Magnetic resonance imaging and computed tomography in the diagnosis of cerebral venous infarction

A clinical observation of the diagnosis of cerebral venous stroke, rare in clinical practice, based on the data of magnetic resonance imaging and computed tomography of the brain, is presented, the semiotics of the revealed changes is described.

Gastric venous reconstruction to reduce gastric venous congestion after total pancreatectomy: study protocol of a single-centre prospective non-randomised observational study (IDEAL Phase 2A) - GENDER study (Gastric vENous DrainagE Reconstruction)

IntroductionTotal pancreatoduodenectomy (TP) is the standard surgical approach for treating extended pancreas tumours. If TP is performed with splenectomy, the left gastric vein (LGV) sometimes needs to be sacrificed for oncological or technical reasons, which can result in gastric venous congestion (GVC). GVC can lead to gastric venous infarction, which in turn causes gastric perforation with abdominal sepsis. To avoid gastric venous infarction, partial or total gastrectomy is usually performed if GVC occurs after TP. However, gastrectomy can be avoided by reconstructing the gastric venous outflow to overcome GVC and avoid gastric venous infarction. The current study aims to assess the role of gastric venous outflow reconstruction to prevent GVC after TP and avoid gastrectomy.Methods and analysisIn the current single-centre observational pilot study, 20 patients will be assigned to study after intraoperative evaluation of gastric venous drainage after LGV resection during TP. During surgery, on-site evaluation by the surgeon, endoscopic examination, indocyanine green, gastric venous drainage flowmetry and spectral analysis will be performed. Postoperatively, patients will receive standard post-TP care and treatment. During hospitalisation, endoscopic examination with indocyanine green will be performed on the 1st, 3rd and 7th postoperative day to evaluate gastric ischaemia. Ischaemia markers will be evaluated daily after surgery. After discharge, patients will be followed-up for 90 days, during which mortality and morbidities will be recorded. The main endpoints of the study will include, rate of GVC, rate of gastric ischaemia, rate of postpancreatectomy gastrectomy, rate of reoperation, morbidity and mortality.Ethics and disseminationThe study protocol has been reviewed and approved by the Ethics Committee of the University of Heidelberg. The results will be actively disseminated through peer-reviewed journals and conference presentations, and are expected in 2022.Trial registration numberNCT04850430.

Balloon-backstop technique: Preserving physiologic venous drainage during transvenous coil embolization of sigmoid sinus dural arteriovenous fistulas

Dural arteriovenous fistulas can lead to catastrophic intracranial hemorrhage if left untreated. Transvenous embolization can cure arteriovenous fistulas, but preserving normal venous structures can be challenging. Inadvertent embolization of a functioning vein can result in catastrophic venous infarction or hemorrhage. Here, we report a case using balloon-assistance to facilitate preservation of the superior petrosal sinus during transvenous embolization of a sigmoid sinus dural arteriovenous fistula.

Risk Factors Influencing Cerebral Venous Infarction After Meningioma Resection

Introduction Cerebral venous infarction is a serious complication after meningioma resection. To reduce the incidence of venous infarction, we identified risk factors for postoperative cerebral venous infarction after surgical resection of meningioma in patients with clinical symptoms.Methods The clinical and imaging data of 1127 patients with intracranial meningiomas who underwent resection in our hospital were retrospectively collected and analyzed. Cerebral venous infarction was evaluated by postoperative imaging and clinical manifestations. Univariate and multivariate analyses were performed to identify risk factors associated with cerebral venous infarction.Results Overall, 3.3% (37/1127) of patients experienced symptomatic cerebral venous infarction after meningioma resection. Multivariate analysis revealed superficial meningioma, moderate to severe peritumoral edema, peritumoral critical vein and WHO grade II-III as independent predictors of a postoperative cerebral venous infarction. After timely intervention, the symptoms were clearly alleviated in one month, and the prognosis was good, but injury to key veins could cause irreversible neurological disorders.Conclusions Intraoperative protection of veins is the primary way to prevent cerebral venous infarction. The present study identified several significant and independent risk factors for postoperative venous infarction, thereby enabling the identification of high-risk patients who require special attention during clinical and surgical management.

Risk Factors Influencing Venous Cerebral Infarction after Meningioma Resection

Introduction Venous cerebral infarction is a serious complication after meningioma resection. To reduce the incidence of venous infarction, we identified risk factors for postoperative venous cerebral infarction after surgical resection of meningioma in patients with clinical symptoms.Methods The clinical and imaging data of 1127 patients with intracranial meningiomas who underwent resection in our hospital were retrospectively collected and analyzed. Venous cerebral infarction was evaluated by postoperative imaging and clinical manifestations. Univariate and multivariate analyses were performed to identify risk factors associated with venous cerebral infarction.Results Overall, 3.3% (37/1127) of patients experienced symptomatic venous cerebral infarction after meningioma resection. Multivariate analysis revealed superficial meningioma, moderate to severe peritumoral edema, peritumoral critical vein and WHO grade II-III as independent predictors of a postoperative venous cerebral infarction. After timely intervention, the symptoms were clearly alleviated in one month, and the prognosis was good, but injury to key veins could cause irreversible neurological disorders.Conclusions Intraoperative protection of veins is the primary way to prevent venous cerebral infarction. The present study identified several significant and independent risk factors for postoperative venous infarction, thereby enabling the identification of high-risk patients who require special attention during clinical and surgical management.

De Novo Pial Arteriovenous Fistula Associated With Cerebral Infarction and Venous Hypertension: Report of 2 Cases Suggesting a “Second Hit Theory”

ABSTRACT BACKGROUND AND IMPORTANCE The etiology of de novo pial arteriovenous fistula (AVF) is unknown. We found 2 cases of de novo pial AVF, which appeared after cerebral infarction and which was associated with venous hypertension secondary to venous sinus thrombosis with a dural AVF (dAVF). Additional angiogenic stimuli (second hit) were considered as one of the mechanisms of de novo pial AVF. CLINICAL PRESENTATION A 63-yr-old male was admitted to our hospital due to an intraventricular hemorrhage. He had a history of cerebral infarction 2 yr before. Angiography demonstrated multiple dAVFs with bilateral occlusion of the distal transverse sinus associated with prominent retrograde cortical venous drainage. A pial AVF was found at the border of his previous cerebral infarction. Both lesions were successfully treated using endovascular technique. A second case involved a 47-yr-old female who was admitted to our hospital due to venous infarction also associated with sinus thrombosis. De novo pial AVF at the border of the venous infarction and dAVF at the transverse sigmoid junction were demonstrated on angiography 6 mo later. CONCLUSION We speculate that venous hypertension associated with additional angiogenic stimuli (second hit) due to brain ischemia and/or brain injury related to infarction caused de novo pial AVF in these 2 cases.