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1.
World Neurosurg ; 137: 94-97, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32006734

RESUMO

BACKGROUND: Elevation of bone for the treatment of depressed skull fractures overlying venous sinuses is rarely required or performed. The neurosurgical literature only describes a handful of cases of surgical intervention in which the posterior two-thirds of the superior sagittal sinus was involved. Clinical course is variable, signs and symptoms suggest increased intracranial pressure, and all conservative measures should be exhausted before proceeding with the surgical route. CASE DESCRIPTION: A 27-year-old man presented with a self-inflicted gunshot wound to posterior head. On presentation, there were no neurologic complaints. On imaging, the bullet fragment was associated with a comminuted anteriorly displaced fracture over the torcula. Vessel imaging showed tapering of the superior sagittal sinus and transverse sinuses near the torcula, suggesting narrowing due to mass effect. The patient did not respond to initial conservative management and developed worsening diplopia and papilledema concerning for increased intracranial pressure. Occipital/suboccipital craniectomy was performed with elevation of depressed skull fracture, decompression of dural venous sinus, removal of bullet, and mesh cranioplasty. Repeat ophthalmology examination postoperatively showed improvement in optic disc edema and diplopia. CONSLUSIONS: This case confirms that the approach of surgical management of superior sagittal venous sinus injuries associated with skull fractures described in the literature also can be used successfully for injuries over the torcula if conservative management does not help alleviate the symptoms and results in good outcome. It was felt that delayed surgery also plays an important role, as it gives time for scar tissue to form, which may help to protect the sinus from injury during surgery.


Assuntos
Cavidades Cranianas/cirurgia , Hipertensão Intracraniana/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adulto , Cavidades Cranianas/lesões , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/etiologia , Masculino , Papiledema/diagnóstico , Papiledema/cirurgia , Fraturas Cranianas/complicações , Fraturas Cranianas/cirurgia , Seio Sagital Superior/cirurgia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico
2.
BMC Neurol ; 20(1): 9, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914955

RESUMO

BACKGROUND: Venous sinus stenosis (VSS) is a type of cerebral venous vascular disease. Cerebral autoregulation is an indicator of cerebral arterial function. The cerebral circulatory system is composed of the venous system and arterial system. Impaired venous function may affect arterial function. Thus, cerebral venous stenosis may influence cerebral autoregulation. CASE PRESENTATION: In this case, a 50-year-old woman with transient blindness and headache was admitted to the hospital. The patient was diagnosed with VSS. A stent was placed at the stenosis. The stent released the intravenous pressure and remitted the patient's symptoms. Measurements of dynamic cerebral autoregulation (dCA) were performed at 3 time points: before stenting, after stenting, and 3 months later. The dCA gradually improved after stenting. CONCLUSION: VSS may have an influence on cerebral autoregulation, and effective treatment improves cerebral autoregulation in patients with VSS.


Assuntos
Cavidades Cranianas/patologia , Cavidades Cranianas/cirurgia , Homeostase , Procedimentos Neurocirúrgicos/métodos , Veias Cerebrais/patologia , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/cirurgia , Constrição Patológica , Cavidades Cranianas/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Stents , Resultado do Tratamento
5.
J Craniofac Surg ; 30(7): 2280-2284, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31369515

RESUMO

Dural sinuses have critical importance during intracranial approaches. Detailed anatomical knowledge of the dural sinuses is crucial for surgeons to reduce unexpected venous bleeding. The aim of this study was to investigate anatomical relation of sigmoid sinus and tentorium cerebelli according to clinically palpable landmarks and cranial morphometry. The authors evaluated 222 individuals' (94 women, 128 men) 3-dimensional computed tomography angiograms, retrospectively. The authors also studied on 12 mid-sagittal cut dried hemiskulls and 8 formalin fixed cadaver heads hemisected midsagitally. All measurements were completed using Osirix-Lite version 9 software. Craniometrical values were measured to define cranium morphology. Furthermore, level of the sigmoid sinus according to asterion and tentorial angle were evaluated in detail. Our results demonstrated that there were significant differences between parameters and genders, except vertical angle of the tentorium cerebelli. Distance between asterion and sigmoid sinus was statistically different between right and left sides in favor of the left side. This also varied depending on the position of the sigmoid sinus, as well. Only transverse angle between the upper point of external acoustic meatus and asterion demonstrated a significant correlation with age. This study evaluated the detailed 3D anatomy of sigmoid sinus and tentorium cerebelli related with the cranium morphology. Determining to sigmoid sinus anatomy according to clinically palpable landmarks has advantages for setting surgical protocols and reducing to unexpected injuries while surgery to these structures.


