Serial antenatal sonographic observation of cerebral dural sinus malformation.
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Dural sinus malformation is an extremely rare congenital cerebrovascular malformation. We report serial antenatal sonographic findings in two patients with dural sinus malformation. Sonography can reveal dural sinus malformation at 24 weeks' gestation. Correct and early diagnosis may help determine the appropriate place, timing, and mode of delivery, which may result in a better therapeutic course and patient outcome. (+info)
Intracranial dural arteriovenous fistulas with or without cerebral sinus thrombosis: analysis of 69 patients.
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OBJECTIVES: To compare the characteristics of dural arteriovenous fistulas (AVFs) with or without cerebral sinus thrombosis (CST), and to analyse the determinants of aggressive manifestations in patients with dural AVF. METHODS: We investigated 69 patients aged 51.4 (SD 15) years who were diagnosed as having dural AVF. According to the location of the lesion and venous drainage pattern, dural AVF was classified into three sites (cavernous sinus, large sinus, and other) and five types (by Cognard's method). Aggressive manifestations of dural AVF were defined as intracranial haemorrhage, venous infarction, seizure, altered mental status, and intracranial hypertension. The diagnosis of CST was based on cerebral angiography. Logistic regression methods were used to analyse the determinants of aggressive manifestation in patients with dural AVF. RESULTS: CST was found in 39% of the patients with dural AVF. It was located at almost either the sinus around the dural AVF or the downstream venous flow pathways of the dural AVF. There was no significant difference with regard to sex, location, or type of dural AVF between patients with dural AVF with and without CST. The location "other sinuses" and the type of dural AVF "IIb/IIa+b/III/IV/V" were significantly related to aggressive manifestations of dural AVF (odds ratio 19 (p = 0.001) and 5.63 (p = 0.033), respectively). Presence of CST in patients with dural AVF had an odds ratio of 4.25 (p = 0.12) for development of aggressive manifestations. CONCLUSIONS: CST affects two fifths of patients with dural AVF. The location and type of dural AVF are major determinants of aggressive manifestations in patients with dural AVF. (+info)
Intracranial MR venography in children: normal anatomy and variations.
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BACKGROUND AND PURPOSE: Little information is available regarding the anatomy of the intracranial veins and sinuses that can be shown on MR venograms of children. The aim of this study was to determine the normal venous anatomy and anatomic variants. METHODS: Fifty children who were referred for investigation of developmental delay and who had normal results of MR imaging of the brain were recruited into the study. The cerebral veins and sinuses, including the occipital sinuses, were assessed by using 2D time-of-flight venography. Particular attention was paid to the anatomy of the venous confluence. RESULTS: Twenty-seven cases had dominant right transverse sinuses, 18 had dominant left transverse sinuses, four had co-dominant transverse sinuses, and one had absence of both transverse sinuses. In 21 (51%) of 41 cases without occipital sinuses, absent or hypoplastic transverse sinuses were found. Nine patients had occipital sinuses. Five (56%) of nine patients with occipital sinuses were younger than 2 years, and patients younger than 2 years accounted for 24% of all patients (12 of 50 patients) in the study. In six (67%) of nine patients with occipital sinuses, absent or hypoplastic transverse sinuses were shown. Two patients had bulbous prominence of the vein of Galen. One had foreshortened superior sagittal sinus, which in turn is drained by two paramedian cortical veins. CONCLUSION: Understanding the normal anatomy of the cerebral venous system and its variants by using MR venography in children provided the background to future studies on anomalous venous structure in malformations of the brain. (+info)
MR venography in the pediatric patient.
