2,876 results on '"Central Nervous System Vascular Malformations"'
Search Results
2. Time-of-flight MRA of intracranial vessels at 7 T
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Mirco Cosottini, Tommaso Calzoni, Guido Andrea Lazzarotti, Alessandro Grigolini, Paolo Bosco, Paolo Cecchi, Michela Tosetti, Laura Biagi, and Graziella Donatelli
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Angiography (digital subtraction) ,Central nervous system vascular malformations ,Magnetic fields ,Magnetic resonance angiography ,Primary angiitis of the central nervous system ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Abstract Background Three-dimensional time-of-flight magnetic resonance angiography (TOF-MRA) is a largely adopted non-invasive technique for assessing cerebrovascular diseases. We aimed to optimize the 7-T TOF-MRA acquisition protocol, confirm that it outperforms conventional 3-T TOF-MRA, and compare 7-T TOF-MRA with digital subtraction angiography (DSA) in patients with different vascular pathologies. Methods Seven-tesla TOF-MRA sequences with different spatial resolutions acquired in four healthy subjects were compared with 3-T TOF-MRA for signal-to-noise and contrast-to-noise ratios as well as using a qualitative scale for vessel visibility and the quantitative Canny algorithm. Four patients with cerebrovascular disease (primary arteritis of the central nervous system, saccular aneurism, arteriovenous malformation, and dural arteriovenous fistula) underwent optimized 7-T TOF-MRA and DSA as reference. Images were compared visually and using the complex-wavelet structural similarity index. Results Contrast-to-noise ratio was higher at 7 T (4.5 ± 0.8 (mean ± standard deviation)) than at 3 T (2.7 ± 0.9). The mean quality score for all intracranial vessels was higher at 7 T (2.89) than at 3 T (2.28). Angiogram quality demonstrated a better vessel border detection at 7 T than at 3 T (44,166 versus 28,720 pixels). Of 32 parameters used for diagnosing cerebrovascular diseases on DSA, 27 (84%) were detected on 7-T TOF-MRA; the similarity index ranged from 0.52 (dural arteriovenous fistula) to 0.90 (saccular aneurysm). Conclusions Seven-tesla TOF-MRA outperformed conventional 3-T TOF-MRA in evaluating intracranial vessels and exhibited an excellent image quality when compared to DSA. Seven-tesla TOF-MRA might improve the non-invasive diagnostic approach to several cerebrovascular diseases. Relevance statement An optimized TOF-MRA sequence at 7 T outperforms 3-T TOF-MRA, opening perspectives to its clinical use for noninvasive diagnosis of paradigmatic pathologies of intracranial vessels. Key points • An optimized 7-T TOF-MRA protocol was selected for comparison with clinical 3-T TOF-MRA for assessing intracranial vessels. • Seven-tesla TOF-MRA outperformed 3-T TOF-MRA in both quantitative and qualitative evaluation. • Seven-tesla TOF-MRA is comparable to DSA for the diagnosis and characterization of intracranial vascular pathologies. Graphical Abstract
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- 2024
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3. Time-of-flight MRA of intracranial vessels at 7 T.
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Cosottini, Mirco, Calzoni, Tommaso, Lazzarotti, Guido Andrea, Grigolini, Alessandro, Bosco, Paolo, Cecchi, Paolo, Tosetti, Michela, Biagi, Laura, and Donatelli, Graziella
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MAGNETIC resonance angiography ,DIGITAL subtraction angiography ,ARTERIOVENOUS fistula ,CENTRAL nervous system ,NONINVASIVE diagnostic tests ,CEREBROVASCULAR disease ,ARTERIOVENOUS malformation - Abstract
Background: Three-dimensional time-of-flight magnetic resonance angiography (TOF-MRA) is a largely adopted non-invasive technique for assessing cerebrovascular diseases. We aimed to optimize the 7-T TOF-MRA acquisition protocol, confirm that it outperforms conventional 3-T TOF-MRA, and compare 7-T TOF-MRA with digital subtraction angiography (DSA) in patients with different vascular pathologies. Methods: Seven-tesla TOF-MRA sequences with different spatial resolutions acquired in four healthy subjects were compared with 3-T TOF-MRA for signal-to-noise and contrast-to-noise ratios as well as using a qualitative scale for vessel visibility and the quantitative Canny algorithm. Four patients with cerebrovascular disease (primary arteritis of the central nervous system, saccular aneurism, arteriovenous malformation, and dural arteriovenous fistula) underwent optimized 7-T TOF-MRA and DSA as reference. Images were compared visually and using the complex-wavelet structural similarity index. Results: Contrast-to-noise ratio was higher at 7 T (4.5 ± 0.8 (mean ± standard deviation)) than at 3 T (2.7 ± 0.9). The mean quality score for all intracranial vessels was higher at 7 T (2.89) than at 3 T (2.28). Angiogram quality demonstrated a better vessel border detection at 7 T than at 3 T (44,166 versus 28,720 pixels). Of 32 parameters used for diagnosing cerebrovascular diseases on DSA, 27 (84%) were detected on 7-T TOF-MRA; the similarity index ranged from 0.52 (dural arteriovenous fistula) to 0.90 (saccular aneurysm). Conclusions: Seven-tesla TOF-MRA outperformed conventional 3-T TOF-MRA in evaluating intracranial vessels and exhibited an excellent image quality when compared to DSA. Seven-tesla TOF-MRA might improve the non-invasive diagnostic approach to several cerebrovascular diseases. Relevance statement: An optimized TOF-MRA sequence at 7 T outperforms 3-T TOF-MRA, opening perspectives to its clinical use for noninvasive diagnosis of paradigmatic pathologies of intracranial vessels. Key points: • An optimized 7-T TOF-MRA protocol was selected for comparison with clinical 3-T TOF-MRA for assessing intracranial vessels. • Seven-tesla TOF-MRA outperformed 3-T TOF-MRA in both quantitative and qualitative evaluation. • Seven-tesla TOF-MRA is comparable to DSA for the diagnosis and characterization of intracranial vascular pathologies. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Usefulness of sectional images in dural AVF for the interpretation of venous anatomy.
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Myongjin Kang and Sanghyeon Kim
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MAGNETIC resonance angiography , *THREE-dimensional imaging , *CARDIOVASCULAR system , *IMAGE reconstruction , *COMPUTED tomography - Abstract
Knowledge of the venous anatomy is essential for appropriately treating dural arteriovenous fistulas (AVFs). It is challenging to determine the overall venous structure despite performing selective angiography for dural AVFs with feeder from multiple selected arteries. This is because only a part of the veins can be observed through the shunt in the selected artery. Therefore, after performing selective angiography of all vessels to understand the approximate venous anatomy, the venous anatomy can be easily understood by closely examining the source image of computed tomographic angiography or magnetic resonance angiography. Through this, it is possible to specify the vein that is to be blocked (target embolization), thereby avoiding extensive blocking of the vein and avoiding various complications. In the case of dural AVF with feeder from single selected artery, if the multiplanar reconstruction image of the three-dimensional rotational computed tomography obtained by performing angiography is analyzed thoroughly, a shunted pouch can be identified. If embolization is performed by targeting this area, unnecessary sinus total packing can be avoided. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Congenital Intracranial Vascular Malformations in Children: Radiological Overview.
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Jung-Eun Cheon and Ji Hye Kim
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HUMAN abnormalities , *ARTERIOVENOUS fistula , *CEREBRAL arteriovenous malformations , *CHILD patients , *ARTERIOVENOUS malformation - Abstract
Prompt medical attention is crucial for congenital intracranial vascular malformations in children and newborns due to potential severe outcomes. Imaging is pivotal for accurate identification, given the diverse risks and treatment strategies. This article aims to enhance the identification and understanding of congenital intracranial vascular abnormalities including arteriovenous malformation, arteriovenous fistula, cavernous malformation, capillary telangiectasia, developmental venous anomaly, and sinus pericranii in pediatric patients. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Pediatric Central Nervous System Vascular Malformation: Pathological Review with Diagram.
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Se Hoon Kim
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CENTRAL nervous system , *CARDIOVASCULAR system , *G proteins , *HUMAN abnormalities , *HEMATOPOIESIS - Abstract
Pediatric central nervous system (CNS) vascular malformations are a group of abnormal blood vessel formations within the brain or spinal cord in children. The most crucial point of pediatric CNS vascular malformation is that no golden standard classifications exist. In addition, there is a big gap in knowledge and the viewpoint of clinicians, radiologists, and pathologists. In addition, many genes associated with pediatric CNS vascular malformation, such as Sturge-Weber-Dimitri syndrome with guanine nucleotide-binding protein G(q) subunit alpha (GNAQ) gene mutation, and cavernous malformations with cerebral cavernous malformations 1 (CCM1), CCM2, and CCM3 gene mutation, were recently revealed. For proper therapeutic approaches, we must understand the lesions' characterizations in anatomical, morphological, and functional views. In this review, the author would like to provide basic pediatric CNS vascular malformation concepts with understandable diagrams. Thus, the author hopes that it might be helpful for the proper diagnosis and treatment of CNS pediatric vascular malformations. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Can we Use Resting-state fMRI and CSD Fiber Tractography for Presurgical Mapping?
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Prof dr Stefan Sunaert, Principal Investigator
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- 2023
8. Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report.
