Search

Congenital extrahepatic portosystemic shunts (CEPS) are rare anomalies connecting the portal system to the inferior vena cava. This report discusses a 10-year-old boy with Type II c CEPS, presenting cyanosis and dyspnea. Surgical ligation resulted in significant improvement in symptoms. Early identification and intervention are crucial, necessitating a protocolized approach. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 32-year-old man with a rare manifestation of port-wine stain (PWS), characterized by rapid hypertrophy and nodularity indicative of a combined capillary-lymphatic-arteriovenous malformation (CLAVM). It mentions that the patient, who had a purple macule since birth, developed additional nodules and discharges, leading to a diagnosis through imaging and biopsy.

Background Anterior cranial fossa dural arteriovenous fistulas (ACF-dAVFs) are aggressive vascular lesions. The pattern of venous drainage is the most important determinant of symptoms. Due to the absence of a venous sinus in the anterior cranial fossa, most ACF-dAVFs have some degree of drainage through small cortical veins. We describe the natural history, angiographic presentation and outcomes of the largest cohort of ACF-dAVFs. Methods The CONDOR consortium includes data from 12 international centers. Patients included in the study were diagnosed with an arteriovenous fistula between 1990-2017. ACF-dAVFs were selected from a cohort of 1077 arteriovenous fistulas. The presentation, angioarchitecture and treatment outcomes of ACF-dAVF were extracted and analyzed. Results 60 ACF-dAVFs were included in the analysis. Most ACF-dAVFs were symptomatic (38/60, 63%). The most common symptomatic presentation was intracranial hemorrhage (22/38, 57%). Most ACF-dAVFs drained through cortical veins (85%, 51/60), which in most instances drained into the superior sagittal sinus (63%, 32/51). The presence of cortical venous drainage predicted symptomatic presentation (OR 9.4, CI 1.98 to 69.1, p=0.01). Microsurgery was the most effective modality of treatment. 56% (19/34) of symptomatic patients who were treated had complete resolution of symptoms. Improvement of symptoms was not observed in untreated symptomatic ACF-dAVFs. Conclusion Most ACF-dAVFs have a symptomatic presentation. Drainage through cortical veins is a key angiographic feature of ACF-dAVFs that accounts for their malignant course. Microsurgery is the most effective treatment. Due to the high risk of bleeding, closure of ACF-dAVFs is indicated regardless of presentation. [ABSTRACT FROM AUTHOR]

Dieulafoy's disease is a rare and important cause of recurrent upper gastrointestinal bleeding, which can cause fatal gastrointestinal bleeding. We reported a patient with Dieulafoy's disease in both of the stomach and duodenum for the first time. The patient achieved no effective hemostasis after two endoscopic treatments and two arterial angiography embolizations. Finally, successful hemostasis was achieved through surgery. There are many endoscopic treatment methods, but there is no consensus on the best treatment for hemorrhagic Dieulafoy's disease. Surgery is only a last resort after the failure of endoscopic treatment and angiography embolization. [ABSTRACT FROM AUTHOR]

Herein, we describe the use of a novel multiplug flow control technique for the curative transarterial embolisation of cerebrovascular malformations using liquid embolic agents (LEAs). The idea behind the use of this technique is to substantially control or arrest flow during LEA injection, with multiple plugs simultaneously formed from microcatheters that are placed within all or multiple feeders, so that the penetration of LEAs is facilitated, with flow control decreasing the washout of a malformation. This technique enables the complete occlusion of a vascular malformation in a shorter injection time than that in other methods because penetration is achieved faster. Details of this technique have been described in the treatment of two cases: one case of unruptured temporal arteriovenous malformation and in the other with a falcotentorial dural arteriovenous fistula, in which the vascular malformations were successfully occluded with transarterial embolisation. [ABSTRACT FROM AUTHOR]

Purpose  The main objective of this study is to demonstrate the diagnostic accuracy of susceptibility-weighted angiography (SWAN) in the diagnosis of slow-flow cerebral vascular malformations, especially developmental venous anomaly (DVA). We also aimed to determine the prevalence of DVAs identified by SWAN at 1.5 T. Methods  We retrospectively evaluated 1,760 axial SWAN images for the diagnosis of low-flow vascular anomaly. Among them were 305 patients who underwent contrast-enhanced examination due to different indications. Postcontrast images were analyzed by different radiologists who were blinded to patients. The presence of DVA and other features such as location, length, depth, and direction of drainage vein was evaluated. Results  Twenty-six patients with DVA had both SWAN and postcontrast images. There were four false-negative patients with SWAN. The sensitivity of the SWAN sequence was 84.6%. In addition, totally 77 DVA (4.36%), 2 capillary telangiectasia (0.11%), and 2 cavernous malformations (0.11%) were detected in 1,760 patients. Conclusion  SWAN is an effective method for the diagnosis of developmental venous anomalies and other low-flow cerebral vascular malformations. Especially in the pediatric age, susceptibility-weighted imaging sequences are useful to limit contrast use. [ABSTRACT FROM AUTHOR]

Background: In the 1980s, vascular anomalies were divided into two major subgroups--vascular tumors and vascular malformations--based on the functional framework. This concept has been fundamental to the management of vascular anomalies and expanded and refined by the International Society for the Study of Vascular Anomalies. Vascular malformations are further sub-divided into several types; however, there are many cases with insufficient information about the disease. Current Concepts: Several instances have shown that the diagnosis of vascular malformations can be achieved after a careful evaluation of patient history and examination. However, recently developed imaging technology has been of great help in the diagnosis. Doppler ultrasonography, magnetic resonance imaging, computed tomography scan, and angiography are valuable tools for diagnostic and therapeutic planning. Advanced diagnostic and therapeutic technologies have also provided more accurate and safer diagnoses and appropriate treatment. Recently, an improved method of managing vascular malformations has emerged, based on a multidisciplinary approach, which is very useful for increasing the treatment efficacy. The development of gene research has enabled the investigation of disease-related genes and the development of new medications. Discussion and Conclusion: Accurate diagnosis of vascular malformations is one of the most crucial factors in determining treatment plan and prognosis, based on which it would be possible to achieve effective results through appropriate management and a multidisciplinary team approach. [ABSTRACT FROM AUTHOR]

Background: Anatomic variation may increase the difficulty and risk of anatomic segmentectomy. The preoperative three-dimensional computed tomography bronchography and angiography (3D-CTBA) can provide a detailed model of the segmental structure, and contribute to precise and safe segmentectomy.Case Presentation: This is a case of anomalous bronchi and pulmonary vessels in the right upper posterior segment (RS2). Under the guidance of 3D-CTBA, anatomic RS2 segmentectomy was performed accurately and safely. The postoperative condition was uneventful.Conclusions: This rare case highlights the importance of 3D-CTBA to guild accurate segmentectomy with anatomic variation. [ABSTRACT FROM AUTHOR]

