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1.
World Neurosurg ; 132: 397, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541758

RESUMO

A 50-year-old man with a history of left-sided retrosigmoid craniotomy for vestibular schwannoma (VS) resection 19 years prior presented with severe headache and left cerebellopontine angle subarachnoid hemorrhage (SAH). Digital subtraction angiography demonstrated a dissected, nonfunctional left posterior inferior cerebellar artery with direct fistulization at the left transverse sinus (Video 1). The lesion was treated with endovascular Onyx embolization. The patient recovered without neurologic deficit. Five additional cases of new dural arteriovenous fistula arising after VS resection have been described; we report the first such case presenting with SAH, suggesting that postoperative magnetic resonance angiography may be of value in long-term VS follow-up imaging protocols.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Artérias Cerebrais/lesões , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/terapia , Hemorragia Subaracnóidea/terapia , Malformações Vasculares do Sistema Nervoso Central/etiologia , Ângulo Cerebelopontino , Cerebelo/irrigação sanguínea , Embolização Terapêutica , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Ruptura , Hemorragia Subaracnóidea/etiologia , Resultado do Tratamento
2.
World Neurosurg ; 132: 57, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479784

RESUMO

Radiation-induced telangiectasia of the central nervous system has been described predominantly in children, with up to 20% of patients affected after 3-41 years of radiotherapy.1,2 We present the case of a 45-year-old male with a pontine pilocytic astrocytoma treated with standard-dose radiation for 6 weeks in 1993. He developed a 3-cm multicystic, hemorrhagic brainstem lesion but was asymptomatic. The lesion caused severe brainstem mass effect, compatible with cavernous malformation or capillary telangiectasia.3 It has been reported that cavernomas and capillary telangiectasias share a similar pathologic process.4,5 The patient was surgically treated with a supracerebellar infratentorial approach to diagnose the hemorrhagic component of the lesion and ensure there was no transformation of the pilocytic astrocytoma (Video 1). He was placed in a gravity-dependent supine position with the head flexed and turned to allow for natural relaxation of the cerebellum via gravity-a technique we previously described.6 Surgical treatment proceeded with a left suboccipital craniotomy to decompress the cyst and facilitate removal of the intraaxial lesion. We took care to avoid injuring the fourth and fifth cranial nerves and branches of the superior cerebellar artery. No further lesional tissue was seen in the resection cavity. Interestingly, the final pathologic diagnosis indicated a mix of both pilocytic astrocytoma and radiation-induced capillary telangiectasia. From the surgeon's perspective, capillary telangiectasias appear similar to cavernous malformations on gross inspection, so pathologic confirmation is essential. Postoperative imaging demonstrated total resection of the lesion. The patient was discharged on postoperative day 3 with no neurologic deficit.


Assuntos
Astrocitoma/radioterapia , Neoplasias do Tronco Encefálico/radioterapia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Ponte/cirurgia , Lesões por Radiação/cirurgia , Astrocitoma/patologia , Neoplasias do Tronco Encefálico/patologia , Malformações Vasculares do Sistema Nervoso Central/etiologia , Malformações Vasculares do Sistema Nervoso Central/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Ponte/patologia , Lesões por Radiação/etiologia , Lesões por Radiação/patologia , Radioterapia/efeitos adversos
3.
World Neurosurg ; 128: 50-54, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054344

RESUMO

BACKGROUND: Formation of a dural arteriovenous fistula (DAVF) after lumbar spine decompression in the lumbar spine has been reported as a late complication, but is extremely rare in the cervical spine. CASE DESCRIPTION: A 57-year-old man who underwent a C5-6, C6-7 anterior fusion 5 years previously for cervical myelopathy at another hospital presented with progressive gait disturbance and thermal hypoalgesia on the right side of the body. Magnetic resonance imaging showed flow voids in the spinal cord dorsally at the C4-7 level, which had not been detected before the initial operation. Digital subtraction angiography showed a fistulous connection at the C7 level between the perimedullary vein and a segmental artery from the right vertebral artery, which was diagnosed as a DAVF. Surgical interruption of the intradural draining vein with multilevel posterior cervical decompression was performed, and his symptoms improved. CONCLUSIONS: To the best of our knowledge, this is the first report of a DAVF developing after multilevel anterior cervical discectomy and fusion. All the published cases of secondary DAVF, especially after spinal surgery, are reviewed.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/etiologia , Vértebras Cervicais/cirurgia , Discotomia , Complicações Pós-Operatórias , Fusão Vertebral , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Medula Espinal/cirurgia
4.
J Craniofac Surg ; 30(7): e585-e586, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31135660