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Chiang, Sharon, Pet, Douglas, Talbott, Jason, LaHue, Sara, Douglas, Vanja, and Rosendale, Nicole
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Case report ,Myeloradiculitis ,Nerve root enhancement ,Spinal dural arteriovenous fistula ,Spinal epidural arteriovenous fistula Myeloradiculopathy ,Transverse myelitis ,Female ,Humans ,Middle Aged ,Spinal Cord ,Contrast Media ,Leukocytosis ,Gadolinium ,Spinal Cord Diseases ,Magnetic Resonance Imaging ,Central Nervous System Vascular Malformations ,Arteriovenous Fistula - Abstract
BACKGROUND: Gadolinium enhancement of spinal nerve roots on magnetic resonance imaging (MRI) has rarely been reported in spinal dural arteriovenous fistula (SDAVF). Nerve root enhancement and cerebrospinal fluid (CSF) pleocytosis can be deceptive and lead to a misdiagnosis of myeloradiculitis. We report a patient who was initially diagnosed with neurosarcoid myeloradiculitis due to spinal nerve root enhancement, mildly inflammatory cerebrospinal fluid, and pulmonary granulomas, who ultimately was found to have an extensive symptomatic SDAVF. CASE PRESENTATION: A 52-year-old woman presented with a longitudinally extensive spinal cord lesion with associated gadolinium enhancement of the cord and cauda equina nerve roots, and mild lymphocytic pleocytosis. Pulmonary lymph node biopsy revealed non-caseating granulomas and neurosarcoid myeloradiculitis was suspected. She had rapid and profound clinical deterioration after a single dose of steroids. Further work-up with spinal angiography revealed a thoracic SDAVF, which was surgically ligated leading to clinical improvement. CONCLUSIONS: This case highlights an unexpected presentation of SDAVF with nerve root enhancement and concurrent pulmonary non-caseating granulomas, leading to an initial misdiagnosis with neurosarcoidosis. Nerve root enhancement has only rarely been described in cases of SDAVF; however, as this case highlights, it is an important consideration in the differential diagnosis of non-inflammatory causes of longitudinally extensive myeloradiculopathy with nerve root enhancement. This point is highly salient due to the importance of avoiding misdiagnosis of SDAVF, as interventions such as steroids or epidural injections used to treat inflammatory or infiltrative mimics may worsen symptoms in SDAVF. We review the presentation, diagnosis, and management of SDAVF as well as a proposed diagnostic approach to differentiating SDAVF from inflammatory myeloradiculitis.
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- 2023
9. Intracranial Hemorrhage Rate and Lesion Burden in Patients With Familial Cerebral Cavernous Malformation.
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Weinsheimer, Shantel, Nelson, Jeffrey, Abla, Adib A, Ko, Nerissa U, Tsang, Cynthia, Okoye, Obiora, Zabramski, Joseph M, Akers, Amy, Zafar, Atif, Mabray, Marc C, Hart, Blaine L, Morrison, Leslie, McCulloch, Charles E, Kim, Helen, and Brain Vascular Malformation Consortium Cerebral Cavernous Malformation Investigator Group *
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Brain Vascular Malformation Consortium Cerebral Cavernous Malformation Investigator Group * ,Humans ,Hemangioma ,Cavernous ,Central Nervous System ,Intracranial Hemorrhages ,Cerebral Hemorrhage ,Central Nervous System Vascular Malformations ,Risk Factors ,cerebral cavernous malformation ,familial ,hemorrhage ,risk factor ,Stroke ,Clinical Research ,Brain Disorders ,Neurosciences ,Rare Diseases ,Aetiology ,2.1 Biological and endogenous factors ,Cardiorespiratory Medicine and Haematology - Abstract
Background Familial cerebral cavernous alformation (CCM) is an autosomal dominant disease caused by mutations in KRIT1, CCM2, or PDCD10. Cases typically present with multiple lesions, strong family history, and neurological symptoms, including seizures, headaches, or other deficits. Intracranial hemorrhage (ICH) is a severe manifestation of CCM, which can lead to death or long-term neurological deficits. Few studies have reported ICH rates and risk factors in familial CCM. We report ICH rates and assess whether CCM lesion burden, a disease severity marker, is associated with risk of symptomatic ICH during follow-up in a well-characterized cohort of familial CCM cases. Methods and Results We studied 386 patients with familial CCM with follow-up data enrolled in the Brain Vascular Malformation Consortium CCM Project. We estimated symptomatic ICH rates overall and stratified by history of ICH before enrollment. CCM lesion burden (total lesion count and large lesion size) assessed at baseline enrollment was tested for association with increased risk of subsequent ICH during follow-up using Cox regression models adjusted for history of ICH before enrollment, age, sex, and family structure and stratified on recruitment site. The symptomatic ICH rate for familial CCM cases was 2.8 per 100 patient-years (95% CI, 1.9-4.1). Those with ICH before enrollment had a follow-up ICH rate of 4.5 per 100 patient-years (95% CI, 2.6-8.1) compared with 2.0 per 100 patient-years (95% CI, 1.3-3.5) in those without (P=0.042). Total lesion count was associated with increased risk of ICH during follow-up (hazard ratio [HR], 1.37 per doubling of total lesion count [95% CI, 1.10-1.71], P=0.006). The symptomatic ICH rate for familial CCM cases was 2.8 per 100 patient-years (95% CI, 1.9-4.1). Those with ICH before enrollment had a follow-up ICH rate of 4.5 per 100 patient-years (95% CI, 2.6-8.1) compared with 2.0 per 100 patient-years (95% CI, 1.3-3.5) in those without (P=0.042). Total lesion count was associated with increased risk of ICH during follow-up (hazard ratio [HR], 1.37 per doubling of total lesion count [95% CI, 1.10-1.71], P=0.006). Conclusions Patients with familial CCM with prior history of an ICH event are at higher risk for rehemorrhage during follow-up. In addition, total CCM lesion burden is significantly associated with increased risk of subsequent symptomatic ICH; hence lesion burden may be an important predictor of patient outcome and aid patient risk stratification.
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- 2023
10. Navigation guided small craniectomy and direct cannulation of pure isolated sigmoid sinus for treatment of dural arteriovenous fistula.
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Jun Ho Shim, Gi Yong Yun, Jae-Min Ann, Jong-Hyun Park, Hyuk-Jin Oh, Jai-Joon Shim, and Seok Mann Yoon
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CRANIAL sinuses , *ARTERIOVENOUS fistula , *STEREOTACTIC radiosurgery , *CAVERNOUS sinus , *CATHETERIZATION , *ASYMPTOMATIC patients , *OPERATING rooms - Abstract
Dural arteriovenous fistula (DAVF) is a rare condition affecting approximately 1.5% of 1,000,000 individuals annually. It frequently occurs in the transsigmoid and cavernous sinuses. An isolated sigmoid sinus is extremely rare and is treated by performing transfemoral transvenous embolization along the opposite transverse sinus. A 69-year-old woman presented with asymptomatic Borden type III/Cognard type III DAVF involving an isolated sigmoid sinus. She underwent a staged operation in which a navigation system was used to expose the sigmoid sinus in the operating room before transferring the patient to the angio suite for transvenous embolization. Various modalities have been used to treat DAVF, including surgical disconnection, transarterial embolization, transvenous embolization, and stereotactic radiosurgery. However, treating DAVF cases where the affected sinus is isolated can be challenging because an easily accessible surgical route may not be available. In this case, direct sinus cannulation and transvenous embolization were the most effective treatments. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Spontaneous occlusion of a pial arteriovenous fistula after angiography: The role of iodinated contrast media.
