Management of dural arteriovenous malformations of the anterior cranial fossa

1990 ◽  
Vol 72 (5) ◽  
pp. 692-697 ◽  
Author(s):  
Neil A. Martin ◽  
Wesley A. King ◽  
Charles B. Wilson ◽  
Stephen Nutik ◽  
L. Phillip Carter ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Venous Drainage ◽  
Anterior Cranial Fossa ◽  
Venous Aneurysm ◽  
Content Type ◽  
Cortical Vein ◽  
Sagittal Sinus ◽  
Feeding Vessels ◽  
Cranial Fossa

✓ Eight patients with dural arteriovenous malformations (AVM's) of the anterior cranial fossa are presented, and the pertinent literature is reviewed. Unlike cases of dural AVM's in other locations, sudden massive intracerebral hemorrhage was the most frequent reason for presentation. Other symptoms included tinnitus, retro-orbital headache, and a generalized seizure. The malformations were supplied consistently by the anterior ethmoidal artery, usually in combination with other less prominent feeding vessels. The lesion's venous drainage was through the superior sagittal sinus via a cortical vein; in addition, in two cases a subfrontal vein drained the AVM. A venous aneurysm was encountered near the site of anastomosis with the dural feeder in most cases, and was found in all patients who presented with hemorrhage. The AVM was obliterated surgically in six patients, with favorable results achieved in five. One patient died postoperatively from a pulmonary complication. Because of their anatomy and proclivity for hemorrhage, these vascular malformations represent a unique group of dural AVM's. Surgical management of anterior fossa dural AVM's carries low morbidity, and is indicated when the lesions have caused hemorrhage or when there is an associated venous aneurysm.

Harvey W. Cushing and cerebrovascular surgery: Part II, vascular malformations

2004 ◽  
Vol 101 (3) ◽  
pp. 553-559 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Dennis D. Spencer
Keyword(s):  
Carotid Arteries ◽  
Vascular Malformations ◽  
Radical Resection ◽  
External Carotid ◽  
Cerebral Blood Vessels ◽  
Content Type ◽  
Cortical Vein ◽  
Feeding Vessels ◽  
Radiation Treatments ◽  
Cerebrovascular Surgery

✓ The surgical treatment of cerebrovascular malformations intrigued early neurosurgeons. Cushing defined vascular malformations as tumors arising from cerebral blood vessels. He successfully resected the first arteriovenous malformation 3 years after it had been irradiated. In the absence of angiography, the pathoanatomy of these lesions remained elusive and early techniques such as cortical vein ligation proved catastrophic. Cushing demonstrated the favorable results of radiation treatments on vascular malformations and advocated decompressive craniectomy followed by radiotherapy. He ligated cortical feeding vessels and external carotid arteries with an improved understanding of the angioarchitecture of vascular malformations. He stressed the importance of preoperative diagnosis because the radical resection of nonirradiated vascular malformations challenged the limitations of the available neurosurgical armamentarium.

Development of anterior cranial fossa dural arteriovenous malformation following head trauma

1997 ◽  
Vol 86 (2) ◽  
pp. 291-293 ◽  
Author(s):  
Tatsuya Ishikawa ◽  
Kiyohiro Houkin ◽  
Kouichi Tokuda ◽  
Susumu Kawaguchi ◽  
Takeshi Kashiwaba
Keyword(s):  
Head Trauma ◽  
Anterior Cranial Fossa ◽  
Content Type ◽  
Sagittal Sinus ◽  
First Case ◽  
History Of ◽  
Cranial Fossa ◽  
Ethmoidal Arteries ◽  
Dural Avm ◽  
Fine Print

✓ Dural arteriovenous malformations (AVMs) are considered to be acquired lesions that develop secondary to venous obstruction, which sometimes happens in head trauma. However, there has been a report of an anterior cranial fossa dural AVM that occurred independently of a history of head trauma, and there has been speculation that these malformations are congenital. The authors recount their experience with a patient who had an anterior cranial fossa dural AVM that was discovered incidentally. The lesion was fed by the bilateral anterior ethmoidal arteries and drained into the superior sagittal sinus via frontal cortical veins. The patient had a history of severe head trauma that had occurred 30 years earlier. This is the first case report in which a previous head trauma is strongly believed to be the cause of an anterior cranial fossa dural AVM. The authors postulate that anterior cranial fossa dural AVMs can develop secondary to a head trauma.

scholarly journals Cortical Venous Aneurysm Isolated Cerebral Varix

2004 ◽  
Vol 10 (2) ◽  
pp. 161-165 ◽  
Author(s):  
T. Hoell ◽  
C. Hohaus ◽  
A. Beier ◽  
HJ Holzhausen ◽  
HJ Meisel
Keyword(s):  
Mr Imaging ◽  
Arterial Pressure ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Neurological Deficits ◽  
Venous Aneurysm ◽  
Rare Entity ◽  
Cortical Vein ◽  
Developmental Venous Anomalies ◽  
Cortical Localization

Venous aneurysms so-called isolated cerebral varix, are known as a related pathology in arteriovenous malformations (AVM) due to the arterial pressure on venous drainage16. They are also observed in combination with developmental venous anomalies (DVA)2,4,8,15. However, isolated varix is a rare entity1,7,11,13. They appear in most cases without neurological deficits. Some of the cases mimic a meningioma due to their manifestation in CT and MR imaging and their axial cortical localization. The case presented here is a isolated varix of a cortical vein located rostral to the motor strip. The patient was operated on successfully. The MRI and the histology of the case are presented.