Purpose: Pial arteriovenous fistulae (PAVF) are rare intracranial vascular malformations, predominantly seen in children and distinct from arteriovenous malformations and dural arteriovenous fistulae. PAVF often leads to high morbidity and mortality. The aim of our study was to describe the clinical features and endovascular management of PAVF at various intracranial locations; to analyze the use of liquid embolic agents and coils alone or in combination in the treatment of PAVF and to analyze the outcome of embolization. Materials and Methods: Retrospective review of diagnostic angiography and neurointerventional database of our institution identified a cohort of 15 patients with non-galenic PAVF from 2008 to 2014 out of 6750 patients. Fourteen patients were treated endovascularly with coils and liquid embolic materials in combination or alone. Patients were followed up for evaluation of prognosis. Results: Age of the patients ranged from 3 to 37 years. Most patients were male and most common presentation was headache followed by seizure. Most common location of fistula was frontal lobe. The most common type was single artery single hole fistula with venous varix. Satisfactory obliteration was seen in all cases. One patient developed intraparenchymal hematoma on the first post procedural day and outcome was poor. Conclusions: PAVF are rare intracranial vascular malformations which can effectively be managed endovascularly with liquid embolic, coils alone, or in combination. Complete occlusion of the fistula can be achieved in most cases in a single sitting with a reasonable morbidity related to the procedure, compared with the natural history of this disease. [ABSTRACT FROM AUTHOR]

Background Arteriovenous malformation (AVM)-associated aneurysms are common, reported in 15% of cases. Regarding the ruptured posterior fossa AVMs, associated aneurysms are present in 48% of cases and are the cause of the bleed in 37%. We present a 75-year-old female who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm arising from a flow-related basilar perforator artery feeder of an anterior pontine AVM. We report the successful treatment of the aneurysm with coil embolization. Case Description A 75-year-old female presented with subarachnoid hemorrhage primarily contained within the posterior fossa. Angiography demonstrated a 2 × 3-mm fusiform aneurysm arising from a basilar perforator feeding pedicle of an anterior 1 × 2-cm pontine AVM. Venous drainage from the AVM was predominantly to the superior petrosal vein. Under roadmap guidance, super-selective catheterization of the basilar perforator aneurysm was performed. Three HydroSoft 3D coils were deployed within the aneurysm, resulting in complete obliteration. The patient was discharged on postbleed day 15 to an inpatient rehabilitation facility. Follow-up angiography at 5 months demonstrated stable complete obliteration. The patient made a complete recovery and was living independently at the time of this report. Conclusions Basilar trunk perforator aneurysms are rare lesions, particularly in the setting of brainstem AVMs. We report successful endovascular treatment of a flow-related ruptured basilar perforator aneurysm associated with an anterior pontine AVM. To the best of our knowledge, this is the second report addressing this scenario. We hope that the information presented here serves to guide future surgical decision making and management. [ABSTRACT FROM AUTHOR]

Currently the major aim in peripheral vascular malformation diagnosis, crucial for subsequent management and treatment, is to identify its haemodynamic characteristics. Other significant features that should be specified by a radiologist are the exact location of the anomaly, its size, and its morphology. Until recently the diagnostic methods available for comprehensive evaluation of malformations have been rather limited. Moreover, they were often associated with the necessity of exposing the patient to X-ray radiation and with invasive procedures, as for example in angiography. The development of imaging techniques used in the diagnosis of vascular abnormalities in recent years, especially magnetic resonance imaging, has contributed to improved diagnostic value of the tests. In this article we review the currently available imaging modalities with particular consideration of magnetic resonance imaging and its capability to distinguish between high- and low-flow malformations. [ABSTRACT FROM AUTHOR]

Background: Glomangiomyoma is a rare histological variant of glomus tumour. Clinically, it mimicks as a haemangioma and is challenging to diagnose. Its occurrence in the neck of a child has not been previously described. Case presentation: A 3 year old girl presented with the complaints of painless progressive neck swelling in the right side for one and half year. Sonography, computed tomography (CT), magnetic resonance imaging (MRI), CT neck angiography and fine needle aspiration cytology (FNAC) were suggestive of vacular malformation i.e. giant haemangioma or arteriovenous malformation. The mass was removed in toto under general anaesthesia without postoperative complications. The histopathology confirmed it to be glomangiomyoma with haemangiopericytoma like features. Conclusion: It's an extremely rare variant of glomus tumour and may be the first report of a glomangiomyoma in the neck of a child. Despite a rare entity, it should be borne in mind during differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: To examined the curative effect of vitreous injection with ranibizumab,laser coagulation and cryotherapy in treating stage 3 Coats' disease with exudative retinal detachment.Methods: Seventeen patients with stage 3 Coats' disease were enrolled in the study. All eyes were treated with vitreous injection of ranibizumab as initial treatment, and subsequent treatment depended on the absorption of subretinal fluid, Including cryotherapy and laser photocoagulation. Repeat treatment for the two treatment intervals occurred in ≥1 month. The mean follow-up time was 24.12 ± 5.99 months. The main data evaluation and outcome measurements included the patient's vision, intraocular pressure(IOP), optical coherence tomography (OCT), slit lamp examination, indirect ophthalmoscopy, color Doppler imaging (CDI) and color fundus image analysis. The following variables were compared between groups: abnormal vascular changes, subretinal fluid and exudate absorption, retinal reattachment and complications. The final follow-up results were used to determine the effectiveness of treatment.Results: Of the 17 patients included, 88.24% were male and 11.76% were female. Visual acuity was less than 0.02 in 12 eyes before surgery and 8 eyes after surgery. Visual acuity improved in 7 eyes, accounting for 41.18% of cases, and remained unchanged in 7 eyes, accounting for 41.18% of cases. Three patients were too young to undergo the operation, accounting for 17.65% of cases. The best vision was 0.1. Patients were treated 1 to 5 times for an average of 2.82 ± 0.95 times each. There was no statistically significant difference (t = 1.580, p = 0.135) between the preoperative and postoperative intraocular pressures. However, there was a statistically significant difference between the preoperative and postoperative retinal detachment height (2- related samples Wilcoxon signed rank test with z = 3.517, p = 0.000). The results further showed that all patients had different degrees of subretinal fluid absorption, and some of the new blood vessels subsided. All patients were successfully treated with laser and cryosurgery. No ocular or systemic complications were observed during follow-up.Conclusions: Intravitreal ranibizumab (IVR), laser coagulation and cryotherapy were effective in the treatment of Coats' disease with exudative retinal detachment.Trial Registration Number: We retrospectively registered our study, The trial registration number (TRN) is ChiCTR-ONC-17011161 and date of registration is April 16, 2017. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate clinical outcomes of transarterial embolization of bilateral uterine arteries (UAE) in patients with acquired uterine vascular malformation (UVM). Materials and Methods: This retrospective study was performed on the medical records of all 19 patients who underwent transarterial embolization of bilateral UAE for the treatment of symptomatic UVMs from January 2003 to June 2011. Embolization was performed via the unilateral femoral artery approach with a catheter and angiographic techniques. Clinical success was defined as definitive resolution of abnormal vaginal bleeding. Post-procedural complications included all adverse events related to the embolization procedure. Results: A total of 20 procedures were performed in 19 patients. One patient required repeat embolization because of incomplete embolization related to prominent high flow malformation. Clinically, in all patients, bleeding was controlled immediately after embolization. No complications occurred in all patients during the follow up period. In all patients who underwent successful UAE, menstrual cycles were normally restored within 1-2 months. Normal pregnancy with term delivery was observed in two of the 19 cases. Conclusion: Transarterial bilateral UAE is a safe and effective treatment in patients with vaginal bleeding caused by acquired UVM, and it allows the possibility of future pregnancy. [ABSTRACT FROM AUTHOR]

