scholarly journals Traumatic injury of dural venous sinus as cause of epidural hematoma: importance of recognition and adequate surgical planning

2021 ◽  
Vol 47 (1) ◽  
pp. 40-43
Author(s):  
Guilherme Brasileiro de Aguiar ◽  
Leonardo Henrique da Silva Rodrigues ◽  
Paulo Adolfo Wessel Xander ◽  
Tiago Marques Avelar ◽  
Guilherme Henrique Ferreira da Costa ◽  
...  
Keyword(s):  
Epidural Hematoma ◽  
Traumatic Injury ◽  
Middle Meningeal Artery ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Cranial Trauma ◽  
Level Of Consciousness ◽  
Dural Venous Sinus ◽  
The Many ◽  
Acute Epidural Hematoma

Background: Although most traumatic epidural hematomas are secondary to arterial injuries, particularly rupture of the middle meningeal artery, around 9.7% of cases are associated with dural venous sinus injury, leading to poorer prognosis and greater complications. We report a case of a patient presenting cranial trauma with bone fracture and laceration of the transverse sinus producing epidural hematoma, and discuss the main aspects of this condition. Case description: A 47-year-old man struck by a motorcycle was admitted to the Emergency Room with a score of 15 on the Glasgow Coma Scale, evolving over 5 hours with reduced level of consciousness. A cranial CT scan was performed disclosing right parieto- occipital hyperdensity, consistent with acute epidural hematoma, and a parieto-occipital fracture line crossing the path of the ipsilateral transverse sinus. Parietal craniotomy was performed to drain the hematoma, revealing a venous sinus injury requiring immediate repair. Conclusions: This case and discussion highlight the many details and technical specificities to be taken into account by neurosurgeons when encountering intracranial hematoma caused by traumatic injury of the dural venous sinus, and which are pivotal in determining the efficacy of the treatment approach and prognosis of the patient.

Injury to the Dural Venous Sinuses

Neurotrauma ◽  
2019 ◽  
pp. 45-52
Author(s):  
Tarek Y. El Ahmadieh ◽  
Christopher J. Madden ◽  
Shelly D. Timmons
Keyword(s):  
Epidural Hematoma ◽  
Traumatic Injury ◽  
Surgical Techniques ◽  
Air Embolism ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Sinus Surgery ◽  
Initial Assessment ◽  
Intraoperative Control ◽  
Dural Venous Sinus

This chapter presents the case of a large surgically evacuated occipital/suboccipital epidural hematoma, caused by traumatic injury to the left transverse sinus. It reviews the guidelines for surgical evacuation of epidural hematomas, as well as the incidence, initial assessment, surgical planning, and management of dural venous sinus injuries. Further addressed are the surgical techniques and nuances used for intraoperative control of dural venous sinus bleeding and strategies used for dural venous sinus repair. Finally, the potential complications associated with dural venous sinus surgery, including rebleeding and air embolism, and their management in the intraoperative and postoperative settings are discussed.

Abstract TP329: Venous Collateral Drainage Patterns Predict Clinical Worsening in Dural Venous Sinus Thrombosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sunil A Sheth ◽  
Harry Trieu ◽  
David S Liebeskind ◽  
Jeffrey L Saver ◽  
Viktor Szeder ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Complete Recovery ◽  
Transverse Sinus ◽  
Venous Hypertension ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
Dural Venous Sinus ◽  
Dural Venous Sinus Thrombosis ◽  
Clinical Worsening

Background: Dural venous sinus thrombosis (DVST) is an increasingly recognized cause of a wide array of neurological symptoms, with outcomes that range from complete recovery to death. Approximately 23% of patients with DVST will worsen after initial presentation, as a result of restricted venous outflow and venous hypertension, but early identification of this subset is challenging. A venous collateral scale (VCS) that grades alternative drainage routes may improve prediction of clinical deterioration. Methods: From our institutional database, we identified patients with documented DVST on dedicated venous imaging (MR, CT or catheter angiography) from January 2010 to July 2016. Patients were excluded for thrombosis related to arteriovenous fistulae. The VCS (Table) was created and scores were determined from cerebrovascular venous imaging at presentation by two reviewers blinded to subsequent imaging and clinical data. Results: Among 28 patients that met criteria, median age was 42 (IQR 24-57) and 50% (14/28) were female. Presentation symptoms included intracranial hemorrhage in 40% (11/28) and headache without hemorrhage in 18% (5/28). Transverse sinus occlusion was present in 68% (19/28), and superior sagittal sinus occlusion in 39% (11/28). 82% (23/28) of patients were treated with anticoagulation, and 18% (5/28) with endovascular thrombectomy. New hemorrhage or expansion of initial hemorrhage occurred in 21% (6/28). In-hospital mortality occurred in 18% (5/28). VCS was 0 in 18% (5/28), 1 in 39% (11/28), and 2 in 46% (12/28). Lower VCS was significantly associated with development of new hemorrhage or expansion of initial hemorrhage (62% vs. 0%, VCS 0-1 vs. 2, p<0.01). VCS demonstrated excellent discrimination for in-hospital clinical worsening (C-statistic 0.85). Conclusions: The type and quality of venous collaterals influence outcome in DVST. VCS helps identify patients who are likely to deteriorate and may need additional early interventions.

