Dural arteriovenous fistula associated with neoplastic dural sinus thrombosis: two cases

Intracranial dural arteriovenous fistulae are direct arteriovenous shunts within the dura matter. We report two cases of arteriovenous fistulae upstream to a neoplastic dural sinus thrombosis. These cases add further support to the acquired etiology of dural arteriovenous fistulae and to the fact that venous hypertension is one of the most important precipitating factors. Received: 9 January 2001/Accepted: 10 January 2001     

Dural sinus thrombosis

Summary Magnetic resonance imaging has been reported to have advantages over conventional angiography in the diagnosis of dural sinus thrombosis. A case report is presented describing the application of MR techniques including MR angiography, to diagnose and monitor therapy for dural sinus thrombosis.     

Use of single-slice thick slab phase-contrast angiography for the diagnosis of dural venous sinus thrombosis

The aim of this study was to examine the reliability of single-slice phase-contrast angiography (SSPCA) as a rapid technique for the investigation of suspected dural venous sinus occlusion. Images were obtained on 25 normal volunteers to document the accuracy of SSPCA in the demonstration of slow flow states. Normal volunteers were imaged using sagittal and coronal SSPCA (slice thickness 13 cm, matrix 256 × 256, TR 14 ms, TE 7 ms, flip angle 20 °, peak velocity encoding rate 30 cm/s). Sinus patency and flow rate were confirmed by measurement of flow in the superior sagittal and transverse sinuses using quantified single-slice phase difference images. Imaging was performed in 50 patients undergoing routine brain scans in order to determine the optimal slice orientation for clinical use. Twenty-one patients with suspected dural venous sinus thrombosis were also investigated with SSPCA and the diagnosis confirmed by one or more alternative imaging techniques. Imaging time was 29 s per acquisition and image quality was good in all cases. Variations in dural sinus patency and flow in normal volunteers were accurately predicted by SSPCA (kappa = 0.92). Use of a single angulated slice (130 mm thick, para-sagittal image angled 30 ° towards coronal and 30 ° towards transverse) provided sufficient separation of right- and left-sided venous structures to allow use of a single projection. The presence and extent of sinus occlusions in 14 patients and the absence of thrombosis in 7 were accurately identified by SSPCA. Sensitivity and specificity in this limited study were both 100 %. The SSPCA technique takes less than 30 s and provides a reliable and rapid technique for the diagnosis of dural venous sinus thrombosis. Received: 10 July 1998; Revision received: 16 November 1998; Accepted: 11 January 1999     

Follow-up MRI in dural arteriovenous malformations involving the cavernous sinus: emphasis on detection of venous thrombosis

Summary Six patients with a dural arteriovenous malformation (dural AVM) involving the cavernous sinus were followed up with magnetic resonance imaging in order to assess change in the lesions. Spin-echo (SE) imaging of three patients in whom the AVM appeared to have closed at least 1 month earlier (two of them spontaneously, and one after external carotid artery embolization) showed neither apparent flow void in the involved cavernous sinus nor evidence of venous thrombosis. SE images of the other three patients who had not been cured by external carotid artery embolization (two of whom were examined within a week of treatment), detected persisting arteriovenous shunts, including high-flow cortical venous drainage, seen as flow void. Two-dimensional time-of-flight MR angiography (2D TOF MRA) was performed simultaneously in three patients. Whereas shunting blood and the normal cavernous sinus were of high intensity, presumed thrombosed cavernous sinuses were isointense with stationary brain tissue. SE imaging can confirm the resolution of arteriovenous shunts, but poorly delineates ver acute and chronic thrombosis of the draining veins. In contrast, 2D TOF MRA directly demonstrates flowing blood, permitting the diagnosis of venous thrombosis; it should be included in follow-up of a dural AVM involving the cavernous sinus when venous thrombosis is suspected.     

Acute dural venous sinus thrombosis without brain parenchymal abnormality: assessment with cerebral blood volume using dynamic susceptibility contrast magnetic resonance imaging

We report results applying the dynamic susceptibility contrast (DSC) magnetic resonance (MR) technique to a patient with dural venous sinus thrombosis (DVST) of the right transverse-sigmoid sinus without brain parenchymal abnormality. The DSC-MR technique clearly demonstrated increased regional cerebral blood volume of the right temporo-parieto-occipital region adjacent to a right transverse-sigmoid sinus thrombosis in a patient with DVST without cerebral edema or hemorrhage.     