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John, Seby, Maiti, Tanmoy Kumar, Kesav, Praveen, Arif, Ashna, and Hussain, Syed Irteza
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ARTERIOVENOUS fistula , *CONTRAST media , *DIGITAL subtraction angiography , *ANGIOGRAPHY , *CEREBRAL arteriovenous malformations - Abstract
Intracranial non-galenic pial arteriovenous fistula (PAVF) is an extremely rare vascular malformation, where one or more pial arteries feeds directly into a cortical vein without any intervening nidus. Though occasionally they can be asymptomatic, neurological symptoms such as headache, seizure, or focal neurological deficit are more common presenting features. Life threatening or fatal hemorrhage is not uncommon, hence needed to be treated more often than not. Spontaneous occlusion of PAVF is reported only four times before. We report a 49-year-old gentleman, who was diagnosed to have a PAVF, possibly secondary to trauma. He presented 5 months and 22 days from initial digital subtraction angiography (DSA) for treatment, and follow-up angiogram showed complete obliteration. He denied any significant event, medication or alternate treatment during this period. His clinical symptoms were stable as well. We postulate iodinated contrast medium induced vasculopathy as a possible cause, which has been described for other vascular pathologies, but never for PAVF. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Risk of Early Versus Later Rebleeding From Dural Arteriovenous Fistulas With Cortical Venous Drainage
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Durnford, Andrew J, Akarca, Danyal, Culliford, David, Millar, John, Guniganti, Ridhima, Giordan, Enrico, Brinjikji, Waleed, Chen, Ching-Jen, Abecassis, Isaac Josh, Levitt, Michael, Polifka, Adam J, Derdeyn, Colin P, Samaniego, Edgar A, Kwasnicki, Amanda, Alaraj, Ali, Potgieser, Adriaan RE, Chen, Stephanie, Tada, Yoshiteru, Phelps, Ryan, Abla, Adib, Satomi, Junichiro, Starke, Robert M, van Dijk, J Marc C, Amin-Hanjani, Sepideh, Hayakawa, Minako, Gross, Bradley, Fox, W Christopher, Kim, Louis, Sheehan, Jason, Lanzino, Giuseppe, Kansagra, Akash P, Du, Rose, Lai, Rosalind, Zipfel, Gregory J, Bulters, Diederik O, Piccirillo, Jay F, Raman, Hari, Lipsey, , Kim, Vine, Roanna, Cloft, Harry J, Kallmes, David F, Pollock, Bruce E, Link, Michael J, Patibandla, Mohana Rao, Ding, Dale, Buell, Thomas, Paisan, Gabriella, Meyer, R Michael, Kelly, , Cory, Duffill, Jonathan, Ditchfield, Adam, Macdonald, Jason, Laurent, Dimitri, Hoh, Brian, Smith, Jessica, Lockerman, Ashley, Lunsford, L Dade, Jankowitz, Brian T, Gutierrez, Santiago Ortega, Hasan, David, Roa, Jorge A, Rossen, James, Guerrero, Waldo, McGruder, Allen, Charbel, Fady T, Aletich, Victor A, Rose-Finnell, Linda, Peterson, Eric C, Yavagal, Dileep R, Sur, Samir, Kanematsu, Yasuhisa, Yamamoto, Nobuaki, Kinouchi, Tomoya, Korai, Masaaki, Yamaguchi, Izumi, Yamamoto, Yuki, Winkler, Ethan, Lawton, Michael, Rutkowski, Martin, Sultan, M Ali Aziz, Patel, Nirav, and Frerichs, Kai U
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Kidney Disease ,Central Nervous System Vascular Malformations ,Cerebral Angiography ,Drainage ,Embolization ,Therapeutic ,Humans ,Outcome Assessment ,Health Care ,drainage ,fistula ,hemorrhage ,incidence ,natural history ,CONDOR Investigators ,Cardiorespiratory Medicine and Haematology ,Neurosciences ,Neurology & Neurosurgery ,Clinical sciences ,Allied health and rehabilitation science - Abstract
BackgroundCranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage.MethodsPatients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference.ResultsOf 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2-14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3-5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7-12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4-37.7; P, 0.026).ConclusionsThe risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.
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- 2022
13. An aggressive dural arteriovenous fistula manifested by unilateral subcortical calcification and cerebral edema: A case report
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Yuya Kagawa, MD, Taichiro Imahori, MD, PhD, Reiichi Okino, MD, Tomoaki Harada, MD, PhD, Daisuke Yamamoto, MD, PhD, Shigeru Miyake, MD, PhD, and Takashi Sasayama, MD, PhD
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Calcification ,Brain edema ,Central nervous system vascular malformations ,Radiology ,Interventional ,Brain Neoplasms ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Unilateral subcortical calcifications are unique radiographic findings indicating specific focal pathologies. When the lesion is accompanied by edema, cerebral neoplasm usually leads to a differential diagnosis. This report presents a case of unilateral subcortical calcification and edema that resulted in cerebral hemorrhage and a subsequent diagnosis of an aggressive dural arteriovenous fistula. A man in his 60s presented with left hemianopsia and a progressive headache for over 6 months. Initial computed tomography revealed unilateral subcortical calcification and cerebral edema in the right occipital lobe, raising the suspicion of oligodendroglioma. However, 10 days later, a cerebral hemorrhage occurred in the lesion. Magnetic resonance imaging revealed flow void clusters and dilatation of the bilateral external carotid arteries and cortical veins, indicating a dural arteriovenous fistula. Cerebral angiography confirmed the presence of a parasagittal dural arteriovenous fistula (Borden type III). The patient was successfully treated with trans-arterial embolization using Onyx. Thus, calcifications with edema are more commonly associated with cerebral neoplasms; however, in this case, they indicated the presence of a dural arteriovenous fistula with severe corticovenous reflux. The presented case highlights the importance of recognizing these imaging features in dural arteriovenous fistulas and raises awareness of the potential danger of early hemorrhage after diagnosis. Therefore, timely evaluation of cranial vessels is essential in cases of unilateral subcortical calcification and edema to facilitate the early detection and management of aggressive dural arteriovenous fistulas.
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- 2023
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14. Pure spinal intraosseous arteriovenous fistula: A case report.
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Ito, Koki, Ryu, Bikei, Shima, Shogo, Mochizuki, Tatsuki, Sato, Shinsuke, Inoue, Tatsuya, and Niimi, Yasunari
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Spinal osseous arteriovenous fistula (AVF) is a rare disease with a characteristic angioarchitecture involving an intraosseous venous pouch (VP) of the vertebral body where the feeders are converging. Using spinal angiography alone, it is difficult to distinguish spinal osseous AVF from classical spinal epidural AVF (EDAVF) with fistulas in the epidural VP and bone erosion because both subtypes have an angiographically similar dilated VP appearance. Thus, spinal osseous AVF may be often misdiagnosed as spinal EDAVF. With advancing imaging techniques, it would be possible to determine the exact location of the fistula. Here, we present the case of a 37-year-old woman with a pure spinal thoracic osseous AVF and radiculopathy. She was diagnosed with spinal intraosseous AVF using high-resolution three-dimensional rotational angiography (3D-RA). The fistula was located in the Th1 lateral mass with a VP where multiple osseous feeders were converging. There was paravertebral venous drainage without intradural venous drainage. Transvenous embolization with Onyx and coils was performed through the azygos vein to the lateral epidural venous plexus, resulting in complete obliteration. This case suggests that 3D-RA reconstructed images are essential for accurate diagnosis and successful treatment of this condition. It is important to occlude only intraosseous VPs by accurate subtype diagnosis. Transvenous embolization is a treatment option for spinal intraosseous AVF with paravertebral epidural venous drainage. [ABSTRACT FROM AUTHOR]
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- 2023
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15. Endovascular treatment strategy, technique, and outcomes for dural arteriovenous fistulas of the marginal sinus region.
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Caton, Michael Travis, Narsinh, Kazim H, Baker, Amanda, Hetts, Steven W, Cooke, Daniel L, Higashida, Randall T, Dowd, Christopher F, Halbach, Van V, and Amans, Matthew R
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Cranial Sinuses ,Humans ,Central Nervous System Vascular Malformations ,Treatment Outcome ,Embolization ,Therapeutic ,Retrospective Studies ,Endovascular Procedures ,coil ,fistula ,liquid embolic material ,posterior fossa ,technique - Abstract
BackgroundDural arteriovenous fistulas (AVF) of the foramen magnum region (FMR) are technically challenging lesions to treat. Transvenous (TV), transarterial (TA), and surgical approaches have been described, but the optimum treatment strategy is not defined.ObjectiveTo report treatment strategies and outcomes for FMR-AVF at a single, high-volume referral center.MethodsA retrospective review from January 2010 to August 2020 identified patients with FMR-AVF at a single referral center. Angiographic features, treatment (observation, endovascular, surgical), and follow-up of angiographic and clinical results were recorded. The technical aspects of TV embolization are then presented in detail.Results29 FMR-AVF were identified in 28 patients. Of these, 24/29 (82.8%) were treated and 5/29 (17.2%) were observed. Treatment was endovascular in 21/24 (87.5%), combined (endovascular+surgical) in 2/24 (8.3%), and surgical in 1/24 (4.2%). Endovascular treatments were 76.2% TV, 14.3% TA, and 9.5% combined TV/TA. Sufficient follow-up data were available for 20/28 (71.4%) with mean follow-up of 16.8 months. No AVF recurrence was seen for TA/TV, combined endovascular/surgical, or surgical groups, and there was one recurrence (7.1%) in the TV group. Symptomatic improvement was seen in all groups: TV (71.4% complete, 28.6% partial), TA (66.7% complete, 33.3% no follow-up), TV+TA (100% partial), endovascular/surgical (100% complete), and surgical (100% partial). Minor non-neurologic complications included 1/14 (7.1%) in the TV group and 1/3 (33.3%) in the TA/TV group.ConclusionEndovascular treatment is safe and effective for most FMR-AVF. TV embolization has a high cure rate with few complications.