Intracranial diverticulum of the frontal sinus as a complication of frontal craniotomy

1979 ◽  
Vol 51 (6) ◽  
pp. 870-871 ◽  
Author(s):  
L. Anne Hayman ◽  
Alfonso E. Aldama-Luebbert ◽  
Robert A. Evans
Keyword(s):  
Frontal Sinus ◽  
Anterior Cranial Fossa ◽  
Content Type ◽  
Sinus Wall ◽  
Cranial Fossa ◽  
Sinus Mucosa ◽  
Fine Print

✓ A large air-filled intracranial extradural diverticulum of the frontal sinus mucosa was removed from the anterior cranial fossa of a 47-year-old man 2 years after fracture of the posterior sinus wall during craniotomy.

scholarly journals Study of Dural Arteriovenous Fistula Drains into Leptomeningeal Vein without Sinus Interposition

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 127-134 ◽  
Author(s):  
T. Kawaguchi ◽  
M. Nakatani ◽  
T. Kawano
Keyword(s):  
Emergency Treatment ◽  
Superior Sagittal Sinus ◽  
Venous Drainage ◽  
Craniocervical Junction ◽  
Sigmoid Sinus ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Dural Arteriovenous Fistulas ◽  
Cranial Fossa ◽  
Venous Ischemia

We evaluated dural arteriovenous fistulas (DAVF) drains into leptomeningeal vein (LMV) without the venous sinus interposition. This type of DAVF contained the extra-sinusal type DAVF and the DAVF with so-called pure leptomeningeal venous drainage (PLMVD). We studied 15 patients with DAVF that flows into LMVD without passing into the sinus. The subjects were 5 patients with DAVF in the anterior cranial fossa, 2 with DAVF in the tentorium cerebelli, and 3 with DAVF in the craniocervical junction as extra-sinusal type DAVF and 3 with DAVF in the transverse sigmoid sinus and 2 with DAVF in the superior sagittal sinus as DAVF with PLMVD. This type appears to take a very aggressive course. The arterial pressure of the shunt is directly applied to LMV, which causes bending and winding of the vein, eventually varices, inducing intracranial haemorrhage or venous ischemia in the LMV reflux area. Emergency treatment should be performed as soon as possible. Although it is recognized that interruption of the draining vein is very effective, treatment methods such as TAE, direct surgery, and g knife treatment, or their combinations should be carefully chosen for each case.

Specific repression of the preproendothelin-1 gene in intracranial arteriovenous malformations

1997 ◽  
Vol 86 (1) ◽  
pp. 101-108 ◽  
Author(s):  
R. L. Patrick Rhoten ◽  
Youssef G. Comair ◽  
Daniel Shedid ◽  
Douglas Chyatte ◽  
Michael S. Simonson
Keyword(s):  
Messenger Rna ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Receptor Expression ◽  
Content Type ◽  
Endothelin 1 ◽  
Human Control ◽  
Genetic Mechanisms ◽  
Cerebral Avms ◽  
Normal Controls

✓ Cerebrovascular arteriovenous malformations (AVMs) display abnormal vascular development and dysautoregulation of blood flow. Genetic mechanisms that contribute to the pathogenesis and phenotype of cerebral AVMs are unknown. As a first step in understanding the pathophysiology of AVMs, the authors investigated the hypothesis that endothelial dysfunction—specifically, deregulation of endothelin-1 (ET-1) secretion—contributes to the abnormal vascular phenotype and the lack of hemodynamic autoregulation elaborated by these lesions. Endothelin-1 peptide and preproendothelin-1 (ppET1) messenger RNA were not detected in the intranidal vasculature of all 17 patients with AVMs studied, but were prominently expressed in human control subjects with normal cerebrovasculature (p < 0.01). Although AVM vasculature lacked ET-1, its expression was prominent in vasculature distant from these lesions, suggesting local repression of the ppET-1 gene. Local repression of ET-1 was specific to AVMs; ET-1 in vascular malformations of patients with Sturge—Weber disease was actually elevated compared to normal controls (p < 0.01). Repression of the ppET-1 gene was an intrinsic phenotype of AVM endothelial cells and was not due to factors in the AVM microenvironment. The authors also showed that ETA receptor expression was low in AVM vasculature compared to normal controls. Together, these results demonstrate that the ppET-1 gene is locally repressed in AVM lesions and suggest a role for abnormal ppET-1 gene regulation in the pathogenesis and clinical sequelae of cerebral AVMs.