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BACKGROUND AND PURPOSE: Little is known about age-related changes in posterior fossa venous anatomy on 2D time-of-flight MR venography (MRV) or about artifacts that limit its accuracy in diagnosing venous occlusive disease. We evaluated pediatric appearances of posterior fossa venous drainage. METHODS: One hundred and eight children with normal MR imaging or minimal congenital anomalies underwent 2D MRV. Transverse sinus dominance and absence and the presence of an occipital sinus were correlated with age. Venous structure conspicuity was compared on source and maximum intensity projection images. RESULTS: Right, left, and codominance of the transverse sinus, respectively, was as follows: at < 25 months, 37%, 21%, and 42%; 25 months to 5 years, 35%, 30%, 35%; and > or =6 years, 50%, 16%, 34%. Transverse sinus dominance was not related to age between the three groups (P=.58, chi-square contingency), but some relationship was observed when patients <6 years were compared to those > or =6 years (P=.032). Chi-square trends showed a mildly positive correlation between age and an absent transverse sinus (P=.026) and a decreasing trend in the presence of an occipital sinus with age (P=.038). Saturation effects due to in-plane/slow flow were worse in patients <25 months; effects in the transverse sinuses or internal jugular veins were miminized with coronal or axial imaging, respectively. CONCLUSION: 2D TOF MRV shows age-related changes in venous anatomy. Caution should be used before posterior fossa venous occlusive disease is diagnosed on the basis of signal intensity loss, especially in neonates and young infants. (+info)
Hemodynamic evaluation during balloon test occlusion of the sigmoid sinus: clinical and technical considerations.
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Test occlusion of a patent dural sinus requires careful hemodynamic evaluation. We performed balloon test occlusion of the sigmoid sinus in a patient with an advanced-stage temporal bone malignancy that affected the dominant sigmoid sinus. Before and during the test occlusion, intrasinus pressure was monitored upstream from the balloon via the inner lumen of a double-lumen angioplasty balloon microcatheter. On the basis of the hemodynamic findings, permanent balloon occlusion was carried out without complications. (+info)
Idiopathic hypertrophic cranial pachymeningitis associated with total occlusion of the dural sinuses--case report.
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A 44-year-old man presented with a rare case of idiopathic hypertrophic cranial pachymeningitis manifesting as generalized seizure. Neuroimaging and pathological examinations showed the typical features of hypertrophic cranial pachymeningitis. Tuberculosis was a possible cause based on the positive purified protein-derived skin test, but the origin of the disease was not confirmed by further examinations. Cerebral angiography showed total occlusion of the dural sinuses with development of the emissary veins. Histological examination of the dura showed thickening of the fibrous tissue with rare inflammatory cells, suggestive of the extremely long duration of the disease. The diagnosis was idiopathic hypertrophic cranial pachymeningitis, but was treated only with anticonvulsants. The disease did not progress during follow up of 3 years. Idiopathic hypertrophic cranial pachymeningitis may have various causes related to unusual forms of infectious or autoimmune disorders. (+info)
Endovascular treatment of dural sinus malformation with arteriovenous shunt in a low birth weight neonate--case report.
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A boy was born at 36 weeks gestation weighing 2,135 g, with a prenatal diagnosis of dural sinus malformation with arteriovenous shunts. Congestive heart failure and anuria at birth prompted emergency intervention. Transfemoral-transvenous coil embolization was performed on day 1, resulting in partial occlusion of the huge venous pouch with a total length of 2,355 cm of detachable coils. Transarterial glue embolization on days 7, 23, and 42 was required due to persistent heart failure. Transarterial embolization was performed by common carotid puncture because the transfemoral route could not be used due to the small size and compromised blood flow of the femoral artery. Transarterial embolization reduced the arteriovenous shunts markedly and resulted in clinical improvement. Early treatment of a high flow dural arteriovenous fistula in a low birth weight neonate can achieve an excellent result with an acceptable neurological outcome. (+info)
CSF hydrodynamics in superior sagittal sinus thrombosis.
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Cerebrospinal fluid hydrodynamics were investigated with a constant pressure infusion method in patients with superior sagittal sinus thrombosis. Ten patients were studied with serial examinations up to 15 years after the onset of the disease. A total of 70 CSF hydrodynamic examinations were performed. A clear increase in intracranial pressure due to raised pressure in the major dural sinus was seen in all patients. A striking feature was the persistent intracranial pressure increase that declined only gradually. This had no obvious clinical impact. Change in CSF resorption facility played only a minor role in the intracranial pressure elevation. None of the patients developed hydrocephalus. (+info)