ABSTRACT
ABSTRACT Objective To evaluate inflammatory reaction, fibrosis and neovascularization in dural repairs in Wistar rats using four techniques: simple suture, bovine collagen membrane, silicon mesh and silicon mesh with suture. Methods Thirty Wistar rats were randomized in five groups: the first was the control group, submitted to dural tear only. The others underwent durotomy and simple suture, bovine collagen membrane, silicon mesh and silicon mesh with suture. Animals were euthanized and the spine was submitted to histological evaluation with a score system (ranging from zero to 3) for inflammation, neovascularization and fibrosis. Results Fibrosis was significantly different between simple suture and silicon mesh (p=0.005) and between simple suture and mesh with suture (p=0.015), showing that fibrosis is more intense when a foreign body is used in the repair. Bovine membrane was significantly different from mesh plus suture (p=0.011) regarding vascularization. Inflammation was significantly different between simple suture and bovine collagen membrane. Conclusion Silicon mesh, compared to other commercial products available, is a possible alternative for dural repair. More studies are necessary to confirm these findings.
RESUMO Objetivo : Avaliar reação inflamatória, fibrose e neovascularização da reparação da lesão dural em ratos Wistar, comparando quatro diferentes técnicas: pontos simples, membrana de colágeno bovino, tela de silicone e tela de silicone associada a pontos simples. Métodos : Trinta ratos Wistar foram randomizados em cinco grupos: o primeiro foi um grupo controle, submetido somente à durotomia. Os outros também foram submetidos à durotomia, porém sofreram sutura simples, reparo com membrana de colágeno bovino, tela de silicone e tela de silicone com sutura. Os animais foram sacrificados, e a coluna foi submetida à avaliação histológica com um escore (variando de zero a 3) para inflamação, neovascularização e fibrose. Resultados : A fibrose foi significativamente diferente, comparando-se sutura simples e tela de silicone (p=0,005) e sutura simples e tela com fio de sutura (p=0,015), demonstrando que a fibrose foi mais intensa quando um corpo estranho foi utilizado na reparação. Membrana bovina foi significativamente diferente da tela mais sutura (p=0,011) em relação à vascularização. A inflamação foi significativamente diferente entre os grupos submetidos à sutura simples e ao reparo com membrana de colágeno bovino. Conclusão : A tela de silicone, comparada com produtos similares com disponibilidade comercial, é uma possível alternativa como protetor de dura-máter. Mais estudos são necessários para comprovar esses resultados.
Subject(s)
Animals , Cattle , Male , Dura Mater/injuries , Dura Mater/pathology , Neovascularization, Physiologic/drug effects , Surgical Mesh , Silicones/therapeutic use , Wound Healing/drug effects , Disease Models, Animal , Dura Mater/blood supply , Dura Mater/surgery , Fibrosis , Non-Fibrillar Collagens/therapeutic use , Random Allocation , Rats, Wistar , Silicones/pharmacology , Suture Techniques/statistics & numerical dataABSTRACT
A newborn with antenatal diagnosis of fetal hydrops at 36 wk of gestation, presented with congestive heart failure (CHF) and generalized edema. Computed tomographic angiography showed marked dilatation of cerebral duro-venous system including vein of Galen (VOG), straight sinus, torcula and transverse sinus without evidence of arteriovenous fistulae at the vein of Galen. Dilatation of duro-venous system resolved with concomitant improvement in biventricular function and CHF with decongestive therapy. Such entity should be differentiated from more serious conditions like VOG malformation and venous sinus thrombosis.
Subject(s)
Cerebral Veins/pathology , Dilatation, Pathologic , Dura Mater/blood supply , Edema/etiology , Edema/therapy , Heart Failure/etiology , Heart Failure/therapy , Humans , Hydrops Fetalis/diagnosis , Infant, Newborn , Intracranial Hypertension/etiology , Intracranial Hypertension/therapy , Remission, Spontaneous , Tomography, X-Ray ComputedABSTRACT
Esta revisión resume los hallazgos encontrados en el saco dural de cadáveres de recién fallecidos estudiados con diferentes técnicas histológicas. El saco dural espinal está formado por tres estructuras concéntricas: la duramadre, que ocupa el 85-90 por ciento de su espesor, del lado externo; el compartimiento subdural, integrado por células neuroteliales, y la lámina aracnoidea, que ocupa el 5 al 8 por ciento interno. La duramadre, que consta de aproximadamente 80 láminas durales concéntricas, es una estructura permeable y fibrosa, por lo cual posee resistencia mecánica. El compartimiento subdural es una estructura concéntrica, celular, de resistencia mecánica muy baja, donde se pueden producir fisuras concéntricas por rotura de las células neuroteliales dando origen a un espacio subdural adquirido. La lámina aracnoidea es una estructura celular con mayor resistencia mecánica que el compartimiento subdural. Sus células están firmemente unidas por uniones especializadas de membrana y forman una barrera semipermeable que regula el pasaje de sustancias a través del espesor del saco dural.
Subject(s)
Arachnoid/anatomy & histology , Dura Mater/ultrastructure , Subdural Space/anatomy & histology , Hematoma, Subdural, Spinal/etiology , Cadaver , Dura Mater/anatomy & histology , Dura Mater/blood supply , Epidural Space , Fibroblasts , Histological Techniques , Macrophages , Mast Cells , Microscopy, Electron, Scanning , Subarachnoid SpaceABSTRACT
Relata-se o caso de uma gestante de 24 anos, encaminhada ao serviço de neurologia por apresentar agitação, alucinações, confusão mental, cefaléia, perda de visão, afasia e convulsões. Exame neurorradiológico compatível com trombose de seios durais e veias corticais. Foi realizado tratamento com abciximab e efetuada a lise mecânica do trombo obtendo restauração do fluxo venoso cerebral. Após o procedimento, apresentou hematoma frontal o qual foi retirado cirurgicamente. A paciente evoluiu com melhora neurológica progressiva. Discute-se esta infreqüente patologia segundo quadro clínico, patogênese, exames de imagem e terapêutica.
Subject(s)
Adult , Female , Humans , Pregnancy , Dura Mater , Pregnancy Complications, Cardiovascular , Sinus Thrombosis, Intracranial , Antibodies, Monoclonal/administration & dosage , Anticoagulants/administration & dosage , Catheterization , Cerebral Hemorrhage/surgery , Dura Mater/blood supply , Immunoglobulin Fab Fragments/administration & dosage , Magnetic Resonance Angiography , Pregnancy Complications, Cardiovascular/drug therapy , Sinus Thrombosis, Intracranial/drug therapy , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We report a rare case of progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins. A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs. Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord. Cerebral angiography showed a dural arteriovenous fistula fed by the neuromeningeal branch of the left ascending pharyngeal artery. Occlusion of the fistula could be achieved by embolization after a diagnostic and subsequent therapeutic delay. There was no improvement in clinical condition. For the neurologic outcome of these patients it is important that fistula must be treated before ischemic and gliotic changes become irreversible.
Subject(s)
Middle Aged , Male , Humans , Spinal Cord Diseases/etiology , Magnetic Resonance Imaging , Dura Mater/blood supply , Arteriovenous Fistula/complicationsABSTRACT
O material utilizado consistiu de 93 pacientes portadores de malformações arteriovenosas durais (MAVDs) estudados retrospectivamente em relação ao sucesso e ao fracasso terapêutico submetidos aos métodos neurocirúrgico ou endovascular ou, ainda, combinação entre ambos, em que a doença se localizou nas regiões do seio cavernoso, do seio sagital superior, do seio transverso-sigmóide, da fossa anterior e do tentório. As conclusões foram as seguintes: o tratamento das MAVDs deve ser indicado pelo neurorradiologista intervencionista e pelo neurocirurgião, conjuntamente; as MAVDs do seio transverso-sigmóide foram melhor tratadas através do método combinado; as MAVDs do tentório foram melhor tratadas através do método combinado; as MAVDs do seio sagital superior tratadas por método endovascular asseguraram apenas 50% de sucesso terapêutico; as MAVDs do seio cavernoso são melhor tratadas por método endovascular empregando-se a via transvenosa quando comparadas com a via transarterial.
Subject(s)
Humans , Dura Mater/blood supply , Embolization, Therapeutic/methods , Intracranial Arteriovenous Malformations/therapy , Neurosurgical Procedures/methods , Cerebral Angiography , Combined Modality Therapy , Intracranial Arteriovenous Malformations , Intracranial Arteriovenous Malformations/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Dural arteriovenous fistulas are direct arteriovenous connections within the duramater either in the cranial or spinal region. They account for 10 to 15 percent of all intracranial arteriovenous malformations and they have been consistently reported since forty years. The clinical picture is variable with mild symptoms as tinnitus or secondary to ocular venous congestion, or severe ones, like neurologic symptoms or hemorrhage. They can present at any age but most of the patients are over 50 years old. The anatomy of this malformation is variable and sometimes difficult. Natural history is not completely known, therefore the best treatment is still a matter of debate. In order to achieve a favorable treatment, many publications have been focused in the classification of these malformations based on a relation between the anatomy and the natural history.
Subject(s)
Humans , Dura Mater/blood supply , Arteriovenous Fistula/classification , Arteriovenous Fistula/therapy , Intracranial Arteriovenous Malformations/therapy , Spinal Cord/pathology , Intracranial Arteriovenous Malformations/complicationsABSTRACT
A 34-year-old female patient presented with an intracranial subarachnoid hemorrhage and was found to have a dural arteriovenous fistula at the site of previous cervical meningocele repair. Subsequent occlusion was achieved with endovascular embolization. To our knowledge, the phenomenon of the development of a spinal dural fistula at the site of a meningocele repair has not been recorded before.
Subject(s)
Adult , Arteriovenous Fistula/etiology , Cerebral Angiography , Dura Mater/blood supply , Female , Humans , Meningocele/surgery , Postoperative Complications , Spinal Cord/blood supply , Subarachnoid Hemorrhage/etiologyABSTRACT
La enfermedad oclusiva de los senos durales es potencialmente letal (20-78 por ciento), y de manifestación clínica inespecifica. La sensibilidad de la tomografia es solo del 75 por ciento y la angiografía es invasiva. La resonancia ofrece ventajas en su diagnóstico por su sensibilidad al flujo, su alto contraste intrínseco y no invasividad. Los hallazgos en resonancia se describen en 7 casos
Subject(s)
Humans , Dura Mater/abnormalities , Dura Mater/anatomy & histology , Dura Mater/blood supply , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/physiopathology , Sinus Thrombosis, Intracranial/rehabilitationABSTRACT
Carotid cavernous dural arteriovenous fistula (DAVF) usually presents with conjunctival injection, proptosis, loss of visual acuity and ophthalmoplegia. There have been some carotid cavernous DAVF case reports presenting with isolated oculomotor, abducens and trochlear nerve palsy. We experienced a patient presenting with bilateral abducens nerve palsy and no other ocular signs who was diagnosed as carotid cavernous DAVF after conventional angiography. According to this case, carotid cavernous DAVF should be considered in the differential diagnosis of isolated bilateral abducens nerve palsy, in which case conventional angiography may be helpful in diagnosis.
Subject(s)
Female , Humans , Abducens Nerve/physiopathology , Arteriovenous Fistula/complications , Carotid Artery Diseases/complications , Cavernous Sinus/diagnostic imaging , Cranial Nerve Diseases/physiopathology , Cranial Nerve Diseases/etiology , Dura Mater/blood supply , Middle Aged , Paralysis/physiopathology , Paralysis/etiologyABSTRACT
La oclusión aguda de los senos venosos durales es una condición poco común con diversas etiologías. Se reporta un caso idiopático en un hombre a quien los hallazgos tanto por tomografía computarizada (TC) como por Resonancia Magnética (RM), demuestran la presencia de signos directos diagnósticos de esta entidad
Subject(s)
Humans , Dura Mater/abnormalities , Dura Mater/anatomy & histology , Dura Mater/blood supply , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/physiopathologyABSTRACT
Las malformaciones arteriovenosas durales (MAVD) aunque conocidas desde hace unos veinte años, sigue siendo una patología todavía mal definida entre radiólogos y clínicos. Este trabajo se propone realizar una revisión sobre estas lesiones y se acompañará de ilustraciones por diferentes casos examinados recientemente en el Instituto Nacional de Neurología y Neurocirugía de México. Las MAVD aunque pueden localizarse en cualquier punto de la duramadre, comparten un cierto número de puntos comunes. Nos parece lógico tratar en una primera parte los aspectos fisiopatológicos generales, diagnósticos y terapéuticos de estas lesiones. En una segunda parte desarrollaremos los aspectos propios de cada localización.