Anatomical and embryological considerations in the repair of a large vertex cephalocele

1999 ◽  
Vol 90 (3) ◽  
pp. 537-541 ◽  
Author(s):  
Eelco Hoving ◽  
Susan Blaser ◽  
Edmond Kelly ◽  
James T. Rutka
Keyword(s):  
Magnetic Resonance ◽  
Venous Drainage ◽  
Cyst Formation ◽  
Preoperative Imaging ◽  
Drainage Pattern ◽  
Surface Ectoderm ◽  
Content Type ◽  
Sagittal Sinus ◽  
Interhemispheric Fissure ◽  
Cerebral Anomalies

✓ The case of a neonate with a large vertex cephalocele is presented. The anatomical features of this anomaly were evaluated by means of magnetic resonance imaging and magnetic resonance angiography. Fusion of the thalami, dysgenesis of the corpus callosum, and failure of adequate formation of the interhemispheric fissure were characteristics of the major cerebral anomalies associated with the cephalocele. The absence of a falx in the midline, a split configuration of the superior sagittal sinus, and a dysgenetic tentorium with a concomitant abnormal venous drainage pattern were found in association with a large dorsal cyst. Repair of the anomaly was undertaken on the 3rd postnatal day. A cerebrospinal fluid shunt was required to treat hydrocephalus on Day 30. The child is well at age 3 years, but with significant developmental delay. The pathogenesis of this vertex cephalocele relates to semilobar holoprosencephaly and dorsal cyst formation. In addition, a disturbance in the separation of the diencephalic portion of the neural tube from the surface ectoderm or skin during the final phases of neurulation had occurred to help create the large cephalocele. Detailed preoperative imaging studies and awareness of the embryology and anatomy of this lesion facilitated the repair of the cephalocele. The prognosis of the child is determined not only by the presence of hydrocephalus, but also by the number of associated major cerebral anomalies. Options for treatment are discussed.

Clinical significance of pedicle aneurysms on feeding vessels, especially those located in infratentorial arteriovenous malformations

2000 ◽  
Vol 92 (6) ◽  
pp. 995-1001 ◽  
Author(s):  
Manfred Westphal ◽  
Ulrich Grzyska
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Techniques ◽  
Treatment Procedure ◽  
Major Hemorrhage ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
Aggressive Management ◽  
Feeding Vessels ◽  
Fine Print ◽  
Feeding Vessel

Object. The diminishing threshold for the application of neuroimaging leads to an increasingly frequent diagnosis of previously asymptomatic arteriovenous malformations (AVMs). In such a context, it is warranted to define the criteria that make a lesion potentially hazardous so that neurosurgeons and patients reach a decision concerning how to manage the AVM. In addition to the proposed grading system for AVMs, which assesses the risk of an actual treatment procedure, several studies have been concerned with the evaluation of angioarchitectural features. The goal of the present study is to demonstrate the significance of feeding vessel pedicle aneurysms, especially those found in infratentorial AVMs.Methods. To determine the incidence of associated aneurysms, the authors reviewed an unselected cohort of 242 consecutive patients with AVMs managed between 1989 and 1999. Within this group were 240 patients who were treated by surgery, endovascular techniques, or a combination of both. Of these patients, 216 harbored a supratentorial and 24 an infratentorial AVM. Two additional patients with supratentorial AVMs underwent treatment of ruptured aneurysms without treatment of the AVMs. In six of the patients with supratentorial AVMs, proximal flow-related aneurysms were found on major feeding arteries, only one of which had caused hemorrhage. In only one patient were there additional distal feeding vessel pedicle aneurysms near the AVM, one of which had caused a major hemorrhage. In contrast, four of 24 patients with infratentorial AVMs had distal feeding artery pedicle aneurysms. Three of these aneurysms had caused hemorrhage.Conclusions. Pedicle aneurysms on feeding vessels are frequently associated with hemorrhage (four of five cases in this series). In our cohort of 242 treated patients (240 treated for AVM and two for an aneurysm), feeding vessel pedicle aneurysms appear to occur more frequently in conjunction with infratentorial AVMs, which justifies aggressive management to prevent incidences of morbidity associated with rupture of the aneurysm.

Dural arteriovenous malformations in the anterior cranial fossa

1988 ◽  
Vol 30 (5) ◽  
pp. 396-401 ◽  
Author(s):  
Hidenori Kobayashi ◽  
Minoru Hayashi ◽  
Yoshiyuki Noguchi ◽  
Tetsuro Tsuji ◽  
Yuji Handa ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Anterior Cranial Fossa ◽  
Cranial Fossa
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