RESUMO

Sturge-Weber syndrome is a rare neurocutaneous disease, also called encephalotrigeminal angiomatosis. In this study, we aimed to present a patient with Sturge-Weber syndrome who had atypical radiological findings and with dural arteriovenous fistula. The patient presented with hemifacial asymmetry. Sturge-Weber syndrome may present with atypical radiological findings and additional pathologies.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Assimetria Facial , Síndrome de Sturge-Weber/diagnóstico por imagem , Adulto , Malformações Vasculares do Sistema Nervoso Central/etiologia , Humanos , Masculino , Síndrome de Sturge-Weber/complicações
5.
J Craniofac Surg ; 30(7): e583-e585, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31022135

RESUMO

Intracranial dural arteriovenous fistulas (DAVFs) are typified by pathological anastomoses between meningeal arteries and dural venous sinuses or cortical veins. There are many causes contributing to the etiology of DAVFs. Among the variable causes, acquired DAVFs secondary to craniotomy had rarely been reported, especially for delayed DAVFs at the transverse-sigmoid sinus. Till now, there are only 12 published cases of delayed DAVFs at the transverse-sigmoid sinus secondary to craniotomy. Herein, the authors describe such an extraordinary rare case secondary to petroclival meningioma resection via far lateral approach, and to the best knowledge of us, this is the first well-documented case of delayed DAVF at the transverse-sigmoid sinus following far lateral craniotomy. Furthermore, cases of delayed DAVFs at the transverse-sigmoid sinus secondary to craniotomy were reviewed and investigated, and the clinical characteristics and treatment were also broadly discussed.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neoplasias da Base do Crânio/cirurgia , Seios Transversos/cirurgia , Malformações Vasculares do Sistema Nervoso Central/etiologia , Craniotomia , Feminino , Humanos , Neoplasias Meníngeas/complicações , Meningioma/complicações , Pessoa de Meia-Idade , Neoplasias da Base do Crânio/complicações
6.
Acta Neurochir (Wien) ; 161(1): 43-48, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30328524

RESUMO

The development of cavernous malformations many years following conventionally fractionated brain irradiation is well recognized and commonly reported. However, cavernous malformation induction following stereotactic radiosurgery (SRS) is largely unreported. Herein, we describe two cases of cavernous malformation formation years following SRS for brain metastases. A 20-year-old woman with breast cancer brain metastases received treatment with whole brain radiotherapy (WBRT), then salvage SRS 1.4 years later for progression of a previously treated metastasis. This lesion treated with SRS had hemorrhagic enlargement 3.0 years after SRS. Resection revealed a cavernous malformation. A 25-year-old woman had SRS for a brain metastasis from papillary thyroid carcinoma. Resection of a progressive, hemorrhagic lesion within the SRS field 2 years later revealed both recurrent carcinoma as well as cavernous malformation. As patients with brain metastases live longer following SRS, our cases highlight that the differential diagnosis of an enlarging enhancing lesion within a previous SRS field includes not only cerebral necrosis and tumor progression but also cavernous malformation induction.


Assuntos
Neoplasias Encefálicas/radioterapia , Malformações Vasculares do Sistema Nervoso Central/etiologia , Radiocirurgia/efeitos adversos , Adulto , Neoplasias Encefálicas/secundário , Malformações Vasculares do Sistema Nervoso Central/terapia , Feminino , Humanos , Radiocirurgia/métodos
7.
Acta Neurochir (Wien) ; 161(1): 49-55, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30430258

RESUMO

We report a novel case of a radiation-induced cavernous malformation developing in a vestibular schwannoma previously treated with stereotactic radiosurgery. Eleven years after treatment, the patient presented with a large predominantly cystic lesion in the cerebellopontine angle. We performed surgery, and a solid vascular lesion was identified within the schwannoma, which was determined to be a cavernous malformation after histopathological analysis. We review the literature of radiation-induced cavernous lesions, illustrating that while rare, these lesions do pose concern as a long-term complication of brain radiation therapy. We also discuss the possibility that radiation-induced cavernous malformation-like lesions are pathologically distinct from cavernous malformations.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/etiologia , Neuroma Acústico/radioterapia , Radiocirurgia/efeitos adversos , Malformações Vasculares do Sistema Nervoso Central/patologia , Malformações Vasculares do Sistema Nervoso Central/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Neuroma Acústico/patologia
8.
J Laryngol Otol ; 132(11): 1032-1035, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30322412

