Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central , Humanos , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Radiocirugia/métodos , Senos Craneales/cirugía , Senos Craneales/diagnóstico por imagenRESUMEN
Sigmoid sinus diverticulum is a rare vascular anomaly often associated with pulsatile tinnitus. It can occur in cases of chronic otitis media squamous type (unsafe type) due to dehiscence of the sigmoid sinus plate caused by cholesteatoma. The presentation of which is that of pulsatile tinnitus. However, we present an unusual case of sigmoid sinus diverticulum occurring concurrently with chronic otitis media mucosal type (safe type) but in the absence of pulsatile tinnitus. This case report highlights the diagnostic challenges and management of this rare clinical scenario.
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Senos Craneales , Divertículo , Otitis Media , Acúfeno , Humanos , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Divertículo/diagnóstico , Acúfeno/etiología , Enfermedad Crónica , Senos Craneales/anomalías , Senos Craneales/diagnóstico por imagen , Senos Craneales/patología , Otitis Media/complicaciones , Masculino , Tomografía Computarizada por Rayos X , FemeninoRESUMEN
OBJECTIVE: The aim of this study was to investigate whether the relative narrowing of the dural venous sinuses by arachnoid granulations (AGs) is more pronounced in patients with idiopathic intracranial hypertension (IIH) compared to healthy controls. BACKGROUND: IIH is characterized by increased intracranial pressure, which is associated with symptoms such as headache and visual disturbances. The role of cerebral venous drainage obstruction in IIH is the subject of ongoing research. MATERIALS AND METHODS: In this retrospective case-control study, 3D contrast-enhanced magnetic resonance images of a cohort of 43 patients with IIH were evaluated for (1) the number of AGs per venous sinus and (2) the diameters of the dural venous sinuses at the site of an AG and at standardized measurement points. In addition, the minimum width of the transverse/sigmoid sinus was measured. All data were compared to the same data from a cohort of 43 control participants. RESULTS: Patients with IIH showed less relative sinus narrowing by AG compared to controls (median: 7%, interquartile range [IQR] 10% vs. 11%, IQR 9% in controls; p = 0.009). In patients with IIH, sinus diameter was larger at the site of an AG (70 ± 25 mm2) compared to its diameter at the standardized measurement point (48 ± 23 mm2; p = 0.010). In the superior sagittal sinus (SSS), patients with IIH had smaller AGs (median: 3 mm2, IQR 2 mm2 vs. 5 mm2, IQR 3 mm2 in controls; p = 0.023) while the respective sinus segment was larger (median: 69 mm2; IQR 21 mm2 vs. 52 mm2, IQR 26 mm2 in controls; p = 0.002). The right transverse sinus was narrower in patients with IIH (41 ± 21 mm vs. 57 ± 20 mm in controls; p < 0.001). CONCLUSIONS: In contrast to our hypothesis, patients with IIH showed less pronounced relative sinus narrowing by AG compared to controls, especially within the SSS, where AGs were smaller and the corresponding sinus segment wider. Smaller AGs could result in lower cerebrospinal fluid resorption, favoring the development of IIH. Conversely, the smaller AGs could also be a consequence of IIH due to backpressure in the SSS because of the narrower transverse/sigmoid sinus, which widens the SSS and compresses the AG.
Asunto(s)
Aracnoides , Senos Craneales , Imagen por Resonancia Magnética , Seudotumor Cerebral , Humanos , Femenino , Adulto , Masculino , Estudios Retrospectivos , Seudotumor Cerebral/fisiopatología , Seudotumor Cerebral/diagnóstico por imagen , Seudotumor Cerebral/complicaciones , Estudios de Casos y Controles , Aracnoides/diagnóstico por imagen , Aracnoides/patología , Aracnoides/fisiopatología , Senos Craneales/diagnóstico por imagen , Senos Craneales/fisiopatología , Senos Craneales/patología , Persona de Mediana Edad , Adulto JovenRESUMEN
AIM: To assess clinical and radiological characteristics of simultaneous acute supra- and infratentorial epidural hematomas. MATERIAL AND METHODS: We retrospectively reviewed the clinical and radiological data of 18 patients with a concomitant acute supra- and infratentorial epidural hematoma, who were treated and followed up at our hospital. RESULTS: The Glasgow Coma Score was 3-8 in four patients, was 9-12 in seven, and was 13-15 in seven patients. While the concomitant supra- and infratentorial hematoma did not cross the midline in 15 of the patients, it did in three of them. The dural venous sinus rupture was repaired in five of the patients. Functional healing was observed in 14 of the 18 patients. Two of the patients died during the postoperative period. CONCLUSION: A simultaneous supra- and infratentorial epidural hematoma rarely occurs in neurosurgical practice. Mortality and morbidity rates are high if these are not addressed in time. The radiological images of patients should be evaluated carefully preoperatively. In patients with a concomitant infra- and supratentorial hematoma, transverse sinus damage, which is a surgical challenge, should be considered. Herein, we describe a surgical technique (supra- and infratentorial craniotomy leaving the bone bridge over the transverse sinus) for draining a concomitant supra- and infratentorial epidural hematoma; this technique is an effective surgical choice in select patients.