A case of double ophthalmic arteries arising from the internal carotid artery with unique features is reported. This case was discovered following in the course of time the progress of a thrombosis of the anterior cavernous sinus associated with a low-flow direct arteriovenous fistula of the superior ophthalmic vein. At different time points, the same patient underwent four angiographic studies and one computerized tomography with contrast medium. Angiographies showed that the double internal carotid artery origin of the ophthalmic artery was detectable only within a short range of time. To the best of our knowledge, this case is unique as it demonstrates that a second ophthalmic artery may lie hidden, showing itself only under particular hemodynamic requirements. [ABSTRACT FROM AUTHOR]

Objectives: Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign microvascular proliferation tumor. The etiology of ALHE is unknown, though some hypothesize it occurs in reaction to focal trauma. This study presents a case of AHLE within a vascular malformation, its treatment, and a review of the literature. Methods: A retrospective case report was performed with a 4-year follow-up. Medical records including clinic notes, radiography, operative reports, pathology, and long-term follow-up were reviewed. Results: Radiologic imaging revealed a vascular malformation with highly tortuous, corkscrew-shaped arterial vessels. Histology revealed midsized vessels with plump, epithelialized endothelium and focal areas of lymphocytic infiltrate punctuated with eosinophils, consistent with ALHE. Conclusion: This case demonstrates a unique presentation of ALHE in association with vascular malformation. Initial physical exam lacked the classic dermatologic presentation of clusters of red-to-brown nodules; however, the corkscrew vessels lined by epithelized endothelial cells and eosinophilic infiltrate were pathognomonic for ALHE. [ABSTRACT FROM AUTHOR]

Background: Venous and lymphatic malformations of the head and neck can be successfully treated with percutaneous sclerotherapy.Purpose: To examine the utility of three-dimensional volumetric analysis to assess these lesions and their response to therapy.Material and Methods: Prospectively maintained procedure records were retrospectively reviewed to identify all patients with vascular malformations who underwent percutaneous sclerotherapy. Clinical data were used to classify lesions by apparent size and degree of visible physical asymmetry due to the lesions. Lesion volume was calculated using magnetic resonance images. Cohen's weighted kappa coefficients were calculated to assess both intra- and inter-rater agreement. Pearson coefficients were calculated to identify correlation between clinical and volumetric measures, both at initial diagnosis and following treatment.Results: Thirty-seven patients with head and neck venous or lymphatic malformations underwent 55 treatment sessions. Cohen's weighted kappa coefficients were 0.84 and 0.77 for intra- and inter-rater agreement, respectively. Clinical size did not significantly correlate with measured volume at diagnosis (ρ = 0.08, P = 0.57). For lymphatic malformations, total lesion volume correlated with volume of macrocystic components (ρ = 0.47, P < 0.01). Total volume reduction significantly correlated with clinical response grade (ρ = 0.46, P = 0.02). For lymphatic malformations, reduction of volume of the macrocystic component significantly correlated with clinical response grade (ρ = 0.44, P = 0.03).Conclusion: Changes in calculated volume corresponded to clinical measures of treatment response. Variability of qualitative approaches to lesion analysis may have led to the lack of correlation between initial size of a lesion based on clinical measures and calculated volume. Future research should include quantitative metrics to augment qualitative clinical results. [ABSTRACT FROM AUTHOR]

Objective The authors introduce a new fusion technique using 2 three-dimensional digital subtraction angiography images acquired by a flat-panel detector angiographic system to understand the detailed angioarchitecture of complex cerebral and spinal vascular malformations. Methods Eleven consecutive cases of arteriovenous fistula or arteriovenous malformation with lesions that involved 2 major vessels (i.e., internal carotid arteries, external carotid arteries, vertebral arteries, or spinal arteries) were included. Three-dimensional rotational angiography was performed in each affected vessel after conventional cerebral or spinal angiography. Subsequently, the 2 three-dimensional digital subtraction angiography images were fused. Results The fused images provided the accurate three-dimensional angioarchitecture of complex vascular malformations clearly with high spatial resolution. In particular, the relationship between the nidus/fistulous point, the feeding arteries from each major vessel, and the draining veins could be easily delineated from different directions and multiple angles. Surgical or endovascular treatment was performed in all cases based on the information from these fused three-dimensional images. Conclusions A fusion technique using two three-dimensional digital subtraction angiography is beneficial for preoperative planning and successful treatment in cases of complex cerebral and spinal vascular malformations. [ABSTRACT FROM AUTHOR]