RESUMO

OBJECTIVE: This case report illustrates an unusual case of a dural arteriovenous fistula and an associated encephalocele presenting as otitis media with effusion.Case reportA 53-year-old man presented with right-sided hearing loss and aural fullness of 2 years' duration. Examination revealed ipsilateral post-auricular pulsatile tenderness. Computed tomography showed transcalvarial channels suggestive of dural arteriovenous fistula. Further magnetic resonance imaging demonstrated the presence of a temporal encephalocele herniating through the tegmen tympani defect, as well as the abnormal vascularity. Angiography confirmed a Cognard type I dural arteriovenous fistula, which is being managed conservatively. Surgical repair of the encephalocele was recommended but declined by the patient. CONCLUSION: Dural arteriovenous fistula is an uncommon intracranial vascular malformation rarely seen by otolaryngologists, with pulsatile tinnitus being the usual presentation. To our knowledge, this is the first reported case of dural arteriovenous fistula presenting with conductive hearing loss and otalgia.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Dor de Orelha/etiologia , Encefalocele/diagnóstico , Perda Auditiva/etiologia , Malformações Vasculares do Sistema Nervoso Central/etiologia , Tratamento Conservador , Diagnóstico Diferencial , Encefalocele/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Otite Média com Derrame/etiologia , Tomografia Computadorizada por Raios X
9.
Pediatr Blood Cancer ; 65(11): e27311, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30009501

RESUMO

Brain tumors are the second most common childhood cancer. Treatment protocols for high-grade pediatric brain tumors recommend regular follow-up imaging for up to 10 years. We review maximal time to recurrence and minimal time to radiologically detectable long-term sequelae such as secondary malignancies, vascular complications, and white matter disease. No tumors recurred after the 10-year point, but radiological long-term sequelae grew more common as the treatment completion date receded. We do not recommend regular imaging more than 10 years after treatment has ended, unless there are clinical symptoms.


Assuntos
Neoplasias Encefálicas/terapia , Sobreviventes de Câncer , Recidiva Local de Neoplasia/diagnóstico , Adolescente , Antineoplásicos/efeitos adversos , Encefalopatias/diagnóstico , Encefalopatias/etiologia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Malformações Vasculares do Sistema Nervoso Central/etiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Leucoencefalopatias/diagnóstico , Leucoencefalopatias/etiologia , Masculino , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/etiologia , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos
10.
World Neurosurg ; 118: 265-268, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30048792

RESUMO

BACKGROUND: Known facts are that a long period of central catheterization or hemodialysis causes central venous occlusion or stenosis and its further development brings about superior vena cava syndrome. Major symptoms of superior vena cava syndrome include venous congestion caused by the occlusion or stenosis of the central vein in the sites of the head, face, neck, and upper extremity. Clinical manifestations of superior vena cava syndrome are less likely to cause intracranial hypertension, and intracranial venous hypertension does not appear to be a clinical symptom of cavernous sinus-dural arteriovenous fistula. CASE DESCRIPTION: A 35-year-old female patient visited our hospital with chief complaints of a 2-week-old headache, chemosis, pulsatile and exophthalmos and the deteriorating ptosis in the right eye. The patient has been on continuous hemodialysis since diagnosis of renal failure due to diabetes for 20 years. Magnetic resonance images led us to a strong suspicion of cavernous sinus-dural arteriovenous fistula. However, an additionally performed digital subtraction angiogram led us to the diagnosis of superior vena cava syndrome of severe stenosis in both brachiocephalic veins. Balloon angioplasty was performed to the narrowed right-side brachiocephalic vein. No more intracranial venous reflux was to be seen in the postballoon angiogram. CONCLUSIONS: In our case, the clinical manifestations of superior vena cava syndrome seemed to be cavernous sinus-dural arteriovenous fistula and symptoms disappeared when resolving central vein stenosis. We report a case of superior vena cava syndrome with atypical clinical features.