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Craneotomía , Escala de Coma de Glasgow , Hematoma Epidural Craneal , Humanos , Hematoma Epidural Craneal/cirugía , Hematoma Epidural Craneal/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Anciano , Craneotomía/métodos , Resultado del Tratamiento , Procedimientos Neuroquirúrgicos/métodos , Tomografía Computarizada por Rayos X , Drenaje/métodos , Adulto Joven , Adolescente , Senos Craneales/cirugía , Senos Craneales/diagnóstico por imagenAsunto(s)
Senos Craneales , Encefalocele , Stents , Humanos , Senos Craneales/cirugía , Senos Craneales/diagnóstico por imagen , Encefalocele/cirugía , Encefalocele/etiología , Encefalocele/diagnóstico por imagen , Constricción Patológica/cirugía , Base del Cráneo/cirugía , Base del Cráneo/diagnóstico por imagenRESUMEN
PURPOSE: The chordae Willisii (CWs), trabecular projections into the lumen of the dural sinuses, are not well understood. We aimed to explore them using magnetic resonance imaging (MRI). METHODS: Eighty-five patients underwent volumetric contrast-enhanced MRI, while another 30 underwent a fluid-attenuated inversion recovery (FLAIR) sequence in the coronal section. RESULTS: The CWs were detected as linear filling defects lying in the dural sinuses, adjacent to the surrounding dura mater. They were found in the superior sagittal sinus (SSS) in 68.2% of the patients, most frequently in the middle third, with laminar appearance. In 27.1% of the patients, the CWs divided the SSS lumen into separate channels. The CWs were identified in the transverse sinus, transverse-sigmoid sinus junctional area and sigmoid sinus, and straight sinus in 54.1, 47.1, and 8.2%, respectively. On the FLAIR images, dural septi partially dividing the SSS lumen were identified in all patients. In addition, in 73.3% of the patients, fine linear structures were observed in the lumen with inconstant arrangements. CONCLUSIONS: The CWs may be constant structures distributed over the lumen of the intracranial dural sinuses. Contrast-enhanced MRI may be useful for detecting laminar CWs. The FLAIR sequence may be advantageous for delineating the dural septi projecting into the lumen of the dural sinuses.
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Senos Craneales , Duramadre , Imagen por Resonancia Magnética , Humanos , Masculino , Femenino , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Anciano , Adulto , Senos Craneales/diagnóstico por imagen , Senos Craneales/anatomía & histología , Duramadre/diagnóstico por imagen , Duramadre/anatomía & histología , Medios de Contraste/administración & dosificación , Anciano de 80 o más Años , Adulto Joven , AdolescenteRESUMEN
Pulsatile tinnitus (PT) requires detailed workup to evaluate for an underlying structural cause. With advances in neuroimaging, structural venous abnormalities that can cause PT have becoming increasingly recognized. A number of anomalies, including dural arteriovenous fistulas, idiopathic intracranial hypertension, transverse sinus stenosis, sigmoid sinus wall abnormalities, jugular venous anomalies, and hypertrophied emissary veins, have been implicated in flow disruption and turbulence in the vicinity of auditory structures, resulting in PT. Endovascular treatment options, including stenting, coiling, and embolization with liquid agents, have demonstrated high efficacy and safety. These treatments can lead to symptomatic relief in carefully selected cases.
