Development of acquired arteriovenous fistulas in rats due to venous hypertension

1994 ◽  
Vol 80 (5) ◽  
pp. 884-889 ◽  
Author(s):  
Tomoaki Terada ◽  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Mitsuharu Tsuura ◽  
...  
Keyword(s):  
Jugular Vein ◽  
Sinus Thrombosis ◽  
Venous Hypertension ◽  
External Jugular Vein ◽  
Dural Sinus ◽  
Content Type ◽  
Vein Occlusion ◽  
Group I ◽  
Facial Vein ◽  
Fine Print

✓ Dural sinus thrombosis has been hypothesized as a possible cause of dural arteriovenous fistulas (AVF's). The pathogenesis and evolution from thrombosis to actual development of an AVF are still unknown. To study dural fistula formation, a surgically induced venous hypertension model in rats was created by producing an arteriovenous shunt between the carotid artery and the external jugular vein. The external jugular vein beyond the anastomosis was ligated 2 to 3 months after surgery and angiography was performed to identify any new acquired AVF's. Forty-six male Sprague-Dawley rats, each weighing approximately 300 gm, were used for this study. In Group I, 22 rats underwent a common carotid artery anastomosis to the external jugular vein, which is the largest draining vein from the transverse sinus via the posterior facial vein, followed by proximal external jugular vein ligation. In Group II, 13 rats underwent the same surgical procedure, followed by contralateral posterior facial vein occlusion. Group III served as the control group, in which 11 rats underwent only unilateral external jugular vein occlusion with or without contralateral posterior facial vein occlusion. The shunts in Groups I and II were ligated at 2 to 3 months following surgery, and transfemoral angiography was performed immediately before and after occlusion. New acquired AVF's had developed in three rats (13.6%) in Group I, three rats (23.1%) in Group II, and no rats (0%) in Group III. One of these newly formed fistulas was located at the dural sinus, analogous to the human dural AVF. The other five were located in the subcutaneous tissue, including the face and neck. The dural AVF in the rat was present on follow-up angiography at 1 week after the bypass occlusion. It is concluded that chronic venous hypertension of 2 to 3 months' duration, without associated venous or sinus thrombosis, can induce new AVF's affecting the dural sinuses or the subcutaneous tissue.

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.

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.

A transcranial approach for direct mechanical thrombectomy of dural sinus thrombosis

2004 ◽  
Vol 101 (2) ◽  
pp. 347-351 ◽  
Author(s):  
Ali Chahlavi ◽  
Michael P. Steinmetz ◽  
Thomas J. Masaryk ◽  
Peter A. Rasmussen
Keyword(s):  
Mechanical Thrombectomy ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Dural Sinus ◽  
Content Type ◽  
Thrombolytic Agents ◽  
Increased Risk ◽  
Transcranial Approach ◽  
Risk Of Hemorrhage ◽  
Fine Print

✓ Cerebral venous sinus thrombosis is often difficult to manage. Treatment options include systemically delivered anticoagulation therapy or chemical thrombolysis. Targeted endovascular delivery of thrombolytic agents is currently a popular option, but it carries an increased risk of hemorrhage. These strategies require significant time to produce thrombolysis, often in a patient with a rapidly deteriorating neurological condition. Rapid mechanical recanalization with thrombectomy is therefore very attractive; this procedure provides rapid recanalization with no increased risk of hemorrhage from use of thrombolytic agents. Nevertheless, the rheolytic catheter is large and stiff and may not be able to navigate tortuous intracranial vascular anatomy. The authors present their experience with direct dural sinus mechanical thrombectomy performed using the rheolytic catheter via a transcranial route. Two patients with dural sinus thrombosis and rapidly deteriorating levels of consciousness underwent unsuccessful attempts at mechanical thrombolysis via the usual transfemoral route. Through a burr hole over the dural sinus, mechanical thrombectomy was subsequently performed using the thrombectomy catheter. Sinus patency was restored following treatment and both patients demonstrated neurological recovery. Hemorrhage or a rapidly deteriorating neurological condition may preclude the use of systemic or locally delivered thrombolytic agents for the treatment of cerebral venous sinus thrombosis. Mechanical thrombectomy may be the treatment of choice in these circumstances. In patients with limited transfemoral access, a transcranial approach may be used to access the cerebral dural sinuses and thrombectomy may be safely and effectively performed. Further evaluation of this therapy is warranted.