Assuntos
Angioplastia com Balão/métodos , Veias Braquiocefálicas/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Hipertensão Intracraniana/diagnóstico por imagem , Síndrome da Veia Cava Superior/diagnóstico por imagem , Adulto , Malformações Vasculares do Sistema Nervoso Central/etiologia , Malformações Vasculares do Sistema Nervoso Central/terapia , Diagnóstico Diferencial , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/terapia , Síndrome da Veia Cava Superior/complicações , Síndrome da Veia Cava Superior/terapia
11.
Interv Neuroradiol ; 24(4): 435-439, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29788813

RESUMO

Objective Hemorrhage during embolization of dural arteriovenous fistula (DAVF) is a rare but devastating complication. This study was undertaken to analyze the causes of hemorrhage and avoid complication. Methods The clinical data of a case of DAVF with hemorrhagic complication were retrospectively collected and analyzed. Results The patient in this case presented with DAVF and two de novo aneurysms of a feeder artery after the first embolization. One de novo aneurysm ruptured during the second embolization of the DAVF because of hemodynamic change. Computed tomography showed a subdural hematoma, and surgical exploration was emergently performed. However, the patient died at postoperative day 10. Conclusions De novo aneurysm of a feeder artery may form after embolization of DAVF because of hemodynamic change. It has a high risk of rupture and should be a primary consideration in embolization of DAVF.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/etiologia , Malformações Vasculares do Sistema Nervoso Central/terapia , Embolização Terapêutica/efeitos adversos , Adulto , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Cerebral , Dimetil Sulfóxido/uso terapêutico , Evolução Fatal , Humanos , Imagem por Ressonância Magnética , Polivinil/uso terapêutico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
12.
J Neurointerv Surg ; 10(7): e15, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29563208

RESUMO

We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/etiologia , Malformações Vasculares do Sistema Nervoso Central/terapia , Veias Cerebrais/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/terapia , Pseudotumor Cerebral/cirurgia , Stents/efeitos adversos , Ligas , Cavidades Cranianas/cirurgia , Feminino , Humanos , Resultado do Tratamento , Adulto Jovem
13.
J Clin Neurosci ; 50: 51-57, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29398197

RESUMO

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder that causes angiodysplasia and results in mucocutaneous telangiectasias and arteriovenous malformations of organs. Although central nervous system vascular malformations can occur anywhere along the neuraxis, spinal vascular malformations are rare. We present our experience with the presentation and management of spinal vascular malformations in patients with HHT. Of the more than 800 patients with the diagnosis of HHT screened at our institution from 1995 through 2017, four patients with spinal vascular malformations (age range 1 month-77 years; 2 male, 2 female) were identified, three of whom came to clinical attention after significant neurological deterioration from previously unknown malformations. A review of the literature including our patients demonstrated 29 total spinal arteriovenous fistulas (AVFs) in 28 HHT patients (69% male). The lesions were located predominantly in the thoracic spine (65.5%). Three lesions were not treated, 17 were treated with embolization, 6 were surgically resected, and 3 were treated with embolization and surgery. In 14 cases, the patients presented with hemorrhage of the AVF. Overall, 79% of patients achieved complete or near-complete occlusion, with 75% reporting improvement in neurological function. Discovery of spinal lesions often occurs after neurological decline because current screening protocols do not include evaluation of the patient for spinal lesions. Most patients benefit from intervention, which is tailored to the characteristics of the patient and their malformation. Given the often-severe neurological deficit encountered at presentation, we favor a protocol that screens HHT patients for spinal vascular malformations.


Assuntos
Fístula Arteriovenosa/etiologia , Malformações Vasculares do Sistema Nervoso Central/etiologia , Medula Espinal/anormalidades , Telangiectasia Hemorrágica Hereditária/complicações , Idoso , Fístula Arteriovenosa/cirurgia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Medula Espinal/cirurgia , Telangiectasia Hemorrágica Hereditária/cirurgia
14.
Clin Toxicol (Phila) ; 56(8): 795-797, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29343133