Assuntos
Medula Espinal/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Cadáver , Cefalometria , Cavidades Cranianas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
J Clin Neurosci ; 68: 317-321, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31324470

RESUMO

Dural arteriovenous fistulas (dAVF) are rare vascular malformations accounting for only 10-15% that may lead to life threatening deficits due to hemodynamic changes in blood supply and pressure conditions. We present a 64-year old patient who was admitted with disorientation and aphasia. Following images confirmed an infratentorial dural fistula draining into the straight sinus. Additional findings were progressive thrombosis of the straight sinus, microbleedings and bithalamic edema due changes in hemodynamic conditions and venous congestion. Microsurgery was performed. After treatment improvement in clinical condition was observed and the venous congestion was regressive. Hemodynamic changes due to infratentorial dAVFs may lead to bleedings in deep regions and worsening of clinical condition fastly. Treatment requires carefully planning and visualization of angioarchitecture. Symptoms and hemodynamic changes are reversible after treatment, which are essential for treatment decisions.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Disfunção Cognitiva/etiologia , Procedimentos Neurocirúrgicos/métodos , Trombose dos Seios Intracranianos/etiologia , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Cavidades Cranianas/cirurgia , Hemodinâmica/fisiologia , Humanos , Hiperemia/etiologia , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Trombose dos Seios Intracranianos/fisiopatologia
8.
World Neurosurg ; 127: e1097-e1103, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30980969

RESUMO

BACKGROUND: Cerebral venous thrombosis (CVT) is a rare entity with a potentially fatal outcome. Patients who do not respond to standard medical therapy alone may benefit from endovascular treatment options. We evaluate the angiographic and clinical results of mechanical thrombectomy in patients with severe CVT. METHODS: Endovascular procedures were performed in 13 patients with CVT in addition to standard anticoagulation therapy between 2011 and 2018. Clinical and radiologic parameters, procedure details, and angiographic and clinical outcomes were reviewed retrospectively. RESULTS: In total, 14 thrombectomy procedures were executed. Successful recanalization of the occluded sinus was achieved in 86% of cases (12/14); of those, 29% were recanalized completely. Procedural complications included perforation of the transverse sinus in 1 case (7%). Worsening of intracranial hemorrhage occurred in 14% (2/14) of cases. Favorable clinical outcome (modified Rankin Scale score 0-2) was achieved in 12 of 13 patients (92%). CONCLUSIONS: Transvenous mechanical thrombectomy is feasible, safe, and effective, leading to a high degree of successful recanalization rate of occluded dural sinus. It may be a salvage treatment for selected patients with severe CVT refractory to standard medical treatment.


Assuntos
Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/cirurgia , Procedimentos Endovasculares/métodos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/cirurgia , Trombectomia/métodos , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
9.
Brain Behav ; 9(5): e01279, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30950244