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Acúfeno , Humanos , Malformaciones Vasculares del Sistema Nervioso Central/terapia , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Senos Craneales/diagnóstico por imagen , Senos Craneales/cirugía , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Acúfeno/terapia , Acúfeno/etiologíaRESUMEN
The basal vein of Rosenthal, the vein of Galen, and the straight sinus are important venous communication routes connecting the deep, superficial, and dural sinuses. The basal vein is divided into three parts since it originates secondarily from three different areas and its venous areas are diverse. However, care should be taken because disconnection between these segments causes variations that change the venous flow path. Endovascular treatment warrants a proper understanding of this anatomical area and requires consideration of vascular occlusion and venous drainage changes.
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Venas Cerebrales , Senos Craneales , Humanos , Senos Craneales/diagnóstico por imagenRESUMEN
The superior petrosal sinus and petrosal vein are important drainage routes for the posterior cranial fossa, with some variations and collateral vessels. An anterolateral-type tentorial dural arteriovenous fistula, which occurs around the petrosal vein, often develops aggressive symptoms due to venous reflux to the brainstem and cerebellum. Neuroendovascular treatment of this fistula is usually challenging because transarterial embolization has a high risk and indications for transvenous embolization are limited. In the cavernous sinus and transverse sinus/sigmoid sinus dural arteriovenous fistulas, venous reflux to the petrosal vein is dangerous, and a treatment strategy with the occlusion of the petrosal vein is indispensable. Furthermore, attention should be paid to venous approaches through the superior petrosal sinus.
Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central , Humanos , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/terapia , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Senos Craneales/diagnóstico por imagen , Senos Craneales/cirugía , Venas Cerebrales/diagnóstico por imagen , Embolización Terapéutica/métodosRESUMEN
Veins at the craniocervical junction are complex network structures. They empty into two main brain venous drainages, the internal jugular vein and internal vertebral venous plexus, and reroute venous blood according to postural changes. They are also involved in the etiology of dural arteriovenous shunts in this region. Hence, regional venous anatomy is crucial for interventional neuroradiologists to understand the pathophysiology and formulate therapeutic strategies. This article aims to provide a summary on venous anatomy, radiological findings, and related pathological conditions, especially for young and inexperienced interventional neuroradiologists.
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Senos Craneales , Humanos , Senos Craneales/diagnóstico por imagen , Senos Craneales/anatomía & histología , Venas Cerebrales/diagnóstico por imagen , Venas Cerebrales/anatomía & histologíaRESUMEN
Venous sinus stenosis has garnered increasing academic attention as a potential etiology of idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT). The complex anatomy of the cerebral venous sinuses and veins plays a crucial role in the pathophysiology of these conditions. Venous sinus stenosis, often found in the superior sagittal or transverse sinus, can lead to elevated intracranial pressure (ICP) and characteristic IIH symptoms. Stenosis, variations in dural venous anatomy, and flow dominance patterns contribute to aberrant flow and subsequent PT. Accurate imaging plays a vital role in diagnosis, and magnetic resonance (MR) venography is particularly useful for detecting stenosis. Management strategies for IIH and PT focus on treating the underlying disease, weight management, medical interventions, and, in severe cases, surgical or endovascular procedures. Recently, venous sinus stenting has gained interest as a minimally invasive treatment option for IIH and PT. Stenting addresses venous sinus stenosis, breaking the feedback loop between elevated ICP and stenosis, thus reducing ICP and promoting cerebrospinal fluid outflow. The correction and resolution of flow aberrances can also mitigate or resolve PT symptoms. While venous sinus stenting remains an emerging field, initial results are promising. Further research is needed to refine patient selection criteria and evaluate the long-term efficacy of stenting as compared to traditional treatments.