Objective The proximal segment of the anterior cerebral artery (A1) is among the most uncommon locations for occurrence of an intracranial aneurysm. These aneurysms may be missed if small or misinterpreted when they are near the internal cerebral artery bifurcation or Anterior Communicating Artery region. The association with congenital vascular anomalies and multiplicity makes them unique. Methods Seventeen A1 aneurysms were diagnosed in sixteen patients between January 2000 and October 2014 in our institution. A retrospective review of the clinical, radiological, and management (microsurgical and endovascular) details of these patients was conducted. Results The incidence of A1 aneurysm was 1.71% of all patients harboring aneurysms and 1.19% of all aneurysms. Half of these patients exhibited subarachnoid hemorrhage. Fourteen aneurysms underwent microsurgical or endovascular intervention. All patients recovered well, except for one patient who died in the postoperative period. Conclusions A1 aneurysms are rare, with wide anatomic variations. In this article, we discuss those variations in detail with illustrative cases and pictures. We also discussed the microsurgical and endovascular strategies to encounter them highlighting the technical challenges. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the relative accuracy of contrast-enhanced time-resolved angiography with interleaved stochastic trajectories versus conventional contrast-enhanced magnetic resonance imaging (MRI) following International Society for the Study of Vascular Anomalies updated 2014-based classification of soft-tissue vascular anomalies in the head and neck in children.Materials and Methods: Time-resolved angiography with interleaved stochastic trajectories versus conventional contrast-enhanced MRI of children with diagnosis of soft-tissue vascular anomalies in the head and neck referred for MRI between 2008 and 2014 were retrospectively reviewed. Forty-seven children (0-18 years) were evaluated. Two paediatric neuroradiologists evaluated time-resolved MRA and conventional MRI in two different sessions (30 days apart). Blood-pool endovascular MRI contrast agent gadofosveset trisodium was used.Results: The present cohort had the following diagnoses: infantile haemangioma (n=6), venous malformation (VM; n=23), lymphatic malformation (LM; n=16), arteriovenous malformation (AVM; n=2). Time-resolved MRA alone accurately classified 38/47 (81%) and conventional MRI 42/47 (89%), respectively. Although time-resolved MRA alone is slightly superior to conventional MRI alone for diagnosis of infantile haemangioma, conventional MRI is slightly better for diagnosis of venous and LMs. Neither time-resolved MRA nor conventional MRI was sufficient for accurate diagnosis of AVM in this cohort. Conventional MRI combined with time-resolved MRA accurately classified 44/47 cases (94%).Conclusion: Time-resolved MRA using gadofosveset trisodium can accurately classify soft-tissue vascular anomalies in the head and neck in children. The addition of time-resolved MRA to existing conventional MRI protocols provides haemodynamic information, assisting the diagnosis of vascular anomalies in the paediatric population at one-third of the dose of other MRI contrast agents. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of abnormal hepatic venous waveforms in patients suffering from hepatic cirrhosis. Study Design: Cross sectional. Place and of Study Duration: Shafique Medical Centre Quetta & Radiology Department Combined Military Hospital, Quetta from December 15th 2009 to July 15th 2010. Material and Methods: The instrument used in this study was Toshiba Eccocee SSA-340A and ALOKA SSD- 5000 doppler ultrasound machines with linear and convex probes. Hepatic venous Doppler was performed with convex 3-5 MHz probe. Hepatic venous Doppler examination was performed by two radiologists (operators) on all the 135 patients with positive HCV, HBV, chronically raised amino transferase level and clinical & radiological features of cirrhosis, who independently and blindly recorded their findings. Nonprobability, purposive sampling was done. After Doppler ultrasonographic examination liver biopsy & histopathology of all the patients was performed. Data from each patient was collected on designed form for age, gender, types of hepatic vein waveforms and grades/severity of liver cirrhosis on histopathology. Results: 135 patients with maximum 50 years and minimum 41 years of age have mean age of 46.79 ± 2.37. Out of 135 patients in 103 (76.3%) Type 1 (Triphasic) flow was observed in 3%, Type II (Biphasic without reduced oscillation) flow was observed in 29.6%, type III (Biphasic with reduced oscillation) flow was observed in 34.1% and type IV (Monophasic) flow noted in 33.33 %. There was significant correlation between hepatic venous waveform and severity of cirrhosis on histopathology (r=0.887, p< 0.001) Conclusion: Hepatic venous Doppler is noninvasive tool which can be employed to assess the types of abnormal hepatic venous waveforms in patients with hepatic cirrhosis. There is significant correlation between hepatic venous waveform and severity of cirrhosis on histopathology. [ABSTRACT FROM AUTHOR]

A 23-year-old white man was admitted to the hospital for evaluation of recurrent hemoptysis. He denied any other associated symptoms, including dyspnea, chest pain, productive cough, wheezing, fever, or weight loss. He had no significant past medical history and was not taking any medication. He had no significant family history for cardiopulmonary diseases. [ABSTRACT FROM AUTHOR]

The gold standard in dural arteriovenous fistulas (DAVF) evaluation is complete angiography. Treatment options include: conservative management, open surgery, endovascular therapy, stereotactic radiosurgery or multimodality therapy. The goal of microsurgical intervention is DAVF obliteration or selective CVD disconnection. We present a 59 years old male who was brought to the Emergency Department of the National Institute of Neurology and Neurovascular Diseases in a comatose state (GCS- 5p) . [ABSTRACT FROM AUTHOR]

Objective: Venous malformation (VM) is a common vascular malformation in soft tissue. Its morphological and draining features, relationship with main vein, and hemodynamics in the lesion are not completely clear till now. Above information is important for choice of treatment. Methods: From January 2012 to December 2013, 23 patients were enrolled into this study. Percutaneous puncture into the lesion was made and contrast media was injected into venous sinus. Immediately after that CT scan was performed, and repeated several minutes later. Then three-dimensional imaging was performed to show the morphology and draining veins of VMs, and the relevant main veins. The hemodynamics in the lesion was also evaluated. Results: All patients underwent successful examination. Three-dimensional imaging showed an irregular shape of VM. Based on the draining features, VMs were classified into three types: (1) Type I (7/23): malformation without visible draining vein; (2) Type II (10/23): malformation with normal draining vein; (3) Type III (6/23): malformation with abnormal dilated draining vein. The flow in type I VMs was slow. Contrast media retained in the lesion for more than 1 day. The flow in type III VMs was fast. Contrast media flowed away rapidly. The flow of type II VMs was between type I and type III. According to above information and adjacent anatomy, all patients received suitable treatment, including sclerotherapy with absolute ethanol and bleomycin A5, intralesional copper wires retention, surgical removal, and combinational therapy of the above methods. Conclusions: This procedure can clearly show the morphological and draining features of VM and its relationship with main vein, and further evaluate the hemodynamics in the lesion, which are helpful for the choice of treatment. [ABSTRACT FROM AUTHOR]

Vascular malformations (VMs) are developmental abnormalities of the vascular system. Malformations may involve any segment of the vascular tree: arteries, capillaries, veins or lymphatics. High-flow arteriovenous malformations (AVMs) are associated with shunting of large amounts of arterial blood into the venous system; these lesions can have dynamic and dramatic hemodynamic manifestations, such as massive arteriolisation with gross venous engorgement, organomegaly of concerned anatomical region and high-output cardiac failure. Patients with Parkes Weber syndrome have clinically significant micro- or macrofistulous arteriovenous shunts, affecting usually one extremity. The patient has dilated, frequently visible pulsatile varicose veins and other visible signs of AV shunting. The abnormality is sporadic; it is likely a somatic mutation. There is frequent intraosseous involvement. The presence of high AV shunts differentiates Parkes Weber syndrome from Klippel-Trenaunay syndrome which is a clinical triad of capillary malformation, soft tissue and bone hypertrophy and venous and lymphatic malformations. The mutations in RASA 1 gene leads to Parkes Weber syndrome characterised by the presence of multiple, small (1-2 cm in diameter) capillary malformations mostly localized on the face and limbs. We report a case of congenital AVM of the lower limb causing cardiac decompensation. The patient was safely and successfully treated by performing a knee disarticulation. [ABSTRACT FROM AUTHOR]