RESUMO

OBJECTIVES: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure of unknown etiology and venous sinus stenting may be an optional treatment. We aimed to evaluate the effects of venous sinus stenting on visual function, intracranial pressure, and trans-stenotic pressure gradient of the patients with IIH and to determine effects of baseline BMI or weight changes on subjective vision outcome and intracranial pressure. METHODS: From July 2009 to Aug 2016, 88 eligible patients with IIH and venous sinus stenosis who underwent stenting were retrospectively studied. RESULTS: In this study, 67 women and 21 men were included with an average age of 39.01 (18-60) years. The average BMI was 26.75 kg/m2 . Here, 66 (75.9%) patients had papilledema, 39 had impaired vision before stenting; 57 patients were followed-up, 48 (84.2%) showed significant subjective improvement or recovery in visual acuity, 4 (7.0%) patients reported no significant change in visual functions, and 5 (8.8%) suffered permanent vision loss. The cerebrospinal fluid opening pressure and trans-stenotic pressure gradient were significantly decreased postoperatively. Baseline BMI was associated with pre-and postoperative trans-stenotic pressure gradients, as well as changes in cerebrospinal fluid opening pressure. However, baseline BMI and body weight changes during follow-up were not necessarily associated with subjective visual outcomes after stenting. Stenting efficacy was limited in patients with severe preoperative optic symptoms. CONCLUSIONS: Venous sinus stenting represented an effective treatment for resolving visual dysfunction and intracranial pressure associated with venous sinus stenosis. BMI seemed to be associated with intracranial pressure but not subjective visual outcomes after stenting.


Assuntos
Cavidades Cranianas , Procedimentos Endovasculares/métodos , Implantação de Prótese , Pseudotumor Cerebral/cirurgia , Stents , Transtornos da Visão , Adulto , Índice de Massa Corporal , Cavidades Cranianas/patologia , Cavidades Cranianas/cirurgia , Feminino , Humanos , Masculino , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia
10.
World Neurosurg ; 127: 216-219, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30910749

RESUMO

BACKGROUND: Cranial dural arteriovenous fistulas (dAVFs) are abnormal connections between arteries supplying the dura mater and the cranial venous system. These present with various signs and symptoms. Progressive ocular manifestations are quite rare and may be confused with carotid cavernous fistulas (CCF). CASE DESCRIPTION: Here, we present 2 cases of dAVF manifesting with ocular symptomatology referred to our center erroneously diagnosed as CCF, and discuss the effect of venous drainage pattern on the clinical presentation. CONCLUSIONS: Ocular manifestations of cerebrovascular origin are not necessarily associated with CCF or cavernous sinus dAVF. Other vascular malformations such as dAVFs should be considered specifically when accompanied by venous stenosis distal to the site of the fistula.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Cavidades Cranianas/diagnóstico por imagem , Olho/patologia , Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/cirurgia , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Cavidades Cranianas/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade
11.
World Neurosurg ; 127: e337-e345, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30904803

RESUMO

BACKGROUND: Transvenous embolization (TVE) via occluded sinus is one option for the treatment of dural arteriovenous fistulas. Understanding of the anatomical characteristics of the occluded sinus is difficult. It is often hard to reach the shunt point because of some risk of vessel perforation. METHODS: We assessed usefulness of T1 Volumetric Isotropic TSE Acquisition (VISTA) Black Blood (BB) and 3D-T1 Fast Field Echo (FFE) for the evaluation and visualization of an occluded sinus. Evaluation of T1 VISTA BB and 3D-T1 FFE was performed preoperatively. TVE was performed via the occluded sinus while referring to the visualized reconstruction image. RESULTS: Fourteen cases of TVE were performed between 2009 and 2015. The entire occluded sinus, including both thrombus and blood flow, was seen as the high-intensity region on 3D FFE T1 gadlinium (Gd). On the other hand, thrombus was seen as the iso- or high-intensity region and blood flow as the low-intensity region on T1 VISTA BB. The maximum intensity projection reconstruction image of 3D FFE T1Gd could visualize the whole occluded sinus and was useful for microcatheter maneuver. Total shunt obliteration was achieved in 13 cases (92.8%) except for one. CONCLUSIONS: Magnetic resonance imaging evaluation of the occluded sinus using both T1 VISTA BB and 3D FFE T1Gd gives us valuable information of the occluded sinus regarding the development and the course of the occluded sinus, the length of the thrombotic occlusion, and leads to safer catheter maneuvers in TVE.