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Hipertensión Intracraneal , Seudotumor Cerebral , Acúfeno , Humanos , Seudotumor Cerebral/complicaciones , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/cirugía , Acúfeno/diagnóstico , Acúfeno/etiología , Acúfeno/terapia , Constricción Patológica/complicaciones , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/cirugía , Hipertensión Intracraneal/complicaciones , Hipertensión Intracraneal/diagnóstico , Senos Craneales/diagnóstico por imagen , Senos Craneales/cirugía , Stents/efectos adversosRESUMEN
Although numerous case series and meta-analyses have shown the efficacy of venous sinus stenting (VSS) in the treatment of idiopathic intracranial hypertension and idiopathic intracranial hypertension-associated pulsatile tinnitus, there remain numerous challenges to be resolved. There is no widespread agreement on candidacy; pressure gradient and failed medical treatment are common indications, but not all clinicians require medical refractoriness as a criterion. Venous manometry, venography, and cerebral angiography are essential tools for patient assessment, but again disagreements exist regarding the best, or most appropriate, diagnostic imaging choice. Challenges with the VSS technique also exist, such as stent choice and deployment. There are considerations regarding postprocedural balloon angioplasty and pharmacologic treatment, but there is insufficient evidence to formalize postoperative decision making. Although complications of VSS are relatively rare, they include in-stent stenosis, hemorrhage, and subdural hematoma, and the learning curve for VSS presents specific challenges in navigating venous anatomy, emphasizing the need for wider availability of high-quality training. Recurrence of symptoms, particularly stent-adjacent stenosis, poses challenges, and although restenting and cerebrospinal fluid-diverting procedures are options, there is a need for clearer criteria for retreatment strategies. Despite these challenges, when comparing VSS with traditional cerebrospinal fluid-diverting procedures, VSS emerges as a favorable option, with strong clinical outcomes, lower complication rates, and cost-effectiveness. Further research is necessary to refine techniques and indications and address specific aspects of VSS to overcome these challenges.
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Hipertensión Intracraneal , Seudotumor Cerebral , Acúfeno , Humanos , Seudotumor Cerebral/complicaciones , Seudotumor Cerebral/diagnóstico por imagen , Seudotumor Cerebral/cirugía , Acúfeno/etiología , Acúfeno/cirugía , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/cirugía , Constricción Patológica/complicaciones , Senos Craneales/diagnóstico por imagen , Senos Craneales/cirugía , Stents/efectos adversos , Hipertensión Intracraneal/cirugía , Hipertensión Intracraneal/complicaciones , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
Because histopathological aspects of dural arteriovenous fistulas (DAVFs) are often lacking, there can be controversies regarding their angioarchitecture. Depending on various statements or DAVF types, the shunts can be situated directly on the sinuses, at the confluence of sinuses and cortical veins, in adjacent vascular structures surrounding the sinus, or, even, in the bone.1-5 Comprehensive knowledge of the intricate arteriovenous shunt anatomy is crucial for the secure and effective management of DAVFs.1 It has been confirmed that the dural arteries communicate with crack-like veins that connect ≥1 dural veins near the affected sinuses.3 In DAVFs, it is certain that ≥1 draining veins exist before draining into the venous sinus, in contrast to the commonly stated direct artery-to-sinus communication. Arteries branch and taper, and veins receive branches and thicken their lumens. We define fistulous points as the locations where the feeding arteries transition from thick to thin and the draining veins transition from thin to thick. We provide an image description based on superselective angiography.
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Malformaciones Vasculares del Sistema Nervioso Central , Angiografía Cerebral , Humanos , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/patología , Venas Cerebrales/diagnóstico por imagen , Senos Craneales/diagnóstico por imagen , Senos Craneales/patologíaRESUMEN
The petrosquamosal sinus is a rare and almost unknown emissary vein of the temporal bone. It traverses the middle cranial fossa along the petrosquamosal fissure and connects dural sinuses with extracranial venous networks. It is known to undergo normal involution during fetal and early postnatal life, and therefore is rarely found in humans. When encountered during surgery, it can be a significant source of bleeding hindering proper visualization of important surgical landmarks. Here we report the case of a PSS, encountered in a child during cochlear implantation surgery. We discuss its clinical significance and impact on the surgical approach. Laryngoscope, 134:4111-4113, 2024.
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Implantación Coclear , Senos Craneales , Humanos , Implantación Coclear/efectos adversos , Implantación Coclear/métodos , Senos Craneales/anomalías , Senos Craneales/cirugía , Senos Craneales/diagnóstico por imagen , Hueso Temporal/anomalías , Hueso Temporal/diagnóstico por imagen , Hueso Temporal/cirugía , Masculino , FemeninoRESUMEN
Dural sinus malformation (DSM) is a rare vascular malformation characterized by the dilatation of a dural venous sinus with or without an anomalous jugular bulb. Its presentation with venous-reflux-related secondary proptosis is anecdotal, with only six such cases reported so far. We report a 17-month-old boy who presented with a progressive proptosis of the right eye secondary to a DSM of the transverse sinus and torcula. Following endovascular embolization of the arterio-venous fistula, complete thrombosis of the venous lake and improvement in proptosis was noted at 6-month follow-up. Prognosis of this rare malformation is variable and dependent on specific angio-architectural features.
