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Dural sinus stenting is an increasingly recognized intervention for the treatment of lateral sinus stenosis. This procedure can be challenging in tortuous anatomy and in the presence of intraluminal septa because of poor trackability and crossability of long sheath commonly used for stenting. We report a technique using a pilot angioplasty balloon positioned at the distal end of the long sheath that improves its navigability in dural sinuses and facilitated the intervention.

Forty-three patients with arterio-venous fistulae of the dura of the transverse sinus with a complaint of tinnitus are reviewed, with a follow-up of 12 months to 11 years. 34 patients were embolized, 2 treated surgically, and 7 were untreated. Embolization appears to have been beneficial. The frequently benign nature of this abnormality must be emphasized, and serious psychological study of the patient must be made before deciding on therapy.

The purpose of this study was to evaluate the contribution of magnetic resonance imaging (MRI) to the diagnosis of septic thrombosis of transverse and sigmoid sinuses to analyze the different steps of the diagnosis and to identify the origin of the difficulties in diagnosis. This retrospective study included eight patients aged 53-81 years (mean age: 61.9 years) with proven or highly probable septic thrombosis of transverse and sigmoid sinuses. All patients underwent a pre- and post-contrast enhancement brain CT scans and MRI. MR venogram (n=4) and HRCT of the temporal bone were performed when diagnosis was under discussion. After admission, the delay in diagnosis of lateral sinus thrombosis ranged from 8 to 60 days, with an average of 27 days (SD: +/-12.8). The delay in diagnosis was mainly due to non focused CT scans (6/8) or MR images performed at the initial presentation and absence of systematic radiological reading of the related fatty spaces and of skull base in bone windows (3/8). Diagnosis of septic origin of the thrombosis is of great importance, as it completely modifies the therapeutic planning of the patients. However, it remains a difficult challenge due to its lack of suggestive neurological or otolaryngologic symptoms.

Deep cerebral venous thrombosis (DCVT) is a rare, potentially fatal disease. We carried out a retrospective analysis of eight patients presenting with DCVT, using CT and MRI data. Digital subtraction angiography (DSA), MR angiography (MRA) (2D phase-contrast), and angiography were performed in four, four and two patients, respectively. Direct (venous abnormalities) and indirect (parenchymatous involvement) signs of thrombosis were assessed. Follow-up MRI and MRA were performed on two patients. CT was initially normal in two patients, demonstrated a "cord sign" in deep veins in five and deep venous infarcts in three. When performed within a week of admission (seven patients), MRI showed thrombosis as into intense or high signal in deep veins on sagittal T1-weighted spin-echo images in all patients, and on axial T2-weighted spin-echo images in two. Deep venous infarcts were found in five patients. Direct or indirect signs of sagittal or lateral sinus thrombosis were present on CT in two patients and on MRI in five. CT angiography, MRA and DSA were concordant with MRI findings. CT venography showed persistent flow in thrombosed veins. MRI follow-up demonstrated progressive deep venous recanalisation.

The main objectives of the present study are to assess the incidence of cerebral venous thrombosis (CVT) presenting as isolated subarachnoid hemorrhage (SAH) and to determine the occurrence of cortical venous thrombosis (CoVT).Among 332 patients with CVT, investigated with the same CT and MR standardized protocol, 33 (10 %) presented with SAH, associated in 11 cases with hemorrhagic infarct or intracerebral hemorrhage. This study is based on 22 cases of CVT presenting as SAH in the absence of hemorrhagic brain lesion. Diagnosis of sinus thrombosis was established on T2* and magnetic resonance venography and that of CoVT on T2* sequence. Diagnostic of SAH was based on fluid-attenuated inversion recovery (FLAIR) sequence.CVT involved lateral sinus in 18 patients, superior sagittal sinus in 16, and straight sinus in 1. Cortical veins were involved in all patients, in continuity with dural sinus thrombosis when present. SAH was circumscribed to few sulci in all cases and mainly localized at the convexity (21 cases). CoVT implied different areas on the same side in four patients and was bilateral in seven. There was no perimesencephalic or basal cisterns hemorrhage. Cortical swelling was present in 12 cases, associated with localized edema. All patients except one had a favorable outcome.This report shows that the incidence of CVT presenting as isolated SAH is evaluated to 6.4 % and that SAH is, in all cases, in the vicinity of CoVT and when dural thrombosis is present in continuity with it.

The authors describe a case of a large congenital arteriovenous fistula in a child of 3 1/2 years. The middle meningeal artery was the afferent vessel, there was a direct shunt to the lateral sinus. During operation the external carotid artery was ligated twice.

The angiographic features of three cases with holoprosencephaly are reported. In all of them, the galenic venous system seemed to be deficient and the basal ganglia were drained by peculiar veins which coursed laterally and drained directly into the lateral sinus. These peculiar veins are considered to be remnants of the embryonic diencephalic viens, suggesting that these patients retain their early embryonic pattern of venous drainage. The diagnosis of alobar holoprosencephaly is established by the demonstration of the azygos anterior cerebral artery coursing along the frontal bone with excessive undulations. But with lobar holoprosencephaly, this characteristic feature is not present, and dysgenesis of the deep venous system is important for the diagnosis of holoprosencephaly.