Pulsatile tinnitus with normal otoscopic findings often presents a diagnostic challenge to otolaryngologists and can be attributed to serious vascular malformations such as dural arteriovenous fistulas (DAVFs). Spontaneous DAVFs are relatively rare. A 65-year-old woman presented with sudden-onset subjective/objective pulsatile tinnitus on the right side that had persisted for 2 months. Angiography and magnetic resonance angiography revealed DAVF formation. Stereotactic radiosurgery was performed, and total remission of the DAVFs was achieved. [ABSTRACT FROM AUTHOR]

This study was performed to provide a detailed atlas of the normal arterial and venous canine vasculature in the cranial abdomen by dual-phase computed tomographic angiography. Five adult beagles were positioned in dorsal recum-bency on a multislice helical CT scanner. An unenhanced survey CT scan from the diaphragm to the pelvic inlet was performed. Bolus-tracking software was used for the dual-phase angiogram, and contrast medium was administered in a cephalic vein. The arterial phase was scanned from the mid-abdomen to the cranial aspect of the diaphragm; the portal phase was scanned a few seconds after the arterial phase in the opposite direction. The DICOM studies from all dogs were analysed. Representative images were selected and anatomic struc-tures labelled. Maximum intensity projections and three-dimensional images were generated using software techniques. A detailed atlas of the venous and arterial vasculature of the cranial canine abdomen was created with the help of bolus-tracking dual-phase computed tomographic angiography (CTA). Practi-tioners can use this anatomic atlas with its detailed venous and arterial phase CT angiograms of the canine cranial abdomen to compare normal versus abnormal vascular anatomy. [ABSTRACT FROM AUTHOR]

Primary intraventricular haemorrhage (PIVH) is rare. Dural arteriovenous fistula causing PIVH is extremely rare. We report a case of a 17 year old boy who presented with left hemiparesis, left lower motor neuron facial palsy and ataxia. His computed tomography head revealed primary intraventricular hemorrhage. Catheter super selective angiography revealed a dural arterio venous fistula with arterial feeder arising from the middle meningeal artery as well as from the inferior marginal tentorial artery. Glue injection led to successful disappearance of the fistula and eventual clinical recovery. [ABSTRACT FROM AUTHOR]

The unilateral absence of a proximal pulmonary artery (UAPPA) is rare and is most frequently accompanied by cardiovascular anomalies such as tetralogy of Fallot or septal defects. We report a patient with truncus arteriosus with UAPPA in which we performed a two-stage surgical repair. During the first palliative operation, a right modified Blalock-Taussig shunt was constructed to develop the hypoplastic right pulmonary artery. At 10 months, the patient underwent patch closure of a ventricular septal defect with integration of both pulmonary arteries, and reconstruction of the right ventricular outflow tract using a conduit. Four years postoperatively, he continues to do well. [ABSTRACT FROM AUTHOR]

Background: The role of indocyanine green video-angiography (ICG-VA) in the surgical resection of vascular malformations has been largely described; conversely, the utility of ICG-VA before dural opening (transdural ICG-VA) in this situation remains unclear. The aim of this study is to present the application of transdural ICG-VA in a consecutive series of patients in order to explore the potential provided by a transdural visualisation of vascular malformations. Method: We retrospectively analysed the application of intra-operative ICG-VA before dural opening in 15 consecutive patients who underwent surgical resection of vascular malformations. The cases included 12 cerebral arterio-venous malformations (AVMs), 2 cerebral dural arterio-venous fistulas (dAVFs) and 1 spinal arterio-venous fistula (AVF). Results: ICG-VA before dural opening allowed the visualisation of the site and extension of the malformation in 13 out of 15 cases, whilst arterial feeders and venous drainages were identified in 9 out of 15 cases. In two patients with dAVF, the point of fistula could be transdurally identified through ICG-VA. In 14% of cases, the size of bone flap designed on neuronavigation data was then modified according to transdural ICG-VA findings. Conclusions: Transdural ICG-VA proved an efficient tool that allows optimising the exposure of the malformation, performing a safe dural opening and identifying dural vascular connections of the lesion. [ABSTRACT FROM AUTHOR]

Introduction Endovascular embolization for tumors and vascular malformations has emerged as an important preoperative adjunct prior to resection. We describe the advantages of utilizing a recently released dual lumen balloon catheter for ethylene vinyl alcohol copolymer, also known as Onyx (ev3, Irvine, California, USA), embolization for a variety of head and neck pathologies. Methods A retrospective review of all cases utilizing the Scepter C balloon catheter (MicroVention Inc, Tustin, California, USA) for use in balloon augmented embolization was performed over a 4 month period from October 2012 to February 2013 at the Medical University of South Carolina, Charleston, South Carolina, USA. Charts and angiographic images were reviewed. Representative cases involving diverse pathologies are summarized and illustrate the observed advantages of balloon augmented Onyx embolization with a dual lumen balloon catheter. Case illustrations Balloon augmented Onyx embolization utilizing a novel dual lumen balloon catheter was employed to treat both ruptured and unruptured arteriovenous malformations, intracranial dural arteriovenous fi stulae, intracranial neoplasms, carotid body tumors, a thyroid mass, and an extracranial arteriovenous fistula. Conclusions The dual lumen balloon catheter has several advantages for use with Onyx embolization over older devices, including more efficient proximal plug formation and enhanced navigability for placement deep within the pedicles. The balloon augmented Onyx embolization technique represents a valuable tool to add to the armamentarium of the neurointerventionalist to address a variety of head and neck lesions. [ABSTRACT FROM AUTHOR]

The angiographic observation of a radiculomedullary artery variation found in a patient with a spinal cord vascular malformation is presented. A posterior radiculomedullary artery arising from the left L2 intersegmental artery had a duplicated origin. Two radicular trunks were seen aiming towards the neural foramen: a dominant anterior one providing a retrocorporeal artery and the anterior limb of the radicular artery, and a smaller posterior one branching off a prelaminar artery and the posterior limb of the radicular artery. The two limbs then joined to continue as a single posterior radiculomedullary artery, which participated in the vascularization of the vascular malformation. The clinical and developmental aspects of this exceptional variant are discussed. [ABSTRACT FROM AUTHOR]

Children with vascularmalformations are bestmanaged with amultidisciplinary teamof specialists. Interventional radiology may deliver primary treatment such as staged sclerotherapy and embolization for malformations that are poor candidates for primary surgical resection or play a supportive role such as preoperative or intraoperative embolization. A thorough understanding of vascular morphology and flow dynamics is imperative to choosing the best treatment tool and technique. In this review, the author discusses the selection of techniques and tools used to treat vascular malformations based on their angiographic morphology. [ABSTRACT FROM AUTHOR]