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Senos Craneales , Exoftalmia , Humanos , Masculino , Exoftalmia/etiología , Lactante , Senos Craneales/anomalías , Senos Craneales/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Embolización Terapéutica/métodosRESUMEN
OBJECTIVES: To identify the factors associated with venous collaterals in Thai patients with cerebral venous thrombosis. MATERIALS AND METHODS: This retrospective 20-year cohort study enrolled patients diagnosed with cerebral venous thrombosis between January 2002 and December 2022. Data was collected from the electronic medical record, and venous collaterals were independently reviewed by two neuroradiologists using the Qureshi classification. Patients with and without venous collaterals were compared. Significant factors (P<0.05) in the univariate analysis were recruited into the multivariate logistic regression analysis to determine independently associated factors. RESULTS: Among 79 patients with cerebral venous thrombosis, the prevalence of venous collaterals at the initial neuroimaging was 25.3%. In the univariate analysis, patients with cerebral venous thrombosis and venous collaterals were significantly younger (37.0±13.9 years vs. 44.9±17.4 years, P = 0.048), more often had occlusion in the superior sagittal sinus (80.0% vs. 54.2%, P = 0.041), and were associated with hormonal exposure (35.0% vs. 6.8%, P = 0.002). Multivariate logistic regression analysis revealed occlusion in the superior sagittal sinus (adjusted odds ratio [aOR] 3.581; 95% confidence interval [95% CI] 1.941-13.626; P = 0.044) and hormonal exposure (aOR 7.276, 95% CI 1.606-32.966, P = 0.010) as independent factors associated with venous collaterals in cerebral venous thrombosis. CONCLUSIONS: In this cohort, the prevalence of venous collaterals was 25.3%. Occlusion in the superior sagittal sinus and hormonal exposure were independently associated with venous collaterals in patients with cerebral venous thrombosis.
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Trombosis Intracraneal , Trombosis de los Senos Intracraneales , Trombosis de la Vena , Humanos , Estudios Retrospectivos , Estudios de Cohortes , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/epidemiología , Senos Craneales/diagnóstico por imagen , Trombosis de la Vena/epidemiología , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Trombosis de los Senos Intracraneales/complicacionesRESUMEN
BACKGROUND: Transvenous embolization of high-grade dural arteriovenous fistulas (dAVFs) is challenging particularly when the direct sinus access is favorable due to the complex venous anatomy which prohibits endovascular access via the transfemoral approach. METHOD: The procedure was conducted in the hybrid operating suite, where a burr hole was performed, followed by direct catheterization of the superior sagittal sinus. Coil embolization was then executed to achieve complete obliteration of the fistula. CONCLUSION: The direct puncture of the superior sagittal sinus is a safe and effective method for treating complex dAVFs. This approach grants access to the fistula channel which facilitates curative embolization.
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Malformaciones Vasculares del Sistema Nervioso Central , Embolización Terapéutica , Fístula , Humanos , Seno Sagital Superior/diagnóstico por imagen , Seno Sagital Superior/cirugía , Senos Craneales/diagnóstico por imagen , Senos Craneales/cirugía , Embolización Terapéutica/métodos , Punciones , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Fístula/terapiaRESUMEN
INTRODUCTION: Symptomatic intracranial hypertension (IH) due to venous outflow obstruction secondary to dural venous sinus (DVS) tumoral invasion affects up to 3% of intracranial meningioma patients. The literature regarding endovascular therapies of such patients is limited to a few case reports and a recent single-centre case series. PURPOSE: We describe our single-centre experience of endovascular therapy in patients with clinically symptomatic IH secondary to DVS meningioma invasion. METHODS: We performed a retrospective review of clinical and radiological data of all patients with refractory IH and meningiomas invading the DVS who were referred for possible DVS venoplasty and stenting. Seven endovascular procedures in six female patients were done. Presumed secondarily induced lateral transverse sinus stenosis was also stented in four patients as part of the primary intervention. RESULTS: All patients experienced complete symptomatic resolution at 6-month follow-up. Five patients had no symptom recurrence over a mean follow-up period of 3.5 years. One patient with multiple meningiomas developed recurrent IH 2 years following stenting secondary to in-stent tumour re-invasion. This was re-stented with consequent 6 months post-retreatment symptomatic relief at the time of writing. No procedure-related complications occurred. CONCLUSION: In the setting of DVS stenosis secondary to meningioma invasion, endovascular therapy is a safe and successful therapeutic option with promising mid-term results. The procedure should be considered in cases where complete surgical tumour resection is unlikely or carries a significant risk. If present, secondarily induced stenoses at the lateral ends of the transverse sinuses should also be considered for treatment.
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Hipertensión Intracraneal , Neoplasias Meníngeas , Meningioma , Seudotumor Cerebral , Humanos , Femenino , Meningioma/complicaciones , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Constricción Patológica/cirugía , Constricción Patológica/complicaciones , Senos Craneales/diagnóstico por imagen , Senos Craneales/cirugía , Hipertensión Intracraneal/complicaciones , Stents/efectos adversos , Estudios Retrospectivos , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Resultado del Tratamiento , Seudotumor Cerebral/complicacionesRESUMEN
BACKGROUND: Dural sinus malformation (DSM) is a rather rare congenital condition that can be encountered in the fetus and infants. The cause and etiology of DSM remain unclear. Obstetric ultrasound plays a key role in screening fetal brain malformations, and MRI is frequently used as a complementary method to confirm the diagnosis and provide more details. OBJECTIVE: Here, we present a fetus with DSM by multiple imaging methods to help better understand the imaging characteristics of this malformation. CASE PRESENTATION: A 22-year-old primipara was referred to our hospital at 25 weeks of gestation following the detection of a fetal intracranial mass without any symptoms. A prenatal ultrasound performed in our hospital at 25 + 2 gestational weeks showed a large anechoic mass with liquid dark space, while no blood flow was detected. After the initial evaluation, this primipara received a prenatal MRI in our hospital. This examination at 25 + 5 gestational weeks delineated a fan-shaped mass in the torcular herophili, which was iso-to hyperintense on T1WI and hypointense on T2WI. At the lower part of this lesion, a quasi-circular hyperintense on T1WI and a signal slightly hyperintense on T2WI could be seen. Meanwhile, the adjacent brain parenchyma was compressed by the mass. CONCLUSION: We reviewed the current literature to obtain a better understanding of the mechanisms, imaging characteristics, and survival status of DSM. Although the primipara of the present study regretfully opted for elective termination of pregnancy, the reevaluation of DSM survival deserves more attention because of the better survival data from recent studies.
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Malformaciones Vasculares del Sistema Nervioso Central , Imagen por Resonancia Magnética , Adulto , Femenino , Humanos , Lactante , Embarazo , Adulto Joven , Senos Craneales/diagnóstico por imagen , Senos Craneales/anomalías , Senos Craneales/patología , Feto/patología , Imagen por Resonancia Magnética/métodos , Ultrasonografía Prenatal/métodosRESUMEN
BACKGROUND: Dural arteriovenous fistulas of the marginal sinus (DAVFms) are uncommon and complex, with varied symptoms. Their complexity is heightened by the region's dense anastomotic network, posing risks for endovascular treatment. Surgical intervention can be effective, but this depends on thorough pre-operative understanding and optimal intra-operative visualization of the fistula. OBJECTIVE: To review the relevant anatomy, presentation patterns of DAVFms, and provide insights for surgical treatment. METHODS: Recent literature on DAVFms was reviewed, and three surgical cases are discussed to highlight treatment principles. RESULTS: The symptoms of a DAVFms vary depending on its venous drainage pattern. Drainage may be either ascending towards the cranial compartment or descending towards the spinal canal. Patients suffering from DAVFms may experience hemorrhage, particularly when venous drainage is directed upwards. Congestive symptoms of the spinal cord or brainstem can occur in cases of downward venous drainage. Compared to the endovascular approach, open surgery has a higher success rate in obliterating the fistula and yields better outcomes in cases of perimedullary venous drainage. Achieving surgical success necessitates thorough preoperative evaluation and adequate surgical exposure. Brainstem hyperintensity observed on T2-weighted MRI scans is linked to a poorer prognosis for recovery. CONCLUSION: Treating complex DAVFms often requires surgery, as endovascular methods may not be feasible. Successful surgery hinges on a precise understanding of the fistula's venous architecture and its spatial relationships, assessed using digital substraction angiography (DSA), angio-MRI, and angio-CT. Optimal intraoperative exposure is crucial for effective surgery.