RESUMO

INTRODUCTION: Prenatal methamphetamine exposure is related to prematurity, fetal growth restriction, neurobehavioral effects and long-term motor and cognitive sequelae. PATIENT PRESENTATION: We report the case of a newborn from a Filipina with no prenatal care with a complex brain malformation. Methamphetamine was identified in maternal and neonatal urine and in maternal hair, raising our suspicion of methamphetamine as a cause of this malformation. DISCUSSION: Methamphetamine abuse is a growing problem worldwide. There are little data on its effect on the fetus. To our knowledge, no fetal brain abnormalities have been associated with its use. In our case, the lack of antenatal control does not allow us to date when this malformation appeared. CONCLUSION: The aim of our report is to generate awareness of the possible association between methamphetamine abuse during pregnancy and central nervous system malformations.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/complicações , Estimulantes do Sistema Nervoso Central/envenenamento , Malformações Vasculares do Sistema Nervoso Central/etiologia , Desenvolvimento Fetal/efeitos dos fármacos , Metanfetamina/envenenamento , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/fisiopatologia , Feminino , Cabelo/química , Humanos , Recém-Nascido , Metanfetamina/urina , Gravidez , Efeitos Tardios da Exposição Pré-Natal
15.
Interv Neuroradiol ; 24(2): 206-209, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29199500

RESUMO

Posterior condylar canal dural arteriovenous fistula (PCC dAVF) is a rare entity with only three cases having been reported so far in the English literature. We describe the clinical presentation, imaging, and endovascular management of an elderly man with left PCC dAVF presenting with subarachnoid haemorrhage (SAH). Endovascular management of such cases requires thorough understanding of the vascular anatomy around the craniovertebral junction (CVJ) and variable bridging vein draining patterns. The fistula in our case was fed by the posterior meningeal branch of the left vertebral artery and was draining through a dilated and tortuous medullary bridging vein into the antero-lateral pontomedullary venous system. Transarterial glue embolisation was performed with complete exclusion of the fistula and venous pouches. The patient developed intractable hiccough and left-sided facial pain on the second post-procedural day, and MRI showed focal diffusion restriction in the left dorso-lateral medulla. He recovered completely after a short course of steroids.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Procedimentos Endovasculares/métodos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgia , Idoso , Malformações Vasculares do Sistema Nervoso Central/etiologia , Angiografia Cerebral , Humanos , Imagem Tridimensional , Imagem por Ressonância Magnética , Masculino , Hemorragia Subaracnóidea/etiologia , Tomografia Computadorizada por Raios X
16.
BMJ Case Rep ; 20172017 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-28951386

RESUMO

We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Cavidades Cranianas/cirurgia , Procedimentos Endovasculares/métodos , Pseudotumor Cerebral/terapia , Trombose dos Seios Intracranianos/terapia , Stents , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/etiologia , Angiografia Cerebral , Cavidades Cranianas/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Pseudotumor Cerebral/diagnóstico por imagem , Pseudotumor Cerebral/fisiopatologia , Trombose dos Seios Intracranianos/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
17.
J Stroke Cerebrovasc Dis ; 26(12): 2788-2792, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28802521

RESUMO

BACKGROUND AND PURPOSE: The mechanisms and prognosis of underlying subarachnoid hemorrhage of unknown origin remain unclear. Previous investigators have suggested a relationship between nonaneurysmal perimesencephalic subarachnoid hemorrhage and venous abnormalities like a primitive venous drainage of the basal vein of Rosenthal. We report the outcome of a midterm follow-up of 20 consecutive patients with nonaneurysmal subarachnoid hemorrhage of unknown origin, and 2 patients in whom the development of new dural arteriovenous fistulas after subarachnoid hemorrhage of unknown origin were detected during follow-up. METHODS: All patients who were admitted to our hospital for nontraumatic subarachnoid hemorrhage between April 2008 and March 2016 were retrospectively analyzed. RESULTS: Of 705 patients included in the study, 20 (2.8%) were diagnosed with nontraumatic subarachnoid hemorrhage of unknown origin. During the follow-up periods, there was no rebleeding. Although 18 patients did not show any vascular abnormalities, the other 2 patients were diagnosed with dural arteriovenous fistula. Both fistulas were successfully treated with endovascular embolization. CONCLUSIONS: Subarachnoid hemorrhage of unknown origin had a low incidence rate, and its clinical course was excellent without rebleeding. Although no vascular abnormalities were observed during the patients' initial admission, venous lesions might have been involved in both subarachnoid hemorrhages and delayed dural arteriovenous fistulas. Here, the possible pathogenesis is discussed with a review of the literature.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/etiologia , Hemorragia Subaracnóidea/etiologia , Adulto , Idoso , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/terapia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Procedimentos Endovasculares , Feminino , Humanos , Japão , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento
18.
J Clin Neurosci ; 44: 225-226, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28673669