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.

Redefined role of angiogenesis in the pathogenesis of dural arteriovenous malformations

1997 ◽  
Vol 87 (2) ◽  
pp. 267-274 ◽  
Author(s):  
Michael T. Lawton ◽  
Ronald Jacobowitz ◽  
Robert F. Spetzler
Keyword(s):  
Arteriovenous Malformations ◽  
Sinus Thrombosis ◽  
Venous Hypertension ◽  
External Jugular Vein ◽  
Hypertensive Rats ◽  
Angiogenic Activity ◽  
Content Type ◽  
Sagittal Sinus ◽  
Dural Avm

✓ To investigate the role of angiogenesis in the pathogenesis of dural arteriovenous malformations (AVMs), 40 rats underwent common carotid artery—external jugular vein (CCA-EJV) anastomosis, bipolar coagulation of the vein draining the transverse sinus, and sagittal sinus thrombosis to induce venous hypertension. Fifteen rats underwent a similar surgical procedure, but venous hypertension was not induced. The 55 rats were divided into seven groups. Four groups, each containing 10 rats, underwent induced venous hypertension. The other three groups, each containing five rats, did not undergo induced venous hypertension. After 1, 2, or 3 weeks, dura mater was obtained from one group of hypertensive rats and from one group of nonhypertensive rats and was assayed for angiogenic activity (rabbit cornea bioassay). The remaining group of 10 hypertensive rats was not assayed to determine if sampling affected dural AVM formation. Unlike rats without CCA-EJV anastomosis, rats with CCA-EJV anastomosis had significantly increased postoperative sagittal sinus pressures (p < 0.0001). Mean angiogenesis indices were significantly greater in rats with venous hypertension than in rats without venous hypertension (p = 0.004). Dural AVMs formed in 42% of the 55 rats and facial AVMs formed in 51%. Angiogenic activity correlated positively with venous hypertension (ρ = 0.74). Development of dural AVMs correlated positively with both venous hypertension (p = 0.0009) and angiogenic activity (p = 0.04). These data indicate that venous hypertension may induce angiogenic activity either directly or indirectly by decreasing cerebral perfusion and increasing ischemia, and that dural AVM formation may be the result of aberrant angiogenesis.

Treatment of dural sinus thrombosis with local urokinase infusion

1988 ◽  
Vol 68 (2) ◽  
pp. 284-287 ◽  
Author(s):  
John A. Scott ◽  
Robert M. Pascuzzi ◽  
Peter V. Hall ◽  
Gary J. Becker
Keyword(s):  
Intravenous Infusion ◽  
Sinus Thrombosis ◽  
Anticoagulation Therapy ◽  
Current Therapy ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Content Type ◽  
Aggressive Therapy ◽  
Urokinase Infusion ◽  
Fine Print

✓ Current therapy for dural sinus thrombosis consists of supportive measures, anticoagulation therapy, and in some cases intravenous infusion of a fibrinolytic agent. A patient with extensive dural sinus thrombosis was successfully treated with local urokinase infusion. The technique and rationale for this aggressive therapy are discussed.

Neurological manifestations of intracranial dural arteriovenous malformations

1986 ◽  
Vol 64 (5) ◽  
pp. 724-730 ◽  
Author(s):  
Pierre Lasjaunias ◽  
Ming Chiu ◽  
Karel Ter Brugge ◽  
Atul Tolia ◽  
Michel Hurth ◽  
...  
Keyword(s):  
Nervous System ◽  
Sinus Thrombosis ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Clinical Aspects ◽  
Content Type ◽  
Sagittal Sinus ◽  
Cortical Venous Drainage ◽  
Base Of The Skull ◽  
Fine Print

✓ The authors describe their experience with four cases of dural arteriovenous malformation (AVM) which led them to analyze the clinical aspects of these lesions in an attempt to understand their pathophysiology. An additional 191 previously reported cases of dural AVM's were reviewed with special attention to the mechanism of intradural, central, and peripheral nervous system manifestations. Apart from the peripheral cranial nerve symptoms, which are most likely due to arterial steal, the central nervous system (CNS) symptoms appear to be related to passive venous hypertension and/or congestion. Generalized CNS symptoms can be related to cerebrospinal fluid malabsorption due either to increased pressure in the superior sagittal sinus, to venous sinus thrombosis, or to meningeal reaction resulting from minimal subarachnoid hemorrhages. These phenomena are not related to the anatomical type of venous drainage. On the other hand, focal CNS symptoms are specifically indicative of cortical venous drainage. Seizures, transient ischemic attacks, motor weakness, and brain-stem and cerebellar symptoms can be encountered depending on the territory of the draining vein or veins. Therefore, the localizing value of focal CNS symptomatology relates to the venous territory and not to the nidus or to the arterial supply characteristics of dural AVM's. Furthermore, the venous patterns of various dural AVM's at the base of the skull are expressed by differences in their clinical presentation. Dural AVM's of the floor of the anterior cranial fossa and of the tentorium are almost always drained by the cortical veins and, therefore, have a high risk of intradural bleeding. The remarkable similarities in the manifestations of dural and brain AVM's and the differences in the manifestations of dural and spinal dural AVM's are pointed out. High-quality angiograms and a multidisciplinary approach to the study of dural AVM's will provide the best understanding of their symptoms and, therefore, the most appropriate treatment strategy.

Jugular venography for evaluation of abnormalities of the skull base

1976 ◽  
Vol 44 (4) ◽  
pp. 485-492 ◽  
Author(s):  
Robert M. Quencer ◽  
Michael S. Tenner ◽  
Lewis M. Rothman ◽  
D. Wayne Laster
Keyword(s):  
Tumor Growth ◽  
Skull Base ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Venous Occlusion ◽  
Dural Sinus ◽  
Content Type ◽  
Proper Volume ◽  
Base Of The Skull ◽  
Fine Print

✓ Jugular venography done to evaluate abnormalities at the base of the skull demonstrated three distinctly different patterns depending on whether there is occlusion, invasion, or growth within the internal jugular vein. Improper technique results in a lack of intracranial dural sinus filling which may masquerade as venous occlusion. This problem is avoided by adequate neck compression along with proper volume and rate of delivery of contrast. Radiographically, an abnormal jugular vein at the base of the skull will show a concave defect in true occlusion, constriction or invasion of the vein by tumor, or tumor growth within the vein.

scholarly journals Termination of the facial vein into the external jugular vein: an anatomical variation

2008 ◽  
Vol 7 (2) ◽  
pp. 174-175 ◽  
Author(s):  
Suhani Sumalatha D'Silva ◽  
Thejodhar Pulakunta ◽  
Bhagath Kumar Potu
Keyword(s):  
Jugular Vein ◽  
Anatomical Variation ◽  
Venous Drainage ◽  
External Jugular Vein ◽  
Facial Artery ◽  
Drainage Pattern ◽  
Facial Vein ◽  
The Face ◽  
The Common ◽  
Anterior Division

Different patterns of variations in the venous drainage have been observed in the past. During routine dissection in our Department of Anatomy, an unusual drainage pattern of the veins of the left side of the face of a middle aged cadaver was observed. The facial vein presented a normal course from its origin up to the base of mandible, and then it crossed the base of mandible posteriorly to the facial artery. Thereafter, it joined with the anterior division of retromandibular vein to form the common facial vein, which drained into the external jugular vein directly. Sound anatomic knowledge of the above variation in facial veins is essential to the success of surgical procedures in this region.

Sign in / Sign up

Export Citation Format

Share Document