Assuntos
Seio Cavernoso/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Cavidades Cranianas/cirurgia , Embolização Terapêutica , Idoso , Cateteres , Seio Cavernoso/cirurgia , Malformações Vasculares do Sistema Nervoso Central/terapia , Cavidades Cranianas/diagnóstico por imagem , Embolização Terapêutica/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade
12.
J Neurointerv Surg ; 11(8): 841-846, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30872352

RESUMO

BACKGROUND AND OBJECTIVE: Pulsatile tinnitus (PT) can be debilitating and lead to significant morbidity. Cerebral venous sinus lesions, such as venous sinus stenosis, diverticula, and high-riding jugular bulb, are uncommon causes of PT, for which there is no standard treatment. Endovascular interventions have shown promising results for PT secondary to idiopathic intracranial hypertension, and may be a valid therapeutic option for isolated venous PT. METHODS: We conducted a systematic literature review on the outcome and safety of endovascular treatment for patients with isolated, debilitating venous PT. The venous lesion characteristics, endovascular techniques, complications, and clinical outcomes were assessed. In addition, an illustrative case of endovascular stenting for PT caused by venous sinus stenosis was included. RESULTS: A total of 41 patients (90.2% female) from 26 papers were included. The median age was 46 years (IQR 23; range 25-72 years). Focal venous sinus stenosis (20 patients) and sinus diverticula (14 patients) were the most common culprit lesions. Endovascular treatment included venous sinus stenting in 35 patients, 11 of whom had adjuvant coil embolization, and coil embolization alone in six patients. Complete resolution of the tinnitus was achieved in 95.1% of patients. There was one complication of cerebellar infarct, and no procedure-related mortality. CONCLUSIONS: In patients with debilitating PT secondary to venous sinus lesions, endovascular treatment by stenting and/or coil embolization appears to be safe and effective. Prospective randomized studies with objective outcome assessments are needed to confirm the treatment benefits.


Assuntos
Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/cirurgia , Procedimentos Endovasculares/métodos , Stents , Zumbido/diagnóstico por imagem , Zumbido/cirurgia , Adulto , Idoso , Prótese Vascular/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnóstico por imagem , Pseudotumor Cerebral/cirurgia , Zumbido/etiologia
13.
Eur Arch Otorhinolaryngol ; 276(5): 1327-1334, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30879191

RESUMO

PURPOSE: Pulsatile tinnitus (PT) due to sigmoid sinus wall anomalies (SSWA) is a common health disorder. The purpose of this study is to investigate the efficiency of simple sigmoid sinus bony wall repair on tinnitus relief and psychological improvement. METHODS: Nine cases of PT due to SSWA were retrospectively reviewed. All of these cases had defect of sigmoid sinus bony wall with or without diverticulum in high-resolution CT. The bony defects were repaired by multi-layer materials, i.e., temporalis fascia, bone dust and another layer of bone dust. The assessment of visual analog scale (VAS) of tinnitus and Mandarin version of the tinnitus questionnaire (MTQ) were carried out before operation and at 1 week, 3 months, 6 months and 12 months after operation. RESULTS: All of eight cases treated by simple sigmoid sinus bony wall repair reported disappearance or significant relief of PT after operation. The VAS and MTQ scores at 1 week, 3 months, 6 months and 12 months after operation all significantly decreased when compared to that before operation (p < 0.05). CONCLUSION: Simple repair of sigmoid sinus bony wall defects was an effective way to reduce the physical impact as well as the psychological impact of PT due to SSWA. The defect of sigmoid sinus bony wall played a key role in the pathophysiology of PT due to SSWA.


Assuntos
Cavidades Cranianas/cirurgia , Zumbido/cirurgia , Adulto , Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/patologia , Divertículo/cirurgia , Fáscia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Estudos Retrospectivos , Inquéritos e Questionários , Zumbido/fisiopatologia , Zumbido/psicologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Escala Visual Analógica
14.
World Neurosurg ; 127: e179-e185, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30878750

RESUMO

BACKGROUND: In the management of meningiomas invading the major venous sinuses, balance between tumor control and complication prevention is desirable. The aim of this study was to describe an institutional experience in management of meningiomas involving major venous sinuses. METHODS: A retrospective study was carried out over 18 years, between 1999 and 2017, in patients with meningiomas involving major venous sinuses. Clinical features, operative strategy, histology, postoperative complications, adjuvant therapy, and long-term follow-up were studied. RESULTS: The study included 84 patients. Neurologic deficits were seen in 26 (31%) patients at presentation. The recurrence rates in Simpson grade I, II, and III excision were 7.6%, 25%, and 29.4% at a mean follow-up of 45.4 months (range, 1-192 months). No intervention of the involved sinus was done in 64 (76%) cases, venotomy was done in 3 (3.5%) cases, sinus resection without graft was done in 14 (16.6%) cases, and sinus reconstruction with patch was done in 3 (3.5%) cases. There were 53 (67.0%) patients with World Health Organization grade I histology and 25 (31.6%) patients with World Health Organization grade II histology. Fifteen recurrences were treated with Gamma Knife radiosurgery. In univariate analysis using Cox proportional hazards model, World Health Organization grade (P = 0.036, hazard ratio 2.90, 95% confidence interval = 1.07-7.87) and Simpson grade (P = 0.017, hazard ratio 2.90, 95% confidence interval = 1.18-5.29) were found to be significant factors to predict tumor recurrence. CONCLUSIONS: Management of meningiomas involving major venous sinus with microsurgical techniques and adjuvant Gamma Knife radiosurgery achieves a good tumor control rate with an acceptable complication rate.


Assuntos
Cavidades Cranianas/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo , Terapia Combinada , Cavidades Cranianas/patologia , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Microcirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Radiocirurgia , Radioterapia Adjuvante , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Estudos Retrospectivos
15.
World Neurosurg ; 126: 151-155, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30857996

RESUMO

BACKGROUND: Dural arteriovenous fistulae (dAVFs) of the anatomically complex anterior condylar confluence (ACC) are often examined by computed tomography (CT) angiography and conventional angiography before treatment. Contrasted vessels often overlap with skull bones in enhanced CT scan and make it difficult to detect the shunt point of the dAVF. Bone subtraction CT angiography (BSCTA) can overcome this limitation and allow for superior imaging of dAVFs that may help to find an alternative access for catheterization. CASE DESCRIPTION: An 80-year-old woman suffered from right ear tinnitus, headache, and an audible bruit. Preoperative imaging showed a dAVF of the ACC. It was fed by the bilateral ascending pharyngeal artery, drained to the internal jugular vein (IJV) via the inferior petrosal sinus, and had an intraosseous shunt pouch. We therefore performed transvenous embolization (TVE) via the intercavernous sinus because the angle between the anterior condylar vein and the IJV was too sharp to catheterize vessels through the ipsilateral IJV. CONCLUSIONS: Understanding the inherently complex and individually unique venous anatomy of the ACC is crucial for treatment of dAVFs. BSCTA is an effective visualization technique for dAVFs of the ACC and allows for precise preoperative vascular structure evaluation. We suggest that in the case of the angle between the ACV and the IJV being too sharp to catheterize vessels through the ipsilateral IJV, TVE via the intercavernous sinus can be efficiently used.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/terapia , Cavidades Cranianas/cirurgia , Embolização Terapêutica/métodos , Idoso de 80 Anos ou mais , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Cavidades Cranianas/diagnóstico por imagem , Feminino , Humanos , Resultado do Tratamento
16.
Curr Neurovasc Res ; 16(1): 77-81, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30727893

RESUMO

BACKGROUND AND PURPOSE: Cerebral Venous Sinus Stenosis (CVSS) usually results in severe Intracranial Hypertension (IH), which can be corrected by stenting immediately. However, there is a lack of evidence of the long-term good outcomes in patients with CVSS who underwent stenting. METHODS: A total of 62 patients with imaging confirmed non-thrombotic and non-external compression CVSS were enrolled into this single center real-world cohort study after undergoing stenting, and were continuously followed up for more than 12 years. The symptoms and signs of IH prior to stenting and post-stenting and the incidence of restenosis after stenting were analyzed. RESULTS: The mean age of the 62 patients (range, 13 to 62) was 40 years old, and the mean body mass index was 26 (range 23 to 40). Females accounted for 67.7% (42/62). Headache was the most common symptom (79%). Transient visual obscurations occurred in 69% of the patients. 42% of the patients suffered from visual loss, 11.3% pulsatile tinnitus, and 96.8% Papilledema before stenting. The mean trans-stenotic pressure gradients were 6~43 mmHg prior to stenting and returned to 0~4 mmHg after stent placement. During the following 12~126 months (the median was 62) after stenting of the follow-up, 91.9% (57/62) of the patients obtained good outcomes. Headaches disappeared in 96% (47/49) of the patients and papilledema was attenuated in 98.3% (59/60). However, There were still 8.0 % (5/62) of the patients with poor outcomes, including optic disc atrophy in 3 patients and stent-interior thrombosis in 2 patients, which occurred 6.3 months after stenting. CONCLUSION: Our data suggest that stenting may be a promising therapy for CVSS correcting. Patients with CVSS may get long-term benefit from stenting, especially when they are accompanied with severe IH.


Assuntos
Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/cirurgia , Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/cirurgia , Stents Metálicos Autoexpansíveis , Adolescente , Adulto , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Interv Neuroradiol ; 25(3): 315-321, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30714503

RESUMO

BACKGROUND AND PURPOSE: Dural arteriovenous fistulas (DAVFs) with direct antegrade sinus drainage have a benign natural history but bruit can be disabling. Disconnection of the draining sinus is considered curative. We present the treatment results of 14 patients with a dural arteriovenous fistula with antegrade sinus return with emphasis on functionality of the involved sinus and the need for sinus patency. MATERIALS AND METHODS: Between January 2009 and January 2018, 14 patients with a DAVF with direct antegrade sinus drainage were treated in our institution. There were two men and 12 women (1: 6) with a mean age of 61 years (median 61, range 43-78). Clinical presentation was unbearable pulsatile bruit in all cases. Thirteen were draining in the sigmoid or transverse sinus and one drained into the inferior petrosal sinus. RESULTS: Twelve of 14 (86%) patients had a draining sinus non-functional for the brain. In ten of these 12 patients the sinus was occluded with liquid embolic or coils. In the two patients with a functional sinus, the fistula was successfully occluded without occluding the sinus. One patient with inferior petrosal sinus drainage required transvenous embolization. There were no permanent adverse events of treatment. CONCLUSIONS: Patients with DAVFs with direct antegrade sinus drainage were cured using a strategy of endovascular transarterial and transvenous embolization. Most patients had a non-functional sinus that could be occluded for cure.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Cavidades Cranianas/cirurgia , Procedimentos Endovasculares/métodos , Adulto , Idoso , Cateterismo , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Cerebral , Estudos de Coortes , Cavidades Cranianas/diagnóstico por imagem , Embolização Terapêutica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Resultado do Tratamento
18.
World Neurosurg ; 125: 357-363, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30797929

RESUMO

OBJECTIVE: To define, from a series of surgically treated meningiomas of the posterior fossa with dural attachment above the dural sinuses, the best management of the sinus invasion according to the pattern of venous circulation. METHODS: Seventy-five patients with posterior fossa meningioma whose dural attachment involved the major venous sinuses were included in the study. We considered tumor location and dural attachment, pattern of venous sinus circulation, degree of sinus involvement and its management, entity of surgical resection, complications, and recurrences. RESULTS: The resection of the involved sinus segment (Simpson I) was performed in 15 patients (20%) (10 with complete occlusion and pattern of circulation of types A and B and 5 with narrowed sinus and type B circulation); 42 cases (56%, all of type 1) were treated by coagulation and/or removal of the outer dural layer (Simpson II). In 14 (19%) the intrasinusal fragment was left (Simpson III), and in 4 (5%) the resection was partial, with residual intradural tumor (Simpson IV). No postoperative complications secondary to venous obstruction occurred. Eleven patients (15%) experienced tumor recurrence and were reoperated on. Only 4 of them with extensive dural invasion had further recurrence. CONCLUSIONS: In patients with posterior fossa meningiomas, we suggest to safety resect the involved sinus segment only when completely occluded. If the sinus lumen is not invaded or the tumor lies on the side of the unique or dominant transverse sinus, it should be preserved. This results in no or negligible risk of venous infarction and rather low recurrence rate.


Assuntos
Cavidades Cranianas/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neoplasias Vasculares/cirurgia , Adulto , Idoso , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/cirurgia , Cuidados Intraoperatórios/métodos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/etiologia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
19.
Acta Neurochir (Wien) ; 161(4): 821-829, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30798482

RESUMO

BACKGROUND: The bridging vein (BV) and the tentorial sinus (TenS) are important venous structures in neurological surgery. These venous structures during the anterior transpetrosal approach (ATPA) have not been reported. The objective of this study is to examine the BV and the TenS in the subtemporal corridor during the ATPA and propose a technique to identify the BV preoperatively. METHODS: This study included 126 patients treated via the ATPA. The BV and the TenS located in the operative fields were analyzed. Furthermore, in the preoperative evaluation, the cross-sectional shapes of the intradural vein and the interdural sinus were analyzed by curved planar reconstruction (CPR), and the flattening rate was calculated. Flattening rate = (a-b)/a = 1-b/a (a: long radius, b: short radius). RESULTS: Seventeen BVs and 18 TenS were identified. The bridging site was divided into two groups: tentorial and middle fossa. The middle fossa group was divided into three subgroups: cavernous sinus, middle fossa dural sinus, and middle fossa dural adherence. Five isolated TenS were sacrificed and no venous complications were observed. The mean flattening rate was 0.13 in the intradural vein and 0.51 in the interdural sinus, respectively (P = 0.0003). CONCLUSIONS: We showed classification of the BV, and preservation of the BV and TenS during the ATPA. Furthermore, we found that the interdural sinus was significantly flatter than the intradural veins. Measuring the flattening rate by CPR may be useful to identify BVs preoperatively.


Assuntos
Veias Cerebrais/cirurgia , Cavidades Cranianas/cirurgia , Dura-Máter/cirurgia , Procedimentos Neurocirúrgicos/métodos , Veias Cerebrais/diagnóstico por imagem , Cavidades Cranianas/diagnóstico por imagem , Estudos Transversais , Dura-Máter/diagnóstico por imagem , Humanos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
20.
World Neurosurg ; 125: e521-e536, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30716491

RESUMO

OBJECTIVE: Management of meningiomas with major dural venous sinus involvement is challenging. We present our case series and perspective on reconstruction of the sinuses. METHODS: Fifty-five patients underwent operations between 2005 and 2016 and the retrospective data were collected and analyzed. RESULTS: The cohort was younger with a mean of 51.3 years (range, 19-72 years) predominantly involving the superior sagittal sinus (44 patients). Sinus involvement was classified into group 1 (<50% of sinus, n = 28), group 2 (50%-99%, n = 8), and group 3 (total occlusion, n = 19). Venous collateralization was present in 100% of group 2 and 3 and in 36% of group 1 occlusions. Sinus pericranii was seen in 22 patients. Gross total resection was achieved in 87.2%, and sinus reconstruction followed in 38 patients (24 by direct suture and 14 by a patch graft). Pathology showed 36 (65%) World Health Organization grade I, 18 (33%) grade II, and 1 (2%) grade III tumors. During the mean follow-up of 60 months (range, 1-132 months), sinus was patent (74%) or narrowed but patent (24%) in 98%; 2 recurrences (3.6%) were observed (at 24 and 120 months). The mean preoperative/postoperative Karnofsky Performance Status and Kaplan-Meier cumulative overall/recurrence-free survival were 84.2%/88.1% and 90.9%/80.1%, respectively. CONCLUSIONS: These meningiomas present in a younger population, are more likely to be World Health Organization grade II or III, necessitating a more aggressive tumor resection strategy. Aggressive resection coupled with sinus reconstruction results in good long-term surgical outcome and low recurrence rates.


Assuntos
Cavidades Cranianas/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Dura-Máter/cirurgia , Feminino , Humanos , Masculino , Meningioma/classificação , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/mortalidade , Seio Pericrânio/patologia , Seio Pericrânio/cirurgia , Seio Sagital Superior/patologia , Tempo , Adulto Jovem
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