Intraosseous vascular lesions of the maxillofacial region are rare, and the differential diagnosis of intraosseous vascular malformations from other jaw lesions can be challenging. In the present case, magnetic resonance imaging and three-dimensional computed tomographic angiography (CTA) was used for diagnosis, and the lesion was treated wih surgical excision. Diverse characteristics such as the "honeycomb" and "sunburst" radiographic appearances and the absence of major peripheral feeder vessels in the CTA were noted. Intraosseous vascular malformations have a varied radiographic appearance, and the nomenclature of these lesions is equally diverse, with several overlapping terms. Pathologists do not generally differentiate among intraosseous vascular lesions on the basis of histopathology, although these lesions may present with contrasting immunohistochemical and clinical behaviors requiring varied treatment strategies. This case report highlights the need for multiple imaging modalities to differentiate among vascular lesions, as well as to better understand the behaviors of these unique lesions. [ABSTRACT FROM AUTHOR]

Nonmaturing arteriovenous fistula remains a hurdle in improving the fistula rate in the hemodialysis population. Timely referral can assist in salvaging fistula with endovascular interventions. Pathology at the inflow segment is frequently encountered as a primary reason for maturation failure. Conventional retrograde angiography can result in poor delineation of the inflow segment and may not be an ideal method for evaluating nonmaturing fistulae. Moreover, the risk of vascular rupture and overzealous diagnosis of accessory veins often result in additional unnecessary therapeutic interventions. Alternatively, a direct brachial arteriogram can provide complete anatomic delineation to perform appropriate endovascular interventions. [ABSTRACT FROM AUTHOR]

Purpose: To compare the association of age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH) variants between two different angiographic phenotypes of polypoidal choroidal vasculopathy (PCV). Methods: We included 175 Japanese patients with PCV and 150 age- and sex-matched controls. PCV was classified into two phenotypes (Type 1 and Type 2) according to the presence or absence of the feeding vessels found in indocyanine-green angiography. The single nucleotide polymorphism (SNP) at rs10490924 (A69S) in ARMS2 and rs800292 (I62V), rs1061170 (Y402H) in the CFH region were genotyped using the TaqMan assay. Results: The minor allele frequency (MAF) of rs10490924 was significantly different between Type 1 PCV ( n = 81) and control ( p < 0.0001), while no difference was found between Type 2 PCV ( n = 94) and control ( p = 0.20). The MAF of rs800292 was significantly different between each type of PCV and control ( p < 0.0001 and 0.0001 for Type 1 versus control and Type 2 versus control, respectively). The MAF of rs1061170 was not significantly different between either type of PCV and control ( p = 0.084 and 0.15, respectively). Conclusions: There may be significantly different associations in the genetic variants of ARMS2 between two angiographic phenotypes of PCV. [ABSTRACT FROM AUTHOR]

Objective. To compare the outcome, with respect to treatment modality, of patients treated with spinal dural arteriovenous fistulas (SDAVF). Method. Retrospective cohort study of patients with SDAVF assessed at a single tertiary referral centre, between 1999 and 2009. Intervention type, pre-/ post-intervention Aminoff-Logue disability score (ALDS) and recurrence rate were obtained from medical records. Results. 26 patients were identified with 23 receiving intervention. All patients initially received super selective angiogram, with 13 undergoing endovascular embolization at this stage, after discussion between the surgeon and interventional radiologist. Six patients who underwent embolization had a recurrence. The remaining 10 patients had fistulas marked during angiography, and were then treated surgically, after discussion. One of these recurred. The difference in recurrence rate between the two intervention types was not statistically significant. Fistulas treated with the embolization material onyx were twice as likely to recur as those treated with the alternative material, histoacryl-lipiodol. There was a statistically significant difference between the modes of intervention in relation to clinical outcome. Surgeries lead to an improvement in neurology, whereas treatment via embolization did not. Neurological improvement was seen in non-recurring cases, however deterioration in neurological function occurred with fistula recurrence. Conclusion. Super selective angiography is effective in defining the relevant vascular anatomy and allows for precise fistula localization during any potential subsequent surgery. Onyx was associated with a higher recurrence rate, suggesting it is less suitable as an embolization material for SDAVF treatment. Surgery appeared to correlate to reversal of neurological impairment seen at presentation, possibly due to a lower recurrence rate. The study is limited by small patient numbers, emphasizing the need for further studies of SDAVF patients. [ABSTRACT FROM AUTHOR]

Objective : Transfemoral catheter angiography (TFCA) is a basic procedure in neurovascular surgery with increasing importance in surgical and non-invasive treatments. Unfortunately, resident neurosurgeons have relatively few opportunities to perform TFCA in most institutions. We report a method developed in our hospital for training resident neurosurgeons to perform TFCA and evaluate the efficacy of this training. Methods : From May 2011 to September 2011, a total of 112 consecutive patients underwent TFCA by one resident neurosurgeon supervised by two neuroendovascular specialists. Patients who underwent elective diagnostic procedures were included in this study. Patients who underwent endovascular treatment were excluded. Demographic data, indications for TFCA, side of approach, number of selected arteries, and complications were analyzed. Results : This study included 64 males and 48 females with a mean age of 51.6 (12-81) years. All procedures were performed in the angiography suite. Common indications for procedures were as follows : stroke-induced symptoms in 61 patients (54.5%), Moyamoya disease and arteriovenous malformation in 13 patients (11.6%), and unruptured intracranial aneurysm in eight patients (7.1%). Right and left femoral puncture was performed in 98.2% and 1.8% of patients, respectively. A total of 465 selective angiographies were performed without complications. Angiographic examination was performed on 4.15 vessels per patient. Conclusion : TFCA can be performed safely by resident neurosurgeons based on anatomical study and a meticulous protocol under the careful supervision of neuroendovascular specialists. [ABSTRACT FROM AUTHOR]

Spontaneous closures of dural arteriovenous fistulas (dAVFs) are rare. We present spontaneous occlusion of dAVFs in 3 cases (one type IIa dAVF, one type IIb and one type III). Patients were 3 males with a mean age of 55 years (range 45-61). For two patients, the dAVF was revealed by hemorrhage. No head trauma was recorded at the interrogatory. Mean delay for spontaneous closure was 4 months (3-5 months). Review of the literature about this rare occurrence is presented and the factors that may lead to spontaneous occlusion of dAVFs are discussed. [ABSTRACT FROM AUTHOR]

Résumé: Nous rapportons deux accouchements, à l’issue de deux grossesses successives, chez une patiente atteinte d’un syndrome de Parkes-Weber. Cette parturiente présentait une angiodysplasie complexe, associant une hypertrophie des parties molles d’un membre inférieur, un angiome plan cutané et des malformations vasculaires artérioveineuses. L’existence de malformations artérioveineuses médullaires a été éliminée par une angiographie médullaire par résonance magnétique nucléaire. Nous décrivons également d’autres aspects de la prise en charge, notamment l’évaluation cardiovasculaire prépartum, la voie d’accouchement, l’emploi de l’analgésie périmédullaire et la prévention des risques hémorragique et thromboembolique. [ABSTRACT FROM AUTHOR]