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- 2022
16. Utility of modified Rankin Scale for brain vascular malformations in hereditary hemorrhagic telangiectasia
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Thompson, KP, Nelson, J, Kim, H, Weinsheimer, SM, Marchuk, DA, Lawton, MT, Krings, T, and Faughnan, ME
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Genetics ,Neurosciences ,Rare Diseases ,Brain Disorders ,Hematology ,Activin Receptors ,Type II ,Arteriovenous Fistula ,Central Nervous System Vascular Malformations ,Endoglin ,Humans ,Intracranial Arteriovenous Malformations ,Prospective Studies ,Telangiectasia ,Hereditary Hemorrhagic ,Brain Vascular Malformation Consortium HHT Investigator Group ,Other Medical and Health Sciences ,Genetics & Heredity ,Clinical sciences - Abstract
BackgroundApproximately 10% of hereditary hemorrhagic telangiectasia (HHT) patients harbour brain vascular malformations (VMs). Intracranial hemorrhage (ICH) from brain VMs can lead to death or morbidity, while treatment options for brain VMs also have associated morbidity. The modified Rankin Scale (mRS) may provide an approach to identifying HHT-brain VM patients with poor outcomes, and their predictors. We aimed to measure the relationship between mRS score and brain VM, brain VM number, as well as other aspects of HHT, at enrollment and during prospective follow-up.Methods1637 HHT patients (342 with brain VMs) were recruited from 14 HHT centres of the Brain Vascular Malformation Consortium since 2010 and followed prospectively (mean = 3.4 years). We tested whether the presence of brain VM, other HHT organ involvement, and HHT mutation genotype were associated with worse mRS scores at baseline and during follow-up, using linear mixed models, adjusting for age, sex, and year of visit.ResultsPresence of brain VMs was not associated with worse mRS score at baseline and there was no significant worsening of mRS with prospective follow-up in these patients; 92% had baseline mRS of 0-2. HHT-related gastrointestinal (GI) bleeding was associated with worse mRS scores at baseline (0.37, 95% CI 0.26-0.47, p
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- 2021
17. Perioperative management of dural sinus malformation and high-flow arteriovenous fistula in an infant
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Demartini, Jr, Zeferino, Beckhauser, Mayara Thays, Ramos, Marina Machado, Chave, Adriana Luma Valério, and Cardoso-Demartini, Adriane
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- 2024
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18. Intraoperative Laser Speckle Contrast Imaging to Assess Blood Flow During Neurosurgery (LSCI-NSURG)
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- 2022
19. Dural Arteriovenous Fistulas of the Foramen Magnum Region: Clinical Features and Angioarchitectural Phenotypes.
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Caton, MT, Narsinh, KH, Baker, A, Dowd, CF, Higashida, RT, Cooke, DL, Hetts, SW, Halbach, VV, and Amans, MR
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Foramen Magnum ,Cranial Sinuses ,Humans ,Central Nervous System Vascular Malformations ,Cerebral Angiography ,Retrospective Studies ,Phenotype ,Middle Aged ,Female ,Male ,Neurosciences ,Brain Disorders ,Clinical Sciences ,Nuclear Medicine & Medical Imaging - Abstract
Background and purposeAVFs of the foramen magnum region, including fistulas of the marginal sinus and condylar veins, have complex arterial supply, venous drainage, symptoms, and risk features that are not well-defined. The purpose of this study was to present the angioarchitectural and clinical phenotypes of a foramen magnum region AVF from a large, single-center experience.Materials and methodsWe retrospectively reviewed cases from a 10-year neurointerventional data base. Arterial and venous angioarchitectural features and clinical presentation were extracted from the medical record. Venous drainage patterns were stratified into 4 groups as follows: type 1 = unrestricted sinus drainage, type 2 = sinus reflux (including the inferior petrosal sinus), type 3 = reflux involving sinuses and cortical veins, and type 4 = restricted cortical vein outflow or perimedullary congestion.ResultsTwenty-eight patients (mean age, 57.9 years; 57.1% men) had 29 foramen magnum region AVFs. There were 11 (37.9%) type 1, nine (31.0%) type 2, six (20.7%) type 3, and 3 (10.3%) type 4 fistulas. Pulsatile tinnitus was the most frequent symptom (82.1%), followed by orbital symptoms (31.0%), subarachnoid hemorrhage (13.8%), cranial nerve XII palsy (10.3%), and other cranial nerve palsy (6.9%). The most frequent arterial supply was the ipsilateral ascending pharyngeal artery (93.1% ipsilateral, 55.5% contralateral), vertebral artery (89.7%), occipital artery (65.5%), and internal carotid artery branches (48.3%).ConclusionsWe present the largest case series of foramen magnum region AVFs to date and show that clinical features relate to angioarchitecture. Orbital symptoms are frequent when sinus reflux is present. Hemorrhage was only observed in type 3 and 4 fistulas.
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- 2021
20. Intraoperative Laser Speckle Contrast Imaging of Cerebral Blood Flow
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St. Joseph's Hospital & Medical Center
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- 2022
21. Jugular Venous Reflux Can Mimic Posterior Fossa Dural Arteriovenous Fistulas on MRI-MRA.
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Caton, M Travis, Callen, Andrew L, Copelan, Alexander Z, Narsinh, Kazim H, Smith, Eric R, and Amans, Matthew R
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Biomedical Imaging ,Clinical Research ,Adult ,Aged ,Aged ,80 and over ,Brain ,Central Nervous System Vascular Malformations ,Diagnosis ,Differential ,Female ,Humans ,Jugular Veins ,Magnetic Resonance Angiography ,Magnetic Resonance Imaging ,Male ,Middle Aged ,arterial spin labeling ,arteriovenous fistula ,cerebral angiography ,jugular vein ,reflux ,MRA ,Clinical Sciences ,Nuclear Medicine & Medical Imaging - Abstract
Dural arteriovenous fistulas (DAVFs) are high-flow acquired shunts that can carry high risk of intracranial hemorrhage. Because DAVFs can often be managed by endovascular means, early and accurate diagnosis can markedly improve patient morbidity. Time-of-flight and arterial spin-labeling MRA have increased the diagnostic utility of MRI for DAVF by showing hemodynamic rather than anatomic evidence of shunting. The purpose of this article is to describe the cases of seven patients who had co-localization of arterial spin-labeling signal intensity and time-of-flight flow-related enhancement in the left skull base, resulting in a misdiagnosis of DAVF and a recommendation for catheter angiography by the interpreting radiologist. Benign jugular venous reflux is identified as a common mechanism in each case, and the physiology behind this imaging pitfall is described. An algorithmic diagnostic approach to differentiating physiologic venous reflux from true posterior skull base DAVFs is presented.
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- 2021
22. PHIL Evaluation in the Endovascular Treatment of Intracranial Dural AVF
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ClinSearch
- Published
- 2021
23. Postsurgical dural supply to the spinal cord arteriovenous malformation in spinal arteriovenous metameric syndrome.
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Ryu, Bikei, Mochizuki, Tatsuki, Shima, Shogo, Sato, Shinsuke, Inoue, Tatsuya, Kawamata, Takakazu, and Niimi, Yasunari
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SPINAL cord , *ARTERIES , *THERAPEUTIC embolization , *POSTOPERATIVE period , *VASCULAR diseases , *ANGIOGRAPHY , *ARTERIOVENOUS malformation - Abstract
Dural supply from the external carotid system in cerebral arteriovenous malformations (AVMs) is well known, but actual angiographic evidence of dural supply to spinal cord AVMs (SCAVMs) has not been reported. Here, we report a case of dural supply to the conus SCAVM in the spinal arteriovenous metameric syndrome segment 25–30. Thirteen years after spinal surgery (T12–L2 laminoplasty), spinal angiography showed multiple dural supplies from the dorsal somatic branches, prelaminar arteries, and radiculomeningeal arteries to the SCAVM at the level of the previous spinal surgery. To the best of our knowledge, this is the first reported case with dural supply to the spinal cord. This case demonstrates that the extradural and extraspinal branches can supply the spinal cord in rare instances of spinal dural adhesions following repeated hemorrhages and surgical intervention under a metameric link background. [ABSTRACT FROM AUTHOR]
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- 2023
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24. Case of Amaurosis Fugax in the Setting of a Persistent Primitive Hypoglossal Artery Requiring Carotid Endarterectomy with Regional Anesthesia.
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Telianidis, Stacey, Westcott, Mark J., Ironfield, Craig M., and Sanders, Lauren M.
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CAROTID endarterectomy , *INTERNAL carotid artery , *CONDUCTION anesthesia , *CAROTID artery , *BLINDNESS , *NEUROECTODERMAL tumors - Abstract
Objective: Congenital defects/diseases Background: A persistent primitive hypoglossal artery (PPHA) is a rare congenital anomaly leading to persistent carotid-basilar anastomosis. This is a report of an 83-year-old man with a PPHA presenting with amaurosis fugax of the left eye requiring carotid endarterectomy under regional anesthesia. Case Report: An 83-year-old man presented with 2 weeks of intermittent self-resolving visual disturbances, followed by an episode of left eye amaurosis fugax. The patient had been referred to the hospital for further investigation of symptoms 1 day following the amaurosis fugax event. Carotid Doppler ultrasound demonstrated a greater than 90% stenosis of the left internal carotid artery. Computed tomography carotid and Circle of Willis angiography confirmed a mixed, ulcerated plaque and revealed a persistent left hypoglossal artery originating from the left internal carotid artery and continuing as the basilar artery. On day 3 of admission, left carotid endarterectomy was performed under conscious sedation and regional anesthesia to permit continuous monitoring of neurological status and avoid the need for intraoperative shunting. "Permissive hypertension" by targeting a systolic blood pressure of 190 to 200 mmHg was sought for the duration of clamp time. There was no deterioration of neurological function during clamping of the carotid vessels. The patient recovered well and was discharged 2 days after surgery, with no residual neurology. Conclusions: This report has presented a rare case of PPHA to highlight awareness of this congenital vascular anomaly when undertaking carotid endarterectomy. [ABSTRACT FROM AUTHOR]
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- 2023
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25. Comparison of MRI, MRA, and DSA for Detection of Cerebral Arteriovenous Malformations in Hereditary Hemorrhagic Telangiectasia.