Dural sinus malformation (DSM) in fetuses. Diagnostic value of prenatal MRI and follow-up

Dural sinus malformations (DSM) are rare malformations mainly reported after birth. The objectives of this study are to describe their prenatal patterns and to focus on their possible favorable outcome. This multicenter retrospective study reported 13 cases of DSM prenatally diagnosed. The admission criterion was a dural mass posterior to the vermis. In 12 patients, MRI was performed after US. Follow-up in 10 born babies (mean: 8 months) and three neuropathological examinations were available. In all fetuses, DSM presented as a well-delimited round mass involving the torcular. The follow-up examinations (n = 10) revealed progressive thrombosis of the DSM marked by a heterogeneous pattern (US and MRI) with concentric rings. The volume of the mass decreased, with complete regression in seven patients (five before and two after birth). One child died at the age of 5 months in the context of major hydrocephalus and another developed atrophy of the frontal lobes. The eight other babies were doing well (5 days to 3 years) without any treatment (n = 6) or following treatment for hydrocephalus (n = 2). Prenatal DSM may have a typical MR pattern, and the prognosis might not be as bad as has previously been reported. In the absence of criterion to predict the hydrovenous cerebral imbalance, it is mandatory to check the parenchyma and the ventricles during the pregnancy.     

Fat in the dural sinus

Summary Fat density in the dural sinus on computed tomography (CT) is described in eight cases. Of the eight cases, five had fat deposit in the torcular Herophili, and three in the superior sagittal sinus. This finding was incidentally found by CT and there was no common underlying disease in these cases. It is suggested that this finding represents normal adipose tissue in the dural sinus.     

Successful management of dural venous sinus thrombosis secondary to ulcerative colitis in a pediatric patient: A case report

Cerebral venous sinus thrombosis secondary to inflammatory bowel disease is a clinically rare and challenging entity with serious sequela. We preset a case of a 15-year-old female patient who was recently diagnosed with ulcerative colitis and had been suffering from headache for 4 days duration. During the diagnostic workup, computed tomography (CT) venography revealed Dural venous sinus thrombosis in the left transverse sinus extending into the left sigmoid sinus and the upper third of the left internal jugular vein as well as into the sinus confluence with non–occlusive filling defects in the superior sagittal sinus. Anticoagulant therapy with enoxaparin was initiated and the patient is being monitored in an outpatient setting regularly. Post-discharge disease course was uneventful. CT venography performed after 3 months illustrated partial recanalization of both left transverse and sigmoid sinuses. CVST is a rare extraintestinal manifestation of ulcerative colitis with significant morbidity and mortality which requires a high level of suspicion to establish a clear diagnosis. In spite the fact that CVST is rare, it should be ruled out in inflammatory bowel disease patients with new onset seizures, headache, along with focal, and non–focal neurologic symptoms.     

脑静脉窦血栓形成的MRI诊断

目的 :探讨MRI和MR血管成像 (MRA ,MRV)对脑静脉窦血栓形成 (CVST)的诊断价值。方法 :回顾性分析 10例CVST患者的临床和影像资料。全部病例行常规MRI和MRA( 3DTOF)、MRV( 2DTOF)检查 ,其中 9例行增强扫描。结果 :MR常规扫描示脑实质内均出现异常信号 ,仅 1例T2 WI未见异常信号 ,增强扫描 9例全部出现静脉异常强化。有 5例MRA除可见动脉正常显影外 ,还可见受累的静脉和静脉窦显影。MRV示栓塞的静脉窦不显影或显影欠佳。结论 :常规MRI结合MRA、MRV是诊断CVST的无创和有效手段     

颅内静脉窦血栓形成的MRI诊断

目的 探讨颅内静脉窦血栓形成的磁共振成像(MRI)表现及其对本病的诊断价值。方法 搜集8例经临床确诊的颅内静脉窦血栓形成的MRI资料，回顾性分析其MR影像学表现。结果 颅内静脉窦血栓形成的MRI表现有如下特点：(1)常为多处静脉窦同时受累；(2)形成血栓的静脉窦增粗、流空效应消失，呈现等或短、混杂T1、短或长T2信号影，典型表现为“白三角”征；(3)在急性期做增强扫描可见“黑三角”征；(4)MR静脉成像显示：栓堵的静脉窦影缺失。结论 颅内静脉窦血栓形成有比较典型的MR影像学特点；MRI检出本病优于CT，且能作出早期诊断；MRI增强扫描及MR静脉成像在本病的早期诊断及鉴别诊断中具有重要意义。     

Recovery of opthalmoplegia associated with cavernous sinus dural arteriovenous fistulas after transvenous cavernous sinus packing

Background

We report the recovery of ophthalmoplegia in 11 patients with cavernous sinus dural arteriovenous fistula (CSDAVF) after sinus packing at follow-up.

Methods

Of 18 patients with CSDAVF treated with transvenous cavernous sinus packing between August 2002 and December 2007 at Beijing Tiantan Hospital, there were 9 patients with initial CNIII or CNVI dysfunction and 2 patients with CNVI dysfunction immediately after cavernous sinus packing selected and reevaluated.

Results

Of 11 patients with CNIII or CNVI palsy, recovery was complete in 10. In 1 patient, complete CNVI palsy was unchanged because the CSDAVF was not cured. There were 6 men and 5 women with a mean age of 52.9 years. In 5 patients, CNVI palsy was associated with chemosis, proptosis and pulsatile tinnitus. Timing of treatment after onset of symptoms was from 4 to 35 days in 9 patients. All CSDAVFs were Barrow type D. Mean follow-up after treatment was 17.7 months (range, 2-54 months).

Conclusion

CSDAVF-induced CNIII or CNVI palsies can be cured after cavernous sinus packing transvenously in most patients.     

Bilateral dural arteriovenous fistula in the region of the cavernous sinus

Summary The case of a patient with a fistula between the left internal carotid artery and the cavernous sinus, and another fistula between the right external carotid artery and the cavernous sinus, is reported. The clinical symptomatology, which was of spontaneous onset, was unilateral and consisted of exophthalmos and injection of the conjunctiva on the left side. Almost complete remission occurred after angiography.     

MRI结合MRV对颅内静脉窦血栓的诊断价值

目的：探讨颅内静脉窦血栓的MRI及MRV诊断价值。方法：收集13例经临床证实的颅内静脉窦血栓患者,均做MRI及MRV检查,分析MRI及MRV在该病中的应用价值。结果：MRI平扫中见正常的静脉窦流空信号消失,增强MRI见空三角征,MRV见静脉窦闭塞。结论：MRI及MRV是颅内静脉窦血栓形成的最佳诊断手段。     

硬膜窦血栓形成的MRI表现(附6例分析)

目的：探讨硬膜窦血栓形成的ＭＲＩ表现。方法：６例硬膜窦血栓形成，均做了ＭＲＩ检查，其中２例用了ＳＴＩＲ，１例用了ＦＬＡＩＲ序列，３例作了增强检查（Ｇｄ－ＤＴＰＡ），５例作了ＭＲＶ。结果：右横窦栓塞２例，左横窦１例，上矢状窦３例，脑肿胀５例，静脉性脑栓塞２例，脑血肿１例。增强检查，脑皮质及皮质静脉增强１例。结论：ＭＲＩ对硬膜窦血栓形成的诊断有独特的价值。硬膜窦流空信号消失和硬膜窦狭窄、闭塞是直接征像。脑肿胀、静脉性脑梗塞、脑血肿是间接征像     

脑静脉窦血栓形成的MRI诊断(附15例分析)

目的 :探讨MRI对脑静脉窦血栓 (VST)的诊断价值。方法 :回顾性分析 15例VST患者的完整临床和影像学资料。全部行MR检查 ,其中 9例行增强扫描 ,8例行脑静脉MRA检查 ;12例曾行CT检查 ,其中 4例行增强扫描。结果 :上矢状窦受累 12例合并横窦血栓 11例 ,窦汇 7例、乙状窦 6例、下矢状窦、直窦受累 6例 ,海绵窦受累 1例。血栓在T1WI上均呈等、高不均匀信号 ,并出现脑组织肿胀 ,脑沟变浅 ,脑回模糊 ,在T2 WI上信号因发病时间不同而有所不同 ,8例T2 WI脑实质无异常信号 ,7例T2 WI脑实质出现异常信号。增强扫描 9例全部出现静脉异常强化。MRA表现为受累静脉窦信号较淡、边缘模糊且不规则的血流信号或血流信号完全消失。 12例CT检查中 2例见“空delta征” ,4例表现为梗塞、出血等不典型改变。结论 :MRI是诊断VST的首选检查方法 ,并对VST的预后评价有重要意义     

脑静脉窦及深静脉血栓的CT、MRI诊断

目的:探讨脑静脉窦及深静脉血栓的CT和MRI表现及诊断价值。方法:回顾性分析17例脑静脉窦及深静脉血栓患者的CT和MRI表现特点。结果:CT表现为静脉窦密度略高信号增高、窦腔增宽(n=5/12),增强扫描可见“空三角”征(n=3/3);随着病程的改变,MRI可表现为静脉窦T1WI(n=15/17),T2WI(n=13/17)流空效应消失,磁共振静脉成像(MRV)及增强MRV可显示静脉窦闭塞及静脉窦内充盈缺损(n=17/17;n=4/4);CT及MRI还可见皮层及皮层下多发、散在的出血性脑梗塞(n=7/12;n=13/17),基底节区脑梗塞(n=3/12;n=4/17)等间接征象。结论:CT增强可以显示静脉窦血栓,MRI、MRV及增强MRV相结合能准确地诊断脑静脉窦及深静脉血栓,MRI优于CT平扫。     

Mastoid effusion associated with dural sinus thrombosis

We present a series of three patients with mastoid air cell effusions associated with adjacent lateral sinus thrombosis. In all of these cases, the findings support the hypothesis that the mastoid effusion is secondary to sinus thrombosis rather then the other way around. Also shown is the chronology and natural evolution of mastoid air cell effusion secondary to sinus thrombosis as seen on planar imaging.     

Transarterial Onyx packing of the transverse-sigmoid sinus for dural arteriovenous fistulas

Objective

To report transarterial Onyx packing of the transverse–sigmoid sinus for dural arteriovenous fistulae (DAVFs).

Methods

We retrospectively studied consecutive 5 patients (2 female and 3 male) treated for a transverse–sigmoid sinus DAVF since 2008 in whom transverse sinus packing was attempted with a transarterial approach Onyx embolization. The mean clinical follow-up period was 6.2 months.

Results

Of the five lesions, 2 fistulas were type IIa, 3 were type IIb, according to the Cognard classification. Five Onyx embolizations were all performed via the middle meningeal artery. Cure was obtained in all cases after completion of direct sinus packing. No complications were revealed.

Conclusions

Transarterial Onyx packing of transverse–sigmoid sinus for DAVFs via the meningeal arterial system is a safe therapeutic alternative in selected cases.     

海绵窦区硬脑膜型动静脉瘘的诊断和治疗

目的探讨海绵窦区硬脑膜型动静脉瘘的诊断和治疗方法。方法25例硬脑膜动静脉瘘患者,均以眼部表现与首发症状,其中5例患者初诊为“结膜炎”。25例患者全部经Seldinger技术插管行全脑血管造影证实。13例分流量大、供血动脉条数多者行血管内栓塞治疗,12例分流量小,供血动脉条数少者采用压颈保守治疗。结果25例均为海绵窦区硬脑膜型动静脉瘘,其中13例采用经血管内栓塞治疗,12例采用压颈保守治疗,均取得满意疗效。结论海绵窦区硬脑膜型动静脉瘘的诊断通常并不困难。血管内栓塞治疗是非常有效的方法,对分流量小的病变压颈保守治疗同样可获得较好的结果。     

Transvenous embolization of a dural carotid-cavernous fistula through the contralateral superior petrosal sinus

We report a patient with progressive ophthalmological problems related to a dural carotid-cavernous fistula who was successfully treated endovascularly. Cavernous sinus catheterization was achieved through the contralateral superior petrosal sinus, permitting occlusion of the fistula without complications.