Cerebral Veins Research Articles

Venous thromboembolism in adolescents and young adults with acute lymphoblastic leukemia treated on a pediatric-inspired regimen

Asparaginase (ASP)-containing regimens for acute lymphoblastic leukemia (ALL) are associated with venous thromboembolism (VTE). We evaluated the prevalence, risk factors, role of prophylaxis and clinical impact of VTE among adolescents and young adult (AYA) patients (15–50 years) treated on Dana-Farber Cancer Institute (DFCI) ALL protocols. The 1- and 2-year cumulative incidence of VTE were 31.9% (95% CI: 27.0%, 36.9%) and 33.5% (95% CI: 28.5%, 38.5%) respectively, with most events occurring during ASP-based consolidation phase (68.6%). VTE was more frequent in patients with overweight/obese vs. normal BMI (39.2% vs. 29.0%, p = 0.048). In a 1-year landmark analysis, the 4-year overall survival was 91.5%, without difference between patients with vs. without VTE (93.8% vs. 90.0%, p = 0.93). Relapse and non-relapse mortality rates were also similar. Among patients treated at Dana-Farber/Harvard Cancer Center, cerebral sinus vein thrombosis occurred in 3.6% of patients (8.5% of VTE events) in comparison to pulmonary embolism (32.9%) and deep vein thromboses (58.6%, 24.4% line-associated). In a Cox regression model for VTE free-time, elevated BMI was associated with shorter VTE free-time (HR 1.94 [95% CI 1.13-3.35], p = 0.018), while low molecular weight heparin (LMWH) prophylaxis as time-varying covariate was not. In conclusion, we found that VTE was frequent in AYAs treated on DFCI ALL protocols but did not impact survival outcomes. Overweight/obese BMI increased risk for VTE.

Measurement of cerebral venous oxygenation with quantitative susceptibility mapping after subarachnoid hemorrhage: A pilot study.

We measured cerebral venous oxygenation after aneurysmal subarachnoid hemorrhage (aSAH) using quantitative susceptibility mapping (QSM) to explore its relationship with cognitive function. Twenty participants, including 10 patients with aSAH and 10 healthy volunteers as the control group, were included. Patients with aSAH were evaluated at 2days, 3weeks, and 6months after aSAH. Each participant underwent magnetic resonance imaging and completed the Montreal Cognitive Assessment (MoCA) at baseline, midpoint, and endpoint. QSM was used to determine the magnetic susceptibility of the cerebral veins. Furthermore, the relationship between MoCA and oxygen saturation in the cerebral veins was examined. The first scans of the cerebral veins and straight sinus susceptibility were considerably more significant in the aSAH group than in the healthy control group. At the 6-month follow-up, the mean oxygen saturation steadily increased in the aSAH group. Cerebral venous oxygen saturation was moderately correlated with MoCA (r = 0.5319, P = .0025). QSM can be used to measure changes in cerebral venous oxygenation levels in patients with aSAH. During the acute phase of aSAH, there is a reduction in the oxygen saturation in the cerebral veins, and the shift in oxygen saturation levels may correlate with cognitive outcomes in patients with aSAH.

ADL ACTIVITY OF DAILY LIVING DAN KUALITAS HIDUP PASIEN PASCA STROKE ISKEMIK

Ischemic stroke, also referred to as non-hemorrhagic stroke, results in the death of brain tissue due to impaired blood flow, primarily caused by blockages in the cerebral or cervical arteries and, less commonly, in the cerebral veins. This condition profoundly affects various aspects of an individual's life, including physical, emotional, psychological, cognitive, and social well-being. Following a stroke, many individuals experience reduced independence and mobility, which significantly detracts from their quality of life. Often, they face self-care deficits and require assistance to gradually regain the ability to perform activities of daily living (ADL) independently. This study aims to elucidate the strong relationship between ADL independence and the quality of life of post-ischemic stroke patients at Abdul Aziz Hospital in Singkawang City. Employing an analytic observational design with a cross-sectional approach, the research involved a sample of 60 respondents selected from the Neurology Polyclinic at RSUD dr. Abdul Aziz through purposive sampling. Data analysis was conducted using the Spearman Rank test with a 95% confidence level. The results indicate a significant relationship between ADL independence and the quality of life of these patients, as demonstrated by a p-value of 0.000 (p < α) and a correlation strength of 0.514, categorized as moderate (0.40 – 0.599). These findings highlight that the level of independence in activities of daily living is intrinsically linked to the quality of life for post-ischemic stroke patients.