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Vella, M, Alexander, MD, Mabray, MC, Cooke, DL, Amans, MR, Glastonbury, CM, Kim, H, Wilson, MW, Langston, DE, Conrad, MB, and Hetts, SW
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Humans ,Central Nervous System Vascular Malformations ,Telangiectasia ,Hereditary Hemorrhagic ,Magnetic Resonance Imaging ,Magnetic Resonance Angiography ,Angiography ,Digital Subtraction ,Sensitivity and Specificity ,Retrospective Studies ,Adolescent ,Adult ,Aged ,Middle Aged ,Child ,Child ,Preschool ,Infant ,Female ,Male ,Young Adult ,Neuroimaging ,Biomedical Imaging ,Brain Disorders ,Prevention ,Neurosciences ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Clinical Sciences ,Nuclear Medicine & Medical Imaging - Abstract
Background and purposePatients with hereditary hemorrhagic telangiectasia (HHT) have a high prevalence of brain vascular malformations, putting them at risk for brain hemorrhage and other complications. Our aim was to evaluate the relative utility of MR imaging and MRA compared with DSA in detecting cerebral AVMs in the HHT population.Materials and methodsOf 343 consecutive patients evaluated at the University of California, San Francisco HTT Center of Excellence, 63 met the study inclusion criteria: definite or probable hereditary hemorrhagic telangiectasia defined by meeting at least 2 Curacao criteria or positive genetic testing, as well as having at least 1 brain MR imaging and 1 DSA. MRIs were retrospectively reviewed, and the number of AVMs identified was compared with the number of AVMs identified on DSA.ResultsOf 63 patients, 45 (71%) had AVMs on DSA with a total of 92 AVMs identified. Of those, 24 (26%) were seen only on DSA; 68 (74%), on both DSA and MR imaging; and 5 additional lesions were seen only on MR imaging. Of the 92 lesions confirmed on DSA, 49 (53.3%) were seen on the 3D-T1 postgadolinium sequence, 52 (56.5%) were seen on the 2D-T1 postgadolinium sequence, 35 (38.0%) were seen on the SWI sequence, 24 (26.1%) were seen on T2 sequence, and 25 (27.2%) were seen on MRA. The sensitivity and specificity of MR imaging as a whole in detecting AVMs then confirmed on DSA were 80.0% and 94.4%, respectively, and the positive and negative predictive values were 97.3% and 65.4%, respectively.ConclusionsThis study reinforces the use of MR imaging as a primary screening tool for cerebral AVMs in patients with hereditary hemorrhagic telangiectasia and suggests that 3D-T1 postgadolinium and 2D-T1 postgadolinium performed at 3T are the highest yield sequences.
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- 2020
26. Updates in the management of cranial dural arteriovenous fistula
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Baharvahdat, Humain, Ooi, Yinn Cher, Kim, Wi Jin, Mowla, Ashkan, Coon, Alexander L, and Colby, Geoffrey P
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Biomedical and Clinical Sciences ,Clinical Sciences ,Patient Safety ,Central Nervous System Vascular Malformations ,Cerebrovascular Circulation ,Clinical Decision-Making ,Embolization ,Therapeutic ,Endovascular Procedures ,Humans ,Neurosurgical Procedures ,Radiosurgery ,Risk Assessment ,Risk Factors ,Treatment Outcome ,dural arteriovenous fistulas ,dAVF ,embolisation ,transarterial ,transvenous - Abstract
Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. While they can be benign lesions, the presence of retrograde venous drainage and cortical venous reflux makes the natural course of these lesions aggressive high risk of haemorrhage, neurological injury and mortality. Endovascular treatment is often the first line of treatment for dAVF. Both transarterial and transvenous approaches are used to cure dAVF. The selection of treatment approach depends on the angioarchitecture of the dAVF, the location, the direction of venous flow. Surgery and, to a lesser extent, stereotactic radiosurgery are used when endovascular approaches are impossible or unsuccessful.
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- 2020
27. Clinical Outcome in Patients With Spinal Dural Arteriovenous Fistulas (COPSDAVF) (COPSDAVF)
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Beijing Haidian Hospital and Hongqi Zhang, MD, Director
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- 2021
28. Reversible Symptom Aggravation by Intake of Taurine-Rich Foods in Patients with Venous Congestive Myelopathy: Controlled Case Series Study
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Dae Chul Suh, Soo Jeong, Yun Hyeok Choi, Su Min Cho, Su Young Yun, A Yeun Son, Young Min Lim, Boseong Kwon, and Yunsun Song
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taurine ,central nervous system vascular malformations ,spinal cord disease ,hyperemia ,magnetic resonance imaging ,Medicine (General) ,R5-920 ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Purpose Reversible aggravation of myelopathy symptoms was observed after the intake of taurine-rich foods in patients with venous congestive myelopathy (VCM) caused by a spinal arteriovenous shunt (SAVS), and the taurine-challenge test was applied to demonstrate an association between taurine and VCM. Materials and Methods The current study reviewed any aggravation history of myelopathy symptoms, including walking difficulty, after consuming taurine-rich foods among 133 consecutive patients with a SAVS from a prospective institutional database from June 2013 to February 2021. The type of taurine-rich foods, demographic data, arteriovenous shunt level, and follow-up periods were obtained. For the controlled taurine challenge test, Bacchus® (Dong-A Pharmaceutical, Seoul, Korea), a taurine-rich drink, was given to patients who fulfilled test criteria of recovered VCM (pain-sensory-motor-sphincter scale ≥2, improvement of spinal cord signal intensity on magnetic resonance imaging, and follow-up >6 months after SAVS treatment) to confirm the disappearance of such aggravation. Results Ten patients had an aggravation history related to food. Webfoot octopus, small octopus, squid, crab, scallop, and taurine-rich energy drink (Bacchus®) were related to such aggravation in patients with VCM. Aggravation appeared about 30 minutes after food intake followed by expressions such as ‘I could not walk and collapsed to the ground’ and usually lasted for about 3 hours, followed by a slow recovery after taking rest. Four patients who met the test criteria underwent the taurine challenge with Bacchus® and revealed no further symptom aggravation, suggesting that taurine did not affect patients after recovery from VCM. Conclusion The association between taurine-rich food and reversible symptom aggravation can appear in patients with VCM and disappear after VCM treatment. Aggravation of venous hypertension in the spinal cord is suggested as a mechanism but further elucidation is needed.
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- 2022
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29. Treatment of Dural Arteriovenous Fistulas With SQUID™ Liquid Embolic Agent (Liquid)
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University Hospital Schleswig-Holstein and Dr. Markus Alfred Möhlenbruch, Principle Investigator
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- 2020
30. A Practical Grading Scale for Predicting Outcomes of Radiosurgery for Dural Arteriovenous Fistulas: JLGK 1802 Study
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Hirotaka Hasegawa, Masahiro Shin, Jun Kawagishi, Hidefumi Jokura, Toshinori Hasegawa, Takenori Kato, Mariko Kawashima, Yuki Shinya, Hiroyuki Kenai, Takuya Kawabe, Manabu Sato, Toru Serizawa, Osamu Nagano, Kyoko Aoyagi, Takeshi Kondoh, Masaaki Yamamoto, Shinji Onoue, Kiyoshi Nakazaki, Yoshiyasu Iwai, Kazuhiro Yamanaka, Seiko Hasegawa, Kosuke Kashiwabara, and Nobuhito Saito
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central nervous system vascular malformations ,hemorrhagic stroke ,gamma knife radiosurgery ,radiosurgery ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background and Purpose To assess the long-term outcomes of intracranial dural arteriovenous fistula (DAVF) treated with stereotactic radiosurgery (SRS) alone or embolization and SRS (Emb-SRS) and to develop a grading system for predicting DAVF obliteration. Methods This multi-institutional retrospective study included 200 patients with DAVF treated with SRS or Emb-SRS. We investigated the long-term obliteration rate and obliteration-associated factors. We developed a new grading system to estimate the obliteration rate. Additionally, we compared the outcomes of SRS and Emb-SRS by using propensity score matching. Results The 3- and 4-year obliteration rates were 66.3% and 78.8%, respectively. The post-SRS hemorrhage rate was 2%. In the matched cohort, the SRS and Emb-SRS groups did not differ in the rates of obliteration (P=0.54) or post-SRS hemorrhage (P=0.50). In multivariable analysis, DAVF location and cortical venous reflux (CVR) were independently associated with obliteration. The new grading system assigned 2, 1, and 0 points to DAVFs in the anterior skull base or middle fossa, DAVFs with CVR or DAVFs in the superior sagittal sinus or tentorium, and DAVFs without these factors, respectively. Using the total points, patients were stratified into the highest (0 points), intermediate (1 point), or lowest (≥2 points) obliteration rate groups that exhibited 4-year obliteration rates of 94.4%, 71.3%, and 60.4%, respectively (P
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- 2022
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31. Association of common candidate variants with vascular malformations and intracranial hemorrhage in hereditary hemorrhagic telangiectasia.
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Pawlikowska, Ludmila, Nelson, Jeffrey, Guo, Diana E, McCulloch, Charles E, Lawton, Michael T, Kim, Helen, Faughnan, Marie E, and Brain Vascular Malformation Consortium HHT Investigator Group
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Brain Vascular Malformation Consortium HHT Investigator Group ,Liver ,Lung ,Brain ,Humans ,Intracranial Arteriovenous Malformations ,Intracranial Hemorrhages ,Central Nervous System Vascular Malformations ,Telangiectasia ,Hereditary Hemorrhagic ,Transforming Growth Factor beta ,Genotype ,Phenotype ,Mutation ,Adult ,Aged ,Middle Aged ,Female ,Male ,Vascular Malformations ,Genetic Association Studies ,arteriovenous malformation ,genetic modifiers ,hereditary hemorrhagic telangiectasia ,intracerebral hemorrhage ,vascular malformation ,Rare Diseases ,Stroke ,Congenital Structural Anomalies ,Pediatric ,Genetics ,Neurosciences ,Aetiology ,2.1 Biological and endogenous factors ,Medicinal and Biomolecular Chemistry ,Clinical Sciences - Abstract
BackgroundHereditary hemorrhagic telangiectasia (HHT) is caused by mutations in TGFβ/BMP9 pathway genes and characterized by vascular malformations (VM) including arteriovenous malformations (AVM) in lung, liver, and brain, which lead to severe complications including intracranial hemorrhage (ICH) from brain VM. The clinical heterogeneity of HHT suggests a role for genetic modifier effects. Common variants in loci that modify phenotype severity in Tgfb knockout mice were previously reported as associated with lung AVM in HHT. Common variants in candidate genes were reported as associated with sporadic brain AVM and/or ICH. We investigated whether these variants are associated with HHT organ VM or with ICH from brain VM in 752 Caucasian HHT patients enrolled by the Brian Vascular Malformation Consortium.MethodsWe genotyped 11 candidate variants: four variants reported as associated with lung AVM in HHT (PTPN14 rs2936018, USH2A rs700024, ADAM17 rs12474540, rs10495565), and seven variants reported as associated with sporadic BAVM or ICH (APOE ε2, ANGPTL4 rs11672433, EPHB4 rs314308, IL6 rs1800795, IL1B rs1143627, ITGB8 rs10486391, TNFA rs361525). Association of genotype with any VM, lung AVM, liver VM, brain VM or brain VM ICH was evaluated by multivariate logistic regression adjusted for age, gender, and family clustering.ResultsNone of the 11 variants was significantly associated with any phenotype. There was a trend toward association of USH2A rs700024 with ICH (OR = 2.77, 95% CI = 1.13-6.80, p = .026).ConclusionWe did not replicate previously reported associations with HHT lung AVM and variants in Tgfb modifier loci. We also did not find significant associations between variants reported in sporadic brain AVM and VM or ICH in HHT.
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- 2018
32. Surgical Treatment vs Nonsurgical Treatment for Brain Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia: A Retrospective Multicenter Consortium Study.
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Meybodi, Ali Tayebi, Kim, Helen, Nelson, Jeffrey, Hetts, Steven W, Krings, Timo, terBrugge, Karel G, Faughnan, Marie E, Lawton, Michael T, and Brain Vascular Malformation Consortium HHTInvestigator Group
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Brain Vascular Malformation Consortium HHTInvestigator Group ,Brain ,Humans ,Intracranial Arteriovenous Malformations ,Central Nervous System Vascular Malformations ,Telangiectasia ,Hereditary Hemorrhagic ,Treatment Outcome ,Retrospective Studies ,Databases ,Factual ,Adolescent ,Adult ,Aged ,Middle Aged ,Child ,Child ,Preschool ,Infant ,Female ,Male ,Young Adult ,AVM grading ,Arteriovenous malformation ,Brain vascular malformation consortium ,Embolization ,Hereditary hemorrhagic telangiectasia ,Microsurgical resection ,Radiosurgery ,Rendu-Osler-Weber disease ,Neurosciences ,Pediatric ,Clinical Research ,Brain Disorders ,Rare Diseases ,Congenital Structural Anomalies ,Clinical Sciences ,Neurology & Neurosurgery - Abstract
BackgroundCerebral arteriovenous malformations (AVMs) are common in patients with hereditary hemorrhagic telangiectasia (HHT). However, due to the rarity of HHT and little published evidence of outcomes from management of brain AVMs in this disease, current international HHT guidelines recommend an individualized approach. Specifically, the outcomes for surgical vs nonsurgical management of these lesions have not been reported to date.ObjectiveTo report long-term outcomes of surgical resection of brain AVMs in HHT patients compared to outcomes in nonsurgically treated patients.MethodsFrom the database of the Brain Vascular Malformation Consortium HHT project, 19 patients with 20 resected AVMs (group 1) and 22 patients with 33 AVMs who received nonsurgical treatment (group 2) were studied. The groups were retrospectively reviewed for changes in functional status (modified Rankin Scale score) during the follow-up period.ResultsDuring the follow-up period, 9% of patients in group 1 suffered from worsening of functional status, whereas this figure was 16% for group 2 (P > .05). Functional outcomes were not statistically different between the 2 groups at the latest follow-up (P > .05).ConclusionHHT patients treated surgically for brain AVMs appear to have long-term functional outcomes comparable to nonsurgical (including observational) therapy with fewer unfavorable outcomes. It is therefore reasonable to consider surgical resection as a management option in the multidisciplinary team's individualized treatment strategy for HHT patients with brain AVMs.
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- 2018
33. Pial Artery Supply as an Anatomic Risk Factor for Ischemic Stroke in the Treatment of Intracranial Dural Arteriovenous Fistulas.
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Hetts, SW, Yen, A, Cooke, DL, Nelson, J, Jolivalt, P, Banaga, J, Amans, MR, Dowd, CF, Higashida, RT, Lawton, MT, Kim, H, and Halbach, VV
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Arteries ,Brain ,Humans ,Brain Ischemia ,Central Nervous System Vascular Malformations ,Embolization ,Therapeutic ,Risk Factors ,Retrospective Studies ,Adult ,Aged ,Middle Aged ,Female ,Male ,Stroke ,Neurosciences ,Brain Disorders ,Clinical Research ,Clinical Sciences ,Nuclear Medicine & Medical Imaging - Abstract
Background and purposeAlthough intracranial dural arteriovenous fistulas are principally supplied by dural branches of the external carotid, internal carotid, and vertebral arteries, they can also be fed by pial arteries that supply the brain. We sought to determine the frequency of neurologic deficits following treatment of intracranial dural arteriovenous fistulas with and without pial artery supply.Materials and methodsOne hundred twenty-two consecutive patients who underwent treatment for intracranial dural arteriovenous fistulas at our hospital from 2008 to 2015 were retrospectively reviewed. Patient data were examined for posttreatment neurologic deficits; patients with such deficits were evaluated for imaging evidence of cerebral infarction. Data were analyzed with multivariable logistic regression.ResultsOf 122 treated patients, 29 (23.8%) had dural arteriovenous fistulas with pial artery supply and 93 (76.2%) had dural arteriovenous fistulas without pial arterial supply. Of patients with pial artery supply, 4 (13.8%) had posttreatment neurologic deficits, compared with 2 patients (2.2%) without pial artery supply (P = .04). Imaging confirmed that 3 patients with pial artery supply (10.3%) had cerebral infarcts, compared with only 1 patient without pial artery supply (1.1%, P = .03). Increasing patient age was also positively associated with pial supply and treatment-related complications.ConclusionsPatients with dural arteriovenous fistulas supplied by the pial arteries were more likely to experience posttreatment complications, including ischemic strokes, than patients with no pial artery supply. The approach to dural arteriovenous fistula treatment should be made on a case-by-case basis so that the risk of complications can be minimized.
- Published
- 2017
34. Use of a Rigid-Tipped Microguidewire for the Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas with an Occluded Inferior Petrosal Sinus.
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Deniwar, Mohamed Adel, Boseong Kwon, Yunsun Song, Jung Cheol Park, and Deok Hee Lee
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CAVERNOUS sinus , *CRANIAL sinuses , *ARTERIOVENOUS fistula , *ENDOVASCULAR surgery , *CHRONIC total occlusion , *THERAPEUTIC embolization - Abstract
Objective : Transvenous embolization (TVE) via an occluded inferior petrosal sinus (IPS) in a cavernous sinus dural arteriovenous fistula (CSDAVF) is challenging, often requiring navigation of a microcatheter through resistive obstacles between the occluded IPS and shunted pouch (SP), although the reopening technique was successfully performed. We report five cases of successful access to the cavernous sinus (CS) or SP using the rigid-tipped microguidewire such as chronic total occlusion (CTO) wire aiming to share our initial experience with this wire. Methods : In this retrospective study, four patients with CSDAVF underwent five procedures using the CTO wire puncture during transfemoral transvenous coil embolization. Puncture success, shunt occlusion, and complications including any hemorrhage and cranial nerve palsy were evaluated. Results : Despite successful access through the occluded IPS, further entry into the target area using neurointerventional devices was impossible due to a short-segment stricture before the CS (three cases) and a membranous barrier within the CS (two cases). However, puncturing these structures using the rigid-tipped microguidewire was successful in all cases. We could advance the microcatheter over the rigid-tipped microguidewire for the navigation to the SP and achieved complete occlusion of the SP without complications. Conclusion : The use of the rigid-tipped microguidewire in the TVE via the occluded IPS of the CSDAVF would be feasible and safe. [ABSTRACT FROM AUTHOR]
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- 2022
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35. Normal Saline Vrs Balanced i.v. Fluids in Neurosurgery
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Sisters of Mercy University Hospital and Natasa Kovac, Natasa Kovac, M.D., Anesthesiologyst and intensive care medicine subspecialist
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- 2019
36. ONYX Evaluation in the Endovascular Treatment of Intracranial Dural Arteriovenous Fistulae (dAVF)
- Published
- 2019
37. Safety of Apollo Micro Catheter in Pediatric Patients
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- 2019
38. Dural arteriovenous fistula masquerading as neuromyelitis optica spectrum disorder.
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Bourdoncle S, Papeix C, and Lecler A
- Abstract
Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose.
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- 2024
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39. New Intracranial Arteriovenous Malformations Study Findings Reported from Johns Hopkins University (Association of Socioeconomic Status With the Management Outcome of Unruptured Intracranial Arteriovenous Malformation).
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CEREBRAL arteriovenous malformations ,CENTRAL nervous system diseases ,INTRACRANIAL arterial diseases ,CONGENITAL disorders ,CARDIOVASCULAR system - Abstract
A study conducted by researchers at Johns Hopkins University in Baltimore, Maryland, aimed to evaluate the impact of socioeconomic status (SES) on the management outcome of unruptured intracranial arteriovenous malformations (bAVMs). The study analyzed data from 589 patients with unruptured bAVMs and found that relatively disadvantaged patients with lower SES were more likely to experience nonindependent outcomes at the last follow-up. The researchers suggest that an emphasis on social support may be beneficial for patients with lower SES. This research has been peer-reviewed and was published in the Journal of Neurosurgery. [Extracted from the article]
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- 2024
40. Analysis of 30 Spinal Angiograms Falsely Reported as Normal in 18 Patients with Subsequently Documented Spinal Vascular Malformations
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Barreras, P, Heck, D, Greenberg, B, Wolinsky, J-P, Pardo, CA, and Gailloud, P
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Adult ,Aged ,Aged ,80 and over ,Central Nervous System Vascular Malformations ,False Negative Reactions ,Female ,Humans ,Magnetic Resonance Angiography ,Male ,Middle Aged ,Retrospective Studies ,Spinal Cord ,Neurosciences ,Nuclear Medicine & Medical Imaging ,Clinical sciences ,Physical chemistry - Abstract
Background and purposeThe early diagnosis of spinal vascular malformations suffers from the nonspecificity of their clinical and radiologic presentations. Spinal angiography requires a methodical approach to offer a high diagnostic yield. The prospect of false-negative studies is particularly distressing when addressing conditions with a narrow therapeutic window. The purpose of this study was to identify factors leading to missed findings or inadequate studies in patients with spinal vascular malformations.Materials and methodsThe clinical records, laboratory findings, and imaging features of 18 patients with spinal arteriovenous fistulas and at least 1 prior angiogram read as normal were reviewed. The clinical status was evaluated before and after treatment by using the Aminoff-Logue Disability Scale.ResultsEighteen patients with 19 lesions underwent a total of 30 negative spinal angiograms. The lesions included 9 epidural arteriovenous fistulas, 8 dural arteriovenous fistulas, and 2 perimedullary arteriovenous fistulas. Seventeen patients underwent endovascular (11) or surgical (6) treatment, with a delay ranging between 1 week and 32 months; the Aminoff-Logue score improved in 13 (76.5%). The following factors were identified as the causes of the inadequate results: 1) lesion angiographically documented but not identified (55.6%); 2) region of interest not documented (29.6%); or 3) level investigated but injection technically inadequate (14.8%).ConclusionsAll the angiograms falsely reported as normal were caused by correctible, operator-dependent factors. The nonrecognition of documented lesions was the most common cause of error. The potential for false-negative studies should be reduced by the adoption of rigorous technical and training standards and by second opinion reviews.
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- 2017
41. Transvenous ethanol sclerotherapy of feeding arteries for treatment of a dural arteriovenous fistula.
- Author
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Alexander, Matthew David, Halbach, Van, Nicholson, Andrew, Settecase, Fabio, Darflinger, Robert J, and Amans, Matthew R
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Cerebral Veins ,Humans ,Central Nervous System Vascular Malformations ,Ethanol ,Treatment Outcome ,Sclerotherapy ,Embolization ,Therapeutic ,Middle Aged ,Male ,Embolic ,Fistula ,Intervention ,Liquid Embolic Material ,Technique - Abstract
Dural arteriovenous fistulas (DAVFs) can be complex lesions that require a well trained eye for proper characterization and management decisions. With numerous possible arteries to supply and veins to drain them, DAVFs are often complex lesions. To best treat these complex lesions, the neurointerventionalist should be adept at treating them with multiple techniques. This report describes a unique case in which a DAVF was treated with arterial sclerotherapy using ethanol from a transvenous approach.
- Published
- 2017
42. Pediatric intracranial dural arteriovenous fistulas: age-related differences in clinical features, angioarchitecture, and treatment outcomes.
- Author
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Hetts, Steven W, Moftakhar, Parham, Maluste, Neil, Fullerton, Heather J, Cooke, Daniel L, Amans, Matthew R, Dowd, Christopher F, Higashida, Randall T, and Halbach, Van V
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Humans ,Central Nervous System Vascular Malformations ,Treatment Outcome ,Retrospective Studies ,Cohort Studies ,Follow-Up Studies ,Age Factors ,Adolescent ,Child ,Child ,Preschool ,Infant ,Infant ,Newborn ,Female ,Male ,AVM = arteriovenous malformation ,CCA = common carotid artery ,CHF = congestive heart failure ,CI = confidence interval ,DAVF ,DAVF = dural arteriovenous fistula ,DSA = digital subtraction angiogram ,DSM = dural sinus malformation ,NGAVF = non-Galenic pial arteriovenous fistula ,OR = odds ratio ,SSS = superior sagittal sinus ,VOGM = vein of Galen malformation ,cardiopulmonary ,dural arteriovenous fistula ,mRS = modified Rankin Scale ,neurological deficit ,vascular disorders ,Pediatric ,Clinical Research ,Neurosciences ,Paediatrics and Reproductive Medicine ,Neurology & Neurosurgery - Abstract
OBJECTIVE Intracranial dural arteriovenous fistulas (DAVFs) are rare in children. This study sought to better characterize DAVF presentation, angioarchitecture, and treatment outcomes. METHODS Children with intracranial DAVFs between 1986 and 2013 were retrospectively identified from the neurointerventional database at the authors' institution. Demographics, clinical presentation, lesion angioarchitecture, treatment approaches, angiographic outcomes, and clinical outcomes were assessed. RESULTS DAVFs constituted 5.7% (22/423) of pediatric intracranial arteriovenous shunting lesions. Twelve boys and 10 girls presented between 1 day and 18 years of age; boys presented at a median of 1.3 years and girls presented at a median of 4.9 years. Four of 8 patients ≤ 1 year of age presented with congestive heart failure compared with 0/14 patients > 1 year of age (p = 0.01). Five of 8 patients ≤ 1 year old presented with respiratory distress compared with 0/14 patients > 1 year old (p = 0.0021). Ten of 14 patients > 1 year old presented with focal neurological deficits compared with 0/8 patients ≤ 1 year old (p = 0.0017). At initial angiography, 16 patients harbored a single intracranial DAVF and 6 patients had 2-6 DAVFs. Eight patients (38%) experienced DAVF obliteration by the end of treatment. Good clinical outcome (modified Rankin Scale score 0-2) was documented in 77% of patients > 1 year old at presentation compared with 57% of patients ≤ 1 year old at presentation. Six patients (27%) died. CONCLUSIONS Young children with DAVFs presented predominantly with cardiopulmonary symptoms, while older children presented with focal neurological deficits. Compared with other pediatric vascular shunts, DAVFs had lower rates of angiographic obliteration and poorer clinical outcomes.
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- 2016
43. Correlation between angioarchitectural characteristics of brain arteriovenous malformations and clinical presentation of 183 patients.
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BATISTA, Ulysses Caus, PEREIRA, Benedito Jamilson Araujo, JOAQUIM, Andrei Fernandes, TEDESCHI, Helder, and PISKE, Ronie Leo
- Abstract
Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2022
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44. Transvenous ethanol sclerotherapy of feeding arteries for treatment of a dural arteriovenous fistula.
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Alexander, Matthew David, Halbach, Van, Nicholson, Andrew, Settecase, Fabio, Darflinger, Robert J, and Amans, Matthew R
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Humans ,Central Nervous System Vascular Malformations ,Polyvinyls ,Magnetic Resonance Imaging ,Angiography ,Digital Subtraction ,Cerebral Angiography ,Treatment Outcome ,Sclerotherapy ,Middle Aged ,Male ,Administration ,Intravenous ,Embolic ,Fistula ,Intervention ,Liquid Embolic Material ,Technique ,Clinical Sciences - Abstract
Dural arteriovenous fistulas (DAVFs) can be complex lesions that require a well trained eye for proper characterization and management decisions. With numerous possible arteries to supply and veins to drain them, DAVFs are often complex lesions. To best treat these complex lesions, the neurointerventionalist should be adept at treating them with multiple techniques. This report describes a unique case in which a DAVF was treated with arterial sclerotherapy using ethanol from a transvenous approach.
