Dural arteriovenous fistula disguised as cerebral venous sinus thrombosis.

Dural arteriovenous fistulas (DAVFs) are direct communications between the intracranial arterial and venous systems without an intervening nidus. Clinicians sometimes fail to give a correct diagnosis of DAVF. Given the similarity of their clinical and magnetic resonance imaging (MRI) manifestations, diagnostic confusion may arise between DAVF and cerebral venous sinus thrombosis (CVST) (Simon et al., 2009). The clinical management of DAVFs differs from that of CVST (Ma et al., 2015; Yang et al., 2015). Anticoagulation therapy is restricted in some cases of DAVFs, especially when they are associated with retrograde venous flow, due to the increased risk of hemorrhage. Here we present a case of a DAVF patient who had been initially misdiagnosed as CVST. We summarize the reasons for misdiagnosis and give some recommendations to address this problem.

Microvascular decompression in patients with hemifacial spasm: report of 1200 cases.

BACKGROUND: Microvascular Decompression (MVD) operation is the most reliable treatment for hemifacial spasm (HFS), but it causes many complications. The aim of this retrospective study was to investigate the factors relavent to the effects and postoperative complications of microvascular decompression on hemifacial spasm. METHODS: A total of 1200 HFS patients treated with MVD were studied retrospectively. The root exit zone (REZ) of the facial nerve was exposed through the infraflocculus approach, the offending vessels were identified and separated from the REZ, and a Teflon graft was interposed between the offending vessels and the brain stem. Brain stem auditory evoked potential (AEP) was monitored intraoperatively. RESULTS: The offending vessels can be identified in all patients. The anteroinferior cerebellar artery was the main offending vessel (42.6%). Patients with vertebral artery compression had a multiple vascular compression fashion. Follow-up for 2 - 10 years (mean 4.2 years) showed that 88.7% patients were cured and 5.6% relieved, with an effective rate of 94.3%. Recurrence rate was 3.2%, and the ineffective rate was 2.6%. The most frequent complication was hearing dysfunction (2.8%). CONCLUSIONS: MVD is the most definitive treatment method of HFS. The key procedures of this operation include adequate exposure of the REZ, identification of the offending vessels, and proper positioning of Teflon grafts. Complications can be reduced effectively by utilizing a real-time AEP monitoring during the operation.

[Transmaxillary approach for surgical removal of clival chordomas: study of 10 cases].

OBJECTIVE: To study the effectiveness and clinical significance of transmaxillary approach for surgical removal of Al-Mefty type III clival chordomas. METHODS: Ten cases of Al-Mefty type III clival chordoma were treated via the transmaxillary approach and followed up for 34 months on average (10 approximately 56 months). RESULTS: Microscopic total removal of the tumors was achieved in 8 patients, and subtotal removal was achieved in the rest 2 patients. Three patients had tumor recurrence but still lived with tumors 26, 36, and 40 months after operation. The other 7 patients resumed their routine life without tumor. The postoperative complications included infection in 1 case that was cured by antibiotic therapy, postoperative obstructive dyspnoea in 1 case that required tracheostomy, and CSF leakage in 1 case that stopped spontaneously 3 weeks after operation. CONCLUSION: With better exposure, complete removal, and with less brain damages and satisfactory results, transmaxillary approach is effective for surgical treatment of Al-Mefty type III clival chordomas.

[Causes of ineffectiveness of microvascular decompression for hemifacial spasm].

OBJECTIVE: To study causes of ineffectiveness of microvascular decompression (MVD) in treatment of hemifacial spasm (HFS). METHODS: Reoperative MVD was performed in 23 HFS patients with previous ineffective MVD. In the patients, the main causes of ineffectiveness included misjudgment of compressing vessels (7 patients), improper insertion of decompressing grafts (9), improper selection of grafts (5) and small grafts (2). RESULTS: Symptoms of HFS disappeared immediately after the second MVD in 21 patients and delayed in 2 patients (after 2 weeks, 6 weeks). No recurrence of HFS was noted during the follow-up period of 1.0 - 6.0 years (mean 3.4 years). CONCLUSIONS: MVD is an effective microsurgical method for treating HFS. Accurate judgement of compressing vessels and proper decompression are the key to surgical effectiveness.