Transarterial N-Butyl-2-cyanoacrylate Embolization of an Intraosseous Dural Arteriovenous Fistula Associated With Acute Epidural Hematoma: Technical Case Report

2015 ◽  
Vol 11 (3) ◽  
pp. E468-E471 ◽  
Author(s):  
Shotaro Yoshioka ◽  
Kazuyuki Kuwayama ◽  
Junichiro Satomi ◽  
Shinji Nagahiro
Keyword(s):  
Epidural Hematoma ◽  
Clinical Presentation ◽  
Middle Meningeal Artery ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Maxillary Artery ◽  
Microsurgical Anatomy ◽  
The Right ◽  
Acute Epidural Hematoma

Abstract BACKGROUND AND IMPORTANCE Intraosseous dural arteriovenous fistulae (DAVF) are rare, especially those with drainage into the diploic venous system. The clinical presentation depends on the location of the lesion. This is the first report of an intraosseous DAVF associated with acute epidural hematoma. CLINICAL PRESENTATION A 25-year-old man presented with headache and nausea. Imaging of the brain revealed abnormal signals indicative of acute epidural hematoma in the right frontal convexity. Angiography demonstrated a DAVF in the region of the frontal bone. Right external carotid artery angiography showed that the DAVF was fed mainly by the right middle meningeal artery with drainage into diploic veins. Immediately after embolization of the middle meningeal and the distal internal maxillary artery with 17% N-butyl-2-cyanoacrylate, the shunt was completely occluded. The patient was discharged 4 days later without clinical complications. CONCLUSION Intraosseous DAVF can be treated by surgical resection or endovascular embolization. Curative treatment requires careful inspection of the angiographic architecture and microsurgical anatomy.

scholarly journals Computed Tomography Angiography for Detection of Middle Meningeal Artery Lesions Associated with Acute Epidural Hematomas

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Wellingson Silva Paiva ◽  
Almir Ferreira Andrade ◽  
Robson Luis Oliveira De Amorim ◽  
Edson Bor-Seng-Shu ◽  
Gabriel Gattas ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Traffic Accidents ◽  
Epidural Hematoma ◽  
Middle Meningeal Artery ◽  
Vascular Lesion ◽  
Conventional Angiography ◽  
Cerebral Angiogram ◽  
History Of ◽  
Acute Epidural Hematoma ◽  
Meningeal Artery

Background.The natural history of traumatic aneurysms of the middle meningeal artery (MMA) is not well known, but patients with these lesions are more likely to have delayed bleeds. In this paper, we described a series of patients with epidural hematoma who underwent angiotomography (CTA) for MMA vascular lesion diagnosis.Methods.Eleven patients admitted to our emergency unit with small acute epidural hematoma were prospectively studied. All patients with temporal acute epidural hematomas underwent CTA and cerebral angiogram at our institution for diagnosis of posttraumatic lesions of middle meningeal artery. The findings of angiotomography and digital angiography were reviewed by radiologist and angiographers, respectively, to ensure that the lesions were readily diagnosed without knowing the results of angiotomography and to compare CTA findings with standard angiogram.Results.The causes of head injury were traffic accidents, falls, and aggression. Three of these patients presented traumatic MMA pseudoaneurysm. CT angiography was able to diagnose all of them, with dimensions ranging from 1.5 to 2.8 mm. Conventional angiography confirmed the findings of CT angiography, and the lesions presented with similar dimensions at both methods.Conclusions.We believe that angiotomography can be a useful technique for diagnosis of vascular lesion associated with small epidural hematoma.