RESUMO

Development of dural arteriovenous fistula (dAVF) after cerebral venous sinus thrombosis (CVST) was very uncommon and for all these reported cases, the dAVF was a chronic complication. We present a case of acute development of dAVF after CVST. A 40-year-old female was admitted into our department with 2day's headache and vomiting for 9h. Head computed tomography (CT) scan showed only scattered minor hematomas over the right frontal lobe. Blood test indicated an elevated D-dimer. The patient experienced transient paralysis (Todd's paralysis) after intermittent focal epilepsy from day 3, which progressed into sustained epilepsy on day 6. Magnetic resonance imaging (MRI) on day 7 confirmed the thrombosis of the superior sagittal sinus and a large area of infarction and edema in the left frontal and parietal lobe. She was then treated with heparin and warfarin. Cerebral angiography on day 9 demonstrated a dAVF which was classified as Borden Type II and fed by the left occipital artery. Subsequently, endovascular occlusion of the fistula was conducted and the patient recovered well with only slight right limbs weakness at 1year follow up.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Trombose dos Seios Intracranianos/complicações , Adulto , Anticoagulantes/uso terapêutico , Malformações Vasculares do Sistema Nervoso Central/etiologia , Angiografia Cerebral , Cavidades Cranianas/diagnóstico por imagem , Feminino , Heparina/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Trombose dos Seios Intracranianos/tratamento farmacológico , Tomografia Computadorizada por Raios X , Varfarina/uso terapêutico
19.
No Shinkei Geka ; 45(6): 519-526, 2017 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-28634312

RESUMO

Dural arteriovenous fistula(dAVF)is relatively rare, and its etiology remains uncertain. Generally, dAVF is thought to be acquired and has been reported to develop secondary to sinus thrombosis, head injury, infection, and surgery. We report a rare case of dAVF in the anterior cranial fossa that developed remote from the craniotomy site after surgery. A 52-year-old man underwent surgery for hypertensive intracerebral hemorrhage 4 years prior. Perioperative imaging modalities demonstrated no abnormal vascular malformation except for an un-ruptured anterior communicating artery aneurysm. Four years later, follow-up magnetic resonance angiography showed abnormal vascular malformation in the anterior cranial fossa, and cerebral angiography demonstrated dAVF. dAVF and aneurysm were successfully treated. Possible formation of a dAVF should be considered after craniotomy.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Fossa Craniana Anterior/cirurgia , Craniotomia/efeitos adversos , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/etiologia , Fossa Craniana Anterior/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
World Neurosurg ; 105: 1038.e1-1038.e9, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28645600

RESUMO

BACKGROUND: Although an asymptomatic spinal dural arteriovenous fistula (SDAVF) can sometimes be incidentally detected on magnetic resonance imaging (MRI), there are no previous reports showing the development of an SDAVF on MRI or magnetic resonance angiography (MRA). CASE DESCRIPTION: A 64-year old man with unruptured vertebral artery dissection (VAD) developed a subarachnoid hemorrhage (SAH) during regular follow-up. Emergent endovascular coil internal trapping for the VAD was performed; however, angiography after the endovascular treatment showed a lower cervical SDAVF. The SDAVF was considered the bleeding source based on subsequent spinal MRI, and endovascular embolization was performed. In this case, previous serial MRA examinations indicated that the SDAVF appeared for the first time during follow-up, and SAH occurred. CONCLUSIONS: This may be the first report in which serial MRA studies demonstrated the course of this condition, from the appearance of an SDAVF to the development of SAH. An abnormal vascular structure detected on MRA indicated abnormal enlargement of the perimedullary vein and the presence of a cervical SDAVF. A lower cervical SDAVF should be suspected if such an abnormal vascular structure is detected on MRA.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/etiologia , Angiografia por Ressonância Magnética , Medula Espinal/diagnóstico por imagem , Hemorragia Subaracnóidea/complicações , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
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