As a result of their presumed benign natural history, cerebral capillary telangiectasias (CCTs) are infrequently addressed in the neurosurgical literature. We performed a comprehensive review of CCTs via the PubMed database to synthesize overall epidemiological, radiographic, natural history, and treatment results. Across ten series with 203 patients, mean age was 47, and 45 % were male [95 % confidence interval (CI), 0.30-0.65]. Notably, 78 % of CCTs were in the pons (95 % CI, 0.58-1.0). Six percent of CCTs were symptomatic. Across five radiographic series, all lesions enhanced after gadolinium, and all were hypointense on gradient echo sequences. Thirty-three percent were hypointense on T1-weighted pre-contrast imaging (95 % CI, 0.2-0.51), 49 % were hyperintense on T2-weighted imaging (95 % CI, 0.31-0.72), and 74 % were hypointense on diffusion-weighted imaging (95 % CI, 0.5-1.0). Notably, 37 % were associated with a prominent draining vein (95 % CI, 0.21-0.6), and 11 % with a developmental venous anomaly (95 % CI, 0.04-0.25). Across four observational studies with 47 patients, there was no observed change in lesion morphology or hemorrhage in 65.7 patient-years of follow-up. Although the vast majority of CCTs are managed conservatively, we found ten cases of patients treated with surgical excision. We confirm that CCTs are a benevolent entity with a predilection for the pons. They have distinctive radiographic features including their lack of mass effect, consistent enhancement on T1-weighted sequences and hypointensity on gradient echo sequences, and common isointensity on pre-contrast T1-weighted and T2-weighted images. Management for these lesions has been nonoperative in almost all cases. [ABSTRACT FROM AUTHOR]

We describe an extremely rare case of unilateral rete mirabile in a young woman and discuss its significance in embryological development as well as its radiological aspects, differential diagnosis and potential clinical implications. [ABSTRACT FROM AUTHOR]

Purpose: The complex angioarchitecture of spinal dural arteriovenous fistulas (SDAVFs) sometimes preclude angiographic analyses or superselective procedures. Therefore, the effectiveness of 3 dimensional rotational angiography (3DRA) as a detailed imaging technique for SDAVFs was evaluated. Materials and Methods: Of 57 patients with spinal vascular malformations, recent 13 SDAVF patients underwent 3DRA. The advantage of 3DRA compared to digital subtraction angiography (DSA) in imaging SDAVF was assessed. Angioarchitecture of SDAVF was focused on location, number, and course of feeders and draining vein. Appropriate angled views were also selected to reveal the segmental artery and feeders. Results: 3DRA technique provided additional information for imaging evaluation of SDAVFs compared to DSA; the presence of multiple feeders, including their transdural portions, as well as their courses. The contralaterally angled anterior-oblique-caudal (spider) view showed the radicular feeder by separating the intercostal artery and the dorsal muscular branch. The bottom-to-up (tunnel) view was useful for revealing the location (ventral vs. dorsal) including sharp medial turn of the dural feeder. The dual mode, which displays both vessels and bones, revealed the course of the feeders and the fistula related to the spinal bony column. Conclusion: Because spinal vasculature overlaps in DSA, 3DRA revealed additional information for evaluations of the number and transdural course of fistular feeders in SDAVFs, and it offers working angles to obtain appropriate views. [ABSTRACT FROM AUTHOR]

Abstract: Vascular complications after kidney transplantation occur at a rate of 1–4% cases. The commonest of these complications is graft artery stenosis. It is often detected following difficult to control hypertension and/or graft dysfunction. If detected early usually with the help of duplex Doppler ultrasonography it can be successfully treated by endovascular intervention by suitably trained specialists. Interventions are also needed for post graft biopsy hemorrhage or arterio-venous fistula (AVF). Percutaneous transcatheter fibrated platinum coil embolization super selectively in the artery supplying the AVF can be life saving. It may improve blood pressure control and graft function in selected cases. Other endovascular interventions performed in transplanted kidneys are graft renal angioplasty with or without stenting and placement of covered stent graft. Technological advances in noninvasive imaging like CT angiogram, contrast enhanced Doppler ultrasound and MR angiography have simplified diagnosis and follow up of these patients without compromising safety. At our institute since January 2007, we encountered 8 cases of transplant renal artery stenosis, 6 arteriovenous fistulas and a case of extra and intrarenal pseudo aneurysm. All patients with transplant renal artery stenosis underwent angioplasty and stenting successfully both in terms of anatomical correction and improvement in blood pressure control as well as graft function. One patient had arterial stenosis and arteriovenous fistulas both and he underwent simultaneous stenting and coil embolization. Three patients with fistulas who had significant bleeding underwent successful coil embolization while 2 patients who were asymptomatic are under close surveillance. One patient each who had extra and intrarenal pseudo aneurysm underwent successful endovascular covered stent grafting and multiple coil embolization respectively. Vascular interventions in renal allograft by experienced nephrology unit can achieve good success with minimal complications. [Copyright &y& Elsevier]

Purpose: To report the efficacy of percutaneous puncture and sclerosis using polidocanol in the treatment of venous malformations (VMs) in pediatric patients.Patients/methods: Between March 2007 and February 2011, a series of 19 patients with VMs on the upper and lower extremities had undergone a total of 89 sessions of intralesional sclerotherapy using polidocanol. All the procedures were performed in an angiographic suite under general anesthesia in order to maintain sedation for facilitating the procedure. For each injection, approximately 1 ml of 2% polidocanol was injected for each centimeter of the diameter of the lesion, with a maximum of 6 ml. Injection of the sclerosant was guided by real-time sonography and fluoroscopy.Results: After the treatment, the symptoms completely resolved in four patients (21%). Clinical symptoms, such as bulging and pain were improved in 12 out of 19 patients (63%). They remained unchanged in three patients (16%). During the procedures, no major complications were encountered. The minor complications (65%) encountered were swelling and pain after treatment which were resolved by taking NSAID within a few days.Conclusion: In pediatric patients, sonographically guided percutaneous puncture and fluoroscopically guided sclerosis using 2% polidocanol is effective, less invasive and safe for the treatment of VMs, with a high success rate and minimal complications. [ABSTRACT FROM AUTHOR]