Neonatal giant dural sinus ectasia: a multimodality imaging approach

2021 ◽  
Vol 14 (9) ◽  
pp. e242439
Author(s):  
Ralph Rommualdo Abareta Zuniega ◽  
Julian Alejandro Santos ◽  
Romelito Jose Galvan Galsim ◽  
Jonathan Saputil Elevazo
Keyword(s):  
Multimodality Imaging ◽  
Case Reports ◽  
Case Series ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Cardiac Insufficiency ◽  
Dural Sinus ◽  
Dural Sinuses ◽  
Sagittal Sinus ◽  
Dural Venous Sinus

Dural venous sinus ectasia is a rare anomaly characterised by the formation of a large vascular lake within the leaves of the dural sinuses, usually associated with thrombosis. These lesions can cause brain compression, cardiac insufficiency and disseminated intravascular coagulation, which may lead to poor prognosis. We present the case of a neonate who presented with an intracranial mass on prenatal ultrasound. Postnatal transcranial ultrasonography, cranial CT and cranial MRI demonstrated a large lesion predominantly occupying the dural sinus confluence, extending into the sagittal sinus, straight sinus and right transverse sinus. The left marginal sinus remains unfused and patent. Concomitant arteriovenous malformations were evident in the median interhemispheric fissure and the left Sylvian fissure. There are several published case reports and case series describing malformations of the dural sinuses in perinatal and neonatal patients in recent years, but this case is unique in that: (1) there is the presence of a vascular malformation concomitant to the dural sinus ectasia and (2) it highlights the importance of imaging in clinching the diagnosis of giant dural venous sinus ectasia, as it is often misdiagnosed as more common conditions such as extra-axial intracranial haemorrhage.

scholarly journals Operative Nuances of Blind Catheterization of Occluded Sinuses Using Negative Road Map Technique: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Denise Brunozzi ◽  
Ali Alaraj
Keyword(s):  
Transverse Sinus ◽  
Venous Sinus ◽  
External Carotid ◽  
Road Map ◽  
Institutional Review ◽  
First Case ◽  
Patient Consent ◽  
Cortical Venous Reflux ◽  
Retrospective Nature ◽  
Dural Venous Sinus

Abstract Dural arteriovenous fistula (DAVF) are often treated with endovascular transvenous embolization. DAVFs though, are often associated with intracranial venous sinus occlusion, which limits the transvenous route.  Here, we present the operative nuances of blind catheterization of an occluded dural venous sinus in 2 different cases with DAVF. First case is a 72-yr-old patient with indirect right carotid-cavernous fistula associated with an occluded inferior petrosal sinus, with severe orbital congestion. Second patient is a 79-yr-old patient with a new external carotid to a trapped transverse sinus fistula (Cognard IIA + B), extensive cortical venous reflux in the setting of an occluded sigmoid sinus. In both cases, the transarterial route was limited because of small arterial feeders thus, after obtaining patients’ consent, we performed transvenous sacrifice of the isolated sinus. In both cases, the occluded sinus was transvenously blindly retrograde probed using a 0.035 inch Terumo Glidewire (Terumo Medical Corporation, Somerset, New Jersey). Once the occluded segment was probed, a dark roadmap was acquired with the wire in place. This created a negative roadmap once the guidewire is removed. This negative roadmap is used to navigate the microcatheter-microwire into the isolated sinus. In the first case, the cavernous sinus and the superior ophthalmic veins were sacrificed with coils. In the second patient, the entrapped left transverse sinus was embolized using Onyx. In both cases, complete occlusion of the fistula was attained.  In this neuroendovascular video, we demonstrate the nuances of blind catheterization of an occluded sinus using a negative roadmap technique as guidance for the micro-catheterization.  Institutional Review Board approved. Patient consent not required due to retrospective nature of manuscript, based on medical chart and imaging reviews, anonymized in the video.

scholarly journals MRV BRAIN NORMALANATOMICAL VARIANTS IN INDIA POPULATION

2020 ◽  
pp. 59-62
Author(s):  
Vemireddy Sreechand Reddy ◽  
Apoorva. C ◽  
Ankamma Rao. D
Keyword(s):  
Sinus Thrombosis ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Mr Venography ◽  
Medical College ◽  
Sagittal Sinus ◽  
Dural Venous Sinus

Introduction Knowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations Materials and Methods A retrospective study was conducted in NRI medical college in the Department of Radiodiagnosis for a duration of 3 years to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences. Results A total of (46 men, 54 women, age range 12 to 81 years), were included in the study. Most common indication for MR venography was headache (80%). Hypoplastic left transverse sinus was the most common anatomical variation in (25%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to females (13 versus 12). Most common variation of superior sagittal sinus (SSS) was hypoplastic anterior one third SSS ,. Conclusion Hypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders.