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- 2016
45. Brain imaging of neurovascular dysfunction in Alzheimer’s disease
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Montagne, Axel, Nation, Daniel A, Pa, Judy, Sweeney, Melanie D, Toga, Arthur W, and Zlokovic, Berislav V
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Biomedical Imaging ,Clinical Research ,Neurodegenerative ,Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD) ,Bioengineering ,Brain Disorders ,Aging ,Alzheimer's Disease ,Vascular Cognitive Impairment/Dementia ,Alzheimer's Disease Related Dementias (ADRD) ,Acquired Cognitive Impairment ,Neurosciences ,Dementia ,Aetiology ,2.1 Biological and endogenous factors ,Neurological ,Alzheimer Disease ,Animals ,Blood-Brain Barrier ,Brain ,Central Nervous System Vascular Malformations ,Humans ,Neuroimaging ,Alzheimer's disease ,Neurovascular dysfunction ,Blood-brain barrier ,Cerebral blood flow ,Magnetic resonance imaging ,Alzheimer’s disease ,Blood–brain barrier ,Clinical Sciences ,Neurology & Neurosurgery - Abstract
Neurovascular dysfunction, including blood-brain barrier (BBB) breakdown and cerebral blood flow (CBF) dysregulation and reduction, are increasingly recognized to contribute to Alzheimer's disease (AD). The spatial and temporal relationships between different pathophysiological events during preclinical stages of AD, including cerebrovascular dysfunction and pathology, amyloid and tau pathology, and brain structural and functional changes remain, however, still unclear. Recent advances in neuroimaging techniques, i.e., magnetic resonance imaging (MRI) and positron emission tomography (PET), offer new possibilities to understand how the human brain works in health and disease. This includes methods to detect subtle regional changes in the cerebrovascular system integrity. Here, we focus on the neurovascular imaging techniques to evaluate regional BBB permeability (dynamic contrast-enhanced MRI), regional CBF changes (arterial spin labeling- and functional-MRI), vascular pathology (structural MRI), and cerebral metabolism (PET) in the living human brain, and examine how they can inform about neurovascular dysfunction and vascular pathophysiology in dementia and AD. Altogether, these neuroimaging approaches will continue to elucidate the spatio-temporal progression of vascular and neurodegenerative processes in dementia and AD and how they relate to each other.
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- 2016
46. Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes.
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Hetts, SW, Tsai, T, Cooke, DL, Amans, MR, Settecase, F, Moftakhar, P, Dowd, CF, Higashida, RT, Lawton, MT, and Halbach, VV
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Humans ,Intracranial Hemorrhages ,Intracranial Hypertension ,Central Nervous System Vascular Malformations ,Disease Progression ,Cerebral Angiography ,Treatment Outcome ,Radiosurgery ,Retrospective Studies ,Venous Pressure ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Middle Aged ,Child ,Child ,Preschool ,Infant ,Infant ,Newborn ,Female ,Male ,Statistics as Topic ,Young Adult ,Clinical Research ,Neurosciences ,Clinical Sciences ,Nuclear Medicine & Medical Imaging - Abstract
Background and purposeA minority of intracranial dural arteriovenous fistulas progress with time. We sought to determine features that predict progression and define outcomes of patients with progressive dural arteriovenous fistulas.Materials and methodsWe performed a retrospective imaging and clinical record review of patients with intracranial dural arteriovenous fistula evaluated at our hospital.ResultsOf 579 patients with intracranial dural arteriovenous fistulas, 545 had 1 fistula (mean age, 45 ± 23 years) and 34 (5.9%) had enlarging, de novo, multiple, or recurrent fistulas (mean age, 53 ± 20 years; P = .11). Among these 34 patients, 19 had progressive dural arteriovenous fistulas with de novo fistulas or fistula enlargement with time (mean age, 36 ± 25 years; progressive group) and 15 had multiple or recurrent but nonprogressive fistulas (mean age, 57 ± 13 years; P = .0059, nonprogressive group). Whereas all 6 children had fistula progression, only 13/28 adults (P = .020) progressed. Angioarchitectural correlates to chronically elevated intracranial venous pressures, including venous sinus dilation (41% versus 7%, P = .045) and pseudophlebitic cortical venous pattern (P = .048), were more common in patients with progressive disease than in those without progression. Patients with progressive disease received more treatments than those without progression (median, 5 versus 3; P = .0068), but as a group, they did not demonstrate worse clinical outcomes (median mRS, 1 and 1; P = .39). However, 3 young patients died from intracranial venous hypertension and intracranial hemorrhage related to progression of their fistulas despite extensive endovascular, surgical, and radiosurgical treatments.ConclusionsFew patients with dural arteriovenous fistulas follow an aggressive, progressive clinical course despite treatment. Younger age at initial presentation and angioarchitectural correlates to venous hypertension may help identify these patients prospectively.
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- 2015
47. Correlation between angioarchitectural characteristics of brain arteriovenous malformations and clinical presentation of 183 patients
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Ulysses Caus Batista, Benedito Jamilson Araujo Pereira, Andrei Fernandes Joaquim, Helder Tedeschi, and Ronie Leo Piske
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Central Nervous System Vascular Malformations ,Intracranial Arteriovenous Malformations ,Seizures ,Stroke ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
ABSTRACT Background: The correlation between angioarchitecture and clinical presentation of brain arteriovenous malformation (bAVM) remains a subject of debate. Objective: The main purpose of the present study was to assess the correlation between angioarchitectural characteristics of bAVM and clinical presentation. Methods: A retrospective review of all consecutive patients presenting a bAVM who underwent a cerebral angiography at Beneficencia Portuguesa Hospital in São Paulo between January 2006 and October 2016 was carried out. Patients were divided in five groups: group 1 - hemorrhage; group 2 - seizure; group 3 - headache; group 4 - progressive neurological deficits (PND); group 5 - incidental). Results: A total of 183 patients were included, with group 1 comprising 56 cases, group 2 49 cases, group 3 41 cases, group 4 28 cases, and group 5 9 cases. Regarding hemorrhage presentation, a statistical correlation was observed with female gender (P < 0.02), Spetzler-Martin 3B (P < .0015), and lesions with low flow (P < 0.04). A positive association was found between group 2 and age less than 36 years (P < 0.001), male sex (P < 0.018), presence of superficial lesions not classified as SM 3B (P < 0.002), presence of venous ectasia (p
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- 2021
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48. Cerebrofacial Venous Metameric Syndrome Mimicking Vein of Galen Aneurysmal Malformation.
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Demartini Z Jr, Brigid de Zorzi Dalke D, and Teixeira BCA
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Cerebrofacial venous metameric syndrome (CVMS) is a complex low-flow vascular malformation affecting bone and soft tissues including brain, dura mater, and eye. We show images of CVMS in an 18-month-old boy presenting facial venous malformations, developmental venous anomalies, dural sinus malformations, and dilated great cerebral vein, suggesting a vein of Galen aneurysmal malformation. Although Sturge-Weber syndrome is the most known form of CVMS, its presentations are variable and include several venous malformations. Recognizing the various manifestations of CVMS is necessary for adequate screening, treatment, and follow-up., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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49. Usefulness of sectional images in dural AVF for the interpretation of venous anatomy.
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Kang M and Kim S
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Knowledge of the venous anatomy is essential for appropriately treating dural arteriovenous fistulas (AVFs). It is challenging to determine the overall venous structure despite performing selective angiography for dural AVFs with feeder from multiple selected arteries. This is because only a part of the veins can be observed through the shunt in the selected artery. Therefore, after performing selective angiography of all vessels to understand the approximate venous anatomy, the venous anatomy can be easily understood by closely examining the source image of computed tomographic angiography or magnetic resonance angiography. Through this, it is possible to specify the vein that is to be blocked (target embolization), thereby avoiding extensive blocking of the vein and avoiding various complications. In the case of dural AVF with feeder from single selected artery, if the multiplanar reconstruction image of the three-dimensional rotational computed tomography obtained by performing angiography is analyzed thoroughly, a shunted pouch can be identified. If embolization is performed by targeting this area, unnecessary sinus total packing can be avoided.
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- 2024
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50. Pediatric Central Nervous System Vascular Malformation : Pathological Review with Diagram.
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Kim SH
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Pediatric central nervous system (CNS) vascular malformations are a group of abnormal blood vessel formations within the brain or spinal cord in children. The most crucial point of pediatric CNS vascular malformation is that no golden standard classifications exist. In addition, there is a big gap in knowledge and the viewpoint of clinicians, radiologists, and pathologists. In addition, many genes associated with pediatric CNS vascular malformation, such as Sturge-Weber-Dimitri syndrome with guanine nucleotide-binding protein G(q) subunit alpha (GNAQ) gene mutation, and cavernous malformations with cerebral cavernous malformations 1 (CCM1), CCM2, and CCM3 gene mutation, were recently revealed. For proper therapeutic approaches, we must understand the lesions' characterizations in anatomical, morphological, and functional views. In this review, the author would like to provide basic pediatric CNS vascular malformation concepts with understandable diagrams. Thus, the author hopes that it might be helpful for the proper diagnosis and treatment of CNS pediatric vascular malformations.
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- 2024
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