Aim: To assess the accuracy of low-dose contrast-enhanced time-resolved 3T magnetic resonance angiography (MRA) for the morphological and functional assessment of vascular malformations (VM), and to evaluate its diagnostic potential for the depiction of treatment-induced changes. Materials and methods: Twenty-five patients with known VM underwent MRA to evaluate the location and extent of lesions and their haemodynamic characteristics. Three-dimensional (3D) T1-weighted time-resolved sequences were acquired following the administration of 0.05mmol/kg of gadobenate dimeglumine. VM were classified according to their morphology and haemodynamic characteristics. All patients thereafter underwent conventional angiography to confirm the diagnosis and to treat the lesions (embolization or sclerotherapy). Follow-up MRA was performed 30 days after treatment to assess morphological and functional changes. A visual analogue scale (VAS) was used to clinically assess the severity of symptoms before and after therapy. Results: Based on haemodynamic characteristics, VM were classified as predominantly arterial [4 (16%)], artero-venous [19 (76%)] or venous [2 (8%)]. Twenty-three (92%) lesions were classified as high-flow VM and two (8%) as low-flow VM. Intralesional thrombosis was present in 17 (68%) lesions before therapy and in 10 lesions (40%) after therapy. The median VAS scores were 5±1 before treatment and 4±2 after treatment. Very good correlation (Spearman’s correlation coefficient: rho=0.87; p =0.000) was noted between the reduction of lesion size on follow-up MRA and pain relief as assessed by VAS. Conclusion: Low-dose contrast-enhanced time-resolved 3T MRA can be used to define morphological and functional aspects of VM accurately during treatment planning and follow-up, and can identify post-therapy changes that positively correlate with treatment outcome. [ABSTRACT FROM AUTHOR]

In cerebral arterioveneous malformations (AVMs) detailed intraoperative identification of feeding arteries, nidal vessels and draining veins is crucial for surgery. Intraoperative imaging techniques like indocyanine green videoangiography (ICG-VAG) provide information about vessel architecture and patency, but do not allow time-dependent analysis of intravascular blood flow. Here we report on our first experiences with analytical indocyanine green videoangiography (aICG-VAG) using FLOW 800 software as a useful tool for assessing the time-dependent intraoperative blood flow during surgical removal of cerebral AVMs. Microsope-integrated colour-encoded aICG-VAG was used for the surgical treatment of a 38-year-old woman diagnosed with an incidental AVM, Spetzler Martin grade I, of the left frontal lobe and of a 26-year-old man suffering from seizures caused by a symptomatic AVM, Spetzler Martin grade III, of the right temporal lobe. Analytical ICG-VAG visualization was intraoperatively correlated with in situ micro-Doppler investigation, as well as preoperative and postoperative digital subtraction angiography (DSA). Analytical ICG-VAG is fast, easy to handle and integrates intuitively into surgical procedures. It allows colour-encoded visualization of blood flow distribution with high temporal and spatial resolution. Superficial major and minor feeding arteries can be clearly separated from the nidus and draining veins. Effects of stepwise vessel obliteration on velocity and direction of AVM blood flow can be objectified. High quality of visualization, however, is limited to the site of surgery. Colour-encoded aICG-VAG with FLOW 800 enables intraoperative real-time analysis of arterial and venous vessel architecture and might, therefore, increase efficacy and safety of neurovascular surgery in a selected subset of superficial AVMs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the characteristics of six patients with dural arteriovenous fistula (DAVF) with drainage directly into the perimedullary venous system. In five patients with subarachnoid hemorrhage (SAH), cerebral angiography revealed a DAVF with spinal venous drainage located at the petrosal sinus in one, at the tentorium in one, and at the craniocervical junction in four. In the patient with myelopathy, angiographic exploration began with a spinal angiogram. Bilateral vertebral angiography initially failed to demonstrate the fistula, and a tentorial DAVF was established with carotid artery angiography. Patients had no myelopathy when the venous drainage was limited to the cervical cord; myelopathy was present when the venous drainage descended toward the conus medullaris. Diagnosis of a DAVF presenting with myelopathy is more challenging than of those presenting with SAH. [ABSTRACT FROM AUTHOR]

Background: Lower extremity vascular anomalies have been described for patients with clubfoot but few imaging studies have investigated effects on soft tissues such as fat and muscle. To make these assessments we need noninvasive, noncontrast agents to more safely image children. Questions/purposes: We describe a novel noninvasive imaging protocol to identify vascular and soft tissue abnormalities in the lower limbs of patients with clubfoot and determine whether these abnormalities are present in patients who had recurrent clubfoot. Patients and Methods: Three-dimensional noncontrast-enhanced MR angiography was used to identify vascular, bone, and soft tissue abnormalities in patients with clubfoot. We determined whether these abnormalities were more common in patients who had experienced recurrent clubfoot. Results: Four patients with isolated unilateral clubfoot had arterial anomalies in the clubfoot limb. All patients had less muscle volume in the affected limb, and nine of 11 patients (82%) had less subcutaneous fat, with a mean difference of 0.56 cm ± 0.36 cm (range, 0.08-1.12 cm). Vascular anomalies and decreased fat and muscle volumes were present in all three patients with recurrent clubfoot. Conclusions: We found a high frequency of vascular and soft tissue anomalies in the affected limbs of patients with unilateral clubfoot that may correlate with response to treatment. Clinical Relevance: This approach has the potential to enhance our understanding of the anatomy of clubfoot and lead to a larger MRI study that may allow more accurate prediction of the risk of recurrent clubfoot. [ABSTRACT FROM AUTHOR]

Purpose: The Pittsburgh radiosurgery-based arteriovenous malformation (AVM) grading scale was developed to predict patient outcomes after radiosurgery and was later modified with location as a two-tiered variable (deep vs. other). The purpose of this study was to test the modified radiosurgery-based AVM score in a separate set of AVM patients managed with radiosurgery. Methods and Materials: The AVM score is calculated as follows: AVM score = (0.1)(volume, cc) + (0.02)(age, years) + (0.5)(location; frontal/temporal/parietal/occipital/intraventricular/corpus callosum/cerebellar = 0, basal ganglia/thalamus/brainstem = 1). Testing of the modified system was performed on 293 patients having AVM radiosurgery from 1992 to 2004 at the University of Pittsburgh with dose planning based on a combination of stereotactic angiography and MRI. The median patient age was 38 years, the median AVM volume was 3.3 cc, and 57 patients (19%) had deep AVMs. The median modified AVM score was 1.25. The median patient follow-up was 39 months. Results: The modified AVM scale correlated with the percentage of patients with AVM obliteration without new deficits (≤1.00, 62%; 1.01–1.50, 51%; 1.51–2.00, 53%; and >2.00, 32%; F = 11.002, R 2 = 0.8117, p = 0.001). Linear regression also showed a statistically significant correlation between outcome and dose prescribed to the margin (F = 25.815, p <0.001). Conclusions: The modified radiosurgery-based AVM grading scale using location as a two-tiered variable correlated with outcomes when tested on a cohort of patients who underwent both angiography and MRI for dose planning. This system can be used to guide choices among observation, endovascular, surgical, and radiosurgical management strategies for individual AVM patients. [ABSTRACT FROM AUTHOR]