Prevalence of dural venous sinus stenosis and hypoplasia in a generalized population

2016 ◽  
Vol 8 (11) ◽  
pp. 1173-1177 ◽  
Author(s):  
Christopher R Durst ◽  
David A Ornan ◽  
Michael A Reardon ◽  
Prachi Mehndiratta ◽  
Sugoto Mukherjee ◽  
...  
Keyword(s):  
General Population ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Inclusion Criteria ◽  
Multivariate Statistical ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

Background and purposeWhile recent literature has described the prevalence of transverse sinus stenosis in patients with idiopathic intracranial hypertension, tinnitus, and refractory headaches, it is unclear what the prevalence is in the general population. This study evaluates the prevalence of venous sinus stenosis and hypoplasia in the general patient population.Materials and methods355 of 600 consecutive patients who underwent CT angiography of the head met the inclusion criteria. The diameters of the dural venous sinuses were recorded. Each study was evaluated by a neuroradiologist for the presence of stenoses. Univariate and multivariate statistical analyses were performed by a statistician.ResultsThe prevalence of unilateral transverse sinus stenosis or hypoplasia in a sample of patients representing the general population was 33%, the prevalence of bilateral transverse sinus stenosis was 5%, and the prevalence of unilateral stenosis with contralateral hypoplasia was 1%. A multivariate analysis identified arachnoid granulations as a predictor of stenosis (p<0.001). Gender trended toward significance (p=0.094). Race was not a significant predictor of stenosis (p=0.745).ConclusionsThe prevalence of bilateral transverse sinus stenosis in the general population is not trivial. These data may be used as a reference for understanding the mechanistic role of stenoses in idiopathic intracranial hypertension, tinnitus, and refractory headaches.

The Marginal Sinus Normal Anatomy and Involvement with Arteriovenous Fistulae

1996 ◽  
Vol 2 (3) ◽  
pp. 215-221 ◽  
Author(s):  
A.J. Evans ◽  
D.F. Kallmes ◽  
M.E. Jensen ◽  
J.E. Dion
Keyword(s):  
Venous Drainage ◽  
Transverse Sinus ◽  
Foramen Magnum ◽  
Venous Sinus ◽  
Venous Plexus ◽  
Treatment Results ◽  
Arteriovenous Fistulae ◽  
Marginal Sinus ◽  
Dural Venous Sinus ◽  
Lateral Margins

Rationale and Objectives The marginal sinus is an infrequently recognized dural venous sinus at the rim of the foramen magnum. Recognition of this sinus and knowledge of its anatomy will enable the neurointerventionalist to treat dural arteriovenous fistulae (AVF) involving the marginal sinus. Methods We present a report of the signs, symptoms, angiographic appearance, and treatment results of two patients with marginal sinus dural AVF. In addition, we review the literature concerning the marginal sinus and describe the anatomy of this region. Angiograms depicting normal variants are presented to illustrate the various patterns that may be encountered when the marginal sinus participates in the venous drainage of the cranium. Results In two patients with dural arteriovenous fistulae (AVF) the marginal sinus was found to be the venous receptacle. The marginal sinuses are dural venous sinuses located at the lateral margins of the foramen magnum. Superiorly, the marginal sinus connects to the occipital sinus, a single or paired midline venous channel arising at the torcular Herophili or the medial transverse sinus. The marginal sinus typically drains into the sigmoid sinus, and may connect to the condylar veins, the superior aspect of the internal venous plexus, or the occipital plexus. Occasionally, the occipital-marginal sinus system represents the primary drainage pathway of the cranium, completely replacing the transverse sinus. In the two patients we treated with dural AVF in this location, simple transvenous packing of the sinus effectively cured the lesion. Conclusions The marginal sinus is a dural venous sinus that can rarely be involved with a dural AVF. Recognition that a dural AVF involves the marginal sinus can facilitate safe, effective therapy.

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