyrus; after one year no significant hypoperfusion appeared. The restoration of memory was paralleled by rCBF increases in the hippocampus and fronto-limbic-parietal cortex; after one year neither significant rCBF differences nor cognitive deficits were detectable. In conclusion, these data indicate that TGA had no long lasting cognitive and neural alterations in this patient.

Transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder

2002 ◽  
Vol 12 (3) ◽  
pp. 224-228 ◽  
Author(s):  
Haifa Abdul Latiff ◽  
Mazeni Alwi ◽  
Hasri Samion ◽  
Geetha Kandhavel
Keyword(s):  
Transcatheter Closure ◽  
Standard Procedure ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Term Outcome ◽  
Long Term Follow Up ◽  
One Year ◽  
The Right

This study reviewed the short-term outcome of transcatheter closure of the defects within the oval fossa using an Amplatzer® Septal Occluder. From January 1997 to December 2000, 210 patients with defects within the oval fossa underwent successful transcatheter closure. We reviewed a total of 190 patients with left-to-right shunts, assessing the patients for possible complications and the presence of residual shunts using transthoracic echocardiogram at 24 h, 1 month, 3 months and one year. Their median age was 10 years, with a range from 2 to 64 years, and their median weight was 23.9 kg, with a range from 8.9 to 79 kg. In 5 patients, a patent arterial duct was closed, and in 2 pulmonary balloon valvoplasty performed, at the same sitting. The median size of the Amplatzer® device used was 20 mm, with a range from 9 to 36 mm. The median times for the procedure and fluoroscopy were 95 min, with a range from 30 to 210 min, and 18.4 min, with a range from 5 to 144 min, respectively. Mean follow-up was 20.8 ± 12.4 months. Complete occlusion was obtained in 168 of 190 (88%) patients at 24 h, 128 of 133 (96.2%) at 3 months, and 103 of 104 (99%) at one year. Complications occurred in 4 (2.1%) patients. In one, the device became detached, in the second the device embolized into the right ventricular outflow tract, the lower end of the device straddled in the third, and the final patient had significant bleeding from the site of venupuncture. There were no major complications noted on follow-up. We conclude that transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder is safe and effective. Long-term follow-up is required, nonetheless, before it is recommended as a standard procedure.

AVASCULAR NECROSIS OF THE TRIQUETRUM: A CASE REPORT

Hand Surgery ◽  
2005 ◽  
Vol 10 (01) ◽  
pp. 91-94 ◽  
Author(s):  
Y. C. POR ◽  
W. Y. CHEW ◽  
I. Y. Y. TSOU
Keyword(s):  
Case Report ◽  
Avascular Necrosis ◽  
Total Ischemia ◽  
One Year ◽  
The Right

A case of total ischemia of the triquetrum after a crushing injury to the right wrist by a dumbbell is reported. He was treated conservatively with splinting and analgesia. There was complete clinical and radiological recovery after a follow-up of one year.

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