Optimization of image shoot timing for cerebral veins 3D-digital subtraction angiography by interventional angiography systems

Abstract3D-digital subtraction angiography (3D-DSA) is essential for understanding the anatomical structure of cerebral veins, crucial in brain tumor surgery. 3D-DSA produces three-dimensional images of veins by adjusting the X-ray delay time after contrast agent injection, but the delineation of veins varies with the delay in X-ray timing. Our study aimed to refine the delay time using time-enhancement curve (TEC) analysis from 2D-DSA conducted before 3D-DSA imaging. We retrospectively reviewed 26 meningioma patients who underwent cerebral angiography from March 2020 to August 2021. Using 2D-DSA, we analyzed arterial and venous TECs to determine the contrast agent’s peak time and estimated the optimal imaging timing. Cases performed near this optimal time were in Group A, and others in Group B, with cerebral venous pixel values compared between them. TEC analysis identified peak times: internal carotid artery: 2.8 ± 0.7 s, middle cerebral artery (M4): 4.1 ± 0.9 s, superior sagittal sinus: 8.3 ± 1.1 s, sigmoid sinus: 9.5 ± 1.3 s, and venous structures near tumors: 7.3 ± 1.0 s. We observed several veins peaking immediately after arterial contrast passage, suggesting the optimal X-ray delay should incorporate the arterial contrast agent’s transit time. Statistical analysis revealed that Group A, with imaging timed to reflect the contrast agent transit time, demonstrated significantly better contrast effects than Group B. The X-ray delay time for 3D-DSA imaging of cerebral veins can be optimized in angiography systems by incorporating the contrast agent transit time, calculated from TEC analysis of cerebral 2D-DSA images.

Comparative microanatomy and histology of spinal and cerebral veins: Implications for dural arteriovenous fistula clinical presentations

Cranial dural arteriovenous fistulas (DAVFs) that display cortical venous drainage are at risk of hemorrhage, unlike spinal DAVFs, which seldom bleed. The underlying mechanism for this difference is poorly understood. We hypothesized that cerebral veins are more fragile than spinal veins due to differences in histologic compositions. Thus, spinal and cerebral veins from five formalin-fixed human cadavers were examined through macroscopic and histological analysis, using hematoxylin, eosin and safran (HES), and orcein stains to compare them. Twenty-four cerebral veins and thirteen spinal veins were analyzed. The mean diameter of the cerebral veins was 1.02 ± 0.59 mm, while that of spinal veins was 0.52 ± 0.26 mm (p = 0.003). The mean thickness of cerebral veins was similar to their spinal counterparts (0.09 ± 0.07 mm vs 0.06 ± 0.02 mm; p = 0.12). The mean diameter-to-thickness ratio was 13.76 ± 6.05 mm for cerebral veins and 10.06 ± 7.23 mm for spinal veins (p = 0.023). In most of the analyzed vessels, the venous wall was composed of endothelial cells resting on layers of smooth muscle, separated by elastica lamina. Cerebral and spinal veins exhibit distinct calibers while maintaining comparable wall thicknesses, resulting in a greater diameter-to-thickness ratio for cerebral veins compared to spinal veins. This difference may after their resistance to pressure. Furthermore, variations in the transparietal pressure gradient between cranial and spinal subarachnoid space, along with differences in arterial blood flow through the fistulous veins, might contribute to the observed differences in clinical presentation.

Vascular thrombosis and relapse-associated factors in Behcet's syndrome: a comprehensive analysis of 136 patients

Abstract Background Vascular thrombosis in Behçet syndrome (BS) is frequent and associated with high morbidity and mortality rates. Purpose To investigate BS patients presenting with a thrombotic event (TE) and identify the factors associated with relapse. Methods We retrospectively conducted a single-center, descriptive, and analytic study, from 2000 to 2022, enrolling all BS patients presenting TE, including venous thrombosis (VT) and/or arterial thrombosis (AT). Results TE was observed in 136/531 patients (25%), mostly men (83%), aged 29 ± 9 years (11-50) at BS onset. TE was the initial presentation of BS (32%) or occurred after a median of 4 years [0;25]. It included VT (92.5%), AT (18%), and both (13%). VT mostly consisted of DVT in the lower extremities (60%), vena cava (30%), and cerebral (15%) veins. It involved one (55%), two (27%), and multiple (16%) veins (Figure 1). AT mainly affected the pulmonary (42%), femoral (21%), coronary (17%), cerebral (8%) arteries, and aorta (8%). Arterial aneurysms were common (18%), especially in the pulmonary arteries (11%). Intracardiac thrombosis was also visualized (10%). Noncardiovascular manifestations mainly included aphthous ulcers (96%), pseudofolliculitis (36%), ocular lesions (41%), and arthralgias (22%). Hemostasis parameters were within normal ranges. Patients were treated with colchicine (98%), corticoids (98%), and immunosuppressants (80%). Anticoagulation and anti-platelet aggregation were administered in 90% and 15% of the cases, respectively. Six patients underwent vascular surgery. Post-thrombotic syndrome was noted in 14% of the patients. Relapse was common (25%), mainly occurring in men (81%), of younger age (24 ± 6) at first TE. Relapse consisted of one (55%), two (32%), or multiple episodes (13%). It occurred in the same vascular system initially affected (69%), a different one (12%), and both at the same time (19%). Multivariable analysis revealed TE at onset (OR= 2.99, 95% CI[1.14 ; 7.82], p=0.02), arterial thrombosis (OR= 2.91, 95% CI[1.10 ; 8.40], p=0.04), and arterial aneurysms (OR= 2.58, 95% CI [1.09 ; 8.45], p=0.02) as factors significantly associated with TE relapse (Figure 2). Conclusion Our study highlights several particularities of TE in BS, with TE at onset, arterial thrombosis, and arterial aneurysms emerging as significant relapse factors.

Biallelic PIGM Coding Variant Causes Intractable Epilepsy and Intellectual Disability Without Thrombotic Events.

During the past two decades, an emerging group of genes coding for proteins involved in glycosylphosphatidylinositol (GPI) anchor biosynthesis are being implicated in early-infantile epileptic encephalopathy. Amongst these, a hypomorphic promoter mutation in the mannosyltransferase-encoding PIGM gene was described in seven patients to date, exhibiting intractable absence epilepsy, portal and cerebral vein thrombosis and intellectual disability (ID). We describe here three siblings exhibiting intractable epilepsy and ID, found to harbor a homozygous c.224G>A p.(Arg75His) missense variant in PIGM, which segregated with the disease in the family. The variant is evolutionary conserved, extremely rare in general population databases and predicted to be deleterious. Structural modeling of the PIGM protein and the p.(Arg75His) variant indicates that it is located in a short luminal region of the protein, predicted to be hydrophilic. Functional prediction suggests that the entire local region is sensitive to mutations, with the p.(Arg75His) variant in particular. This is the first report of a PIGM coding variant, and the second variant altogether to be described affecting this gene. This phenotype differs from that of patients with the shared PIGM promoter mutation by lack of thrombotic events and no decrease in PIGM cDNA levels or CD59 expression on red blood cells.

Sinus vein thrombosis conundrum: Persistent empty sella vs. flexible optic nerve sheath

IntroductionOur objective was to investigate the potential effect of thrombotic burden on pituitary gland height, bony sella and optic sheath width, taking into consideration the various venous sites and dominant drainage pattern. Patients and MethodsThis retrospective cohort study followed patients diagnosed with cerebral sinus vein thrombosis in a single primary healthcare center between the years 2000 and 2022. Data was collected from both CT/V and MR/V scans available on the local PACS system. Dural sinuses were divided into main anatomical sites and scored for patent, partially or totally blocked lumen. Dominant drainage flow was noted for each patient. For most scans, pituitary mid height, maximal depth and AP width of the bony sella and dorsum sella to tuberculum sella distance were assessed. Optic sheath width was measured for both sides at the maximal retrobulbar diameter. Regression methods, including linear mixed models, and non-parametric tests were used to analyze the data. Results90 patients (mean age, 44 years ±16.8, 54 women) were evaluated. Overall thrombus burden did not correlate with pituitary mid-height, however a relationship was observed between the change (from presentation) in the superficial thrombus score and the average width of the optic nerve sheath; the width of the optic sheath tended to decrease as thrombus burden improved and vice versa (p = 0.010). ConclusionsThrombus recanalization had a favorable effect on the optic nerve sheath diameter but did not appear to reverse the flattening of the pituitary gland, regardless of temporal improvement.

DC-CRP: Deep Cerebral Venous Thrombosis, Clinicoradiological Profile, and Treatment Outcome in Indian Population-A Tertiary Care Experience.

Deep cerebral venous thrombosis (DCVT) is an uncommon cause of stroke with diverse predisposing factors, clinical presentations, imaging findings, and functional outcomes, which makes the diagnosis of DCVT even more challenging. Retrospective observational study (December 2018 to January 2023). Cases with imaging data suggestive of DCVT were included. The neuroradiological assessment was performed using multimodality imaging to determine the location of parenchymal changes and the number of deep veins involved in isolation or with the superficial dural venous system. Clinical variables were tabulated. Of the 206 cases with CVT in the study period, 27 had DCVT (13.1%), of which four (14.8%) had isolated DCVT (male-to-female ratio 13:14; mean age = 33.4 years). Hyperhomocysteinemia (n = 11) is the most common risk factor associated with it. The most common presentations were headaches (n = 27) and focal motor deficits (n = 13). Raised intracranial tension (ICT) was present in almost half of the study population (n = 14). Mean and median modified Rankins score (mRS) at the time of discharge were 2.0 and 1, respectively. The most common deep vein involved was the straight sinus (SS) (n = 25), followed by the internal cerebral vein (n = 23). The mean and median mRS after 3 months from discharge were 0.3 and 0, respectively. A knowledge of diverse clinical presentations in DCVT, its neurovascular anatomy, and imaging characteristics with prompt diagnosis and timely interventions can assist in attenuating the risk of acute complications and long-term sequelae. Extensive deep grey matter involvement in DCVT is associated with neurological manifestations like altered sensorium and motor deficits, with increased severity of illness as measured by the mRS score.

Impact of superficial middle cerebral vein compression on peritumoral brain edema of the sphenoid wing meningioma

ObjectiveSphenoid wing meningiomas (SWMs) often cause occlusion or stenosis of the superficial middle cerebral vein (SMCV) by tumor compression. This study aimed to analyze the correlation between SMCV compression and peritumoral brain edema (PTBE) in SWM patients and to clarify the importance of surgical preservation of the SMCV in SWM surgery. MethodsThis retrospective study included 31 patients who underwent surgery for SWM at our institution from April 2011 to March 2022. Patient demographics, tumor characteristics, PTBE size, and SMCV patency before and after surgery were evaluated using preoperative and postoperative MRI or digital subtraction angiography. ResultsOf the 31 patients, 24 (77.4 %) exhibited PTBE, with varying degrees of severity: mild (32.3 %), moderate (25.8 %), and severe (41.9 %). Preoperative MRI showed SMCV patency in 14 patients (45.2 %) and SMCV compression in 17 patients (54.8 %). There was a significant association between PTBE severity and SMCV compression (p = 0.002). Postoperatively, SMCV recanalization was observed in 4 out of 16 patients (25.0 %) with preoperative SMCV compression. These patients had significantly smaller tumors (p = 0.013) and larger preoperative PTBE volumes (p = 0.042) compared to those without recanalization. ConclusionsOur study demonstrates a significant correlation between SMCV compression and severe PTBE in SWM patients. A subset of patients showed postoperative SMCV recanalization, particularly those with smaller tumors and more pronounced PTBE. These findings highlight the importance of SMCV preservation during SWM surgery to potentially improve postoperative outcomes.

CT perfusion to measure venous outflow in acute ischemic stroke in patients with a large vessel occlusion

BackgroundRobust venous outflow (VO) profiles, measured by degree of venous opacification on pre-thrombectomy CT angiography (CTA) studies, are strongly correlated with favorable outcomes in patients with large vessel occlusion acute...

STUDY OF SOMATIC AND GERMINAL MUTATIONS IN ARTERIOVENOUS MALFORMATIONS OF THE BRAIN USING WHOLE EXOME SEQUENCING

Rare vascular lesions known as brain arteriovenous malformations (bAVMs) are caused by shunts between cerebral arteries and veins that do not involve the capillary bed. The majority of bAVMs do not cause any symptoms, however some can be controlled by seizures and result in potentially fatal brain hemorrhages. Over the past ten years, significant advancements in our understanding of bAVM pathogenesis have been accomplished, primarily through the use of genome sequencing and biomolecular analysis. An autosomal dominant vascular disorder called Hereditary Hemorrhagic Telangiectasia (HHT, also known as Rendu-Osler-Weber Syndrome) affects about 1 in 5000 people globally and is associated with about 5% of brain AVMs, while the remaining 95% are due to sporadic mutations. The major aim of the project is to investigate genetic causes of sporadic forms of AVMs in the brain by means of whole-exome sequencing of tissues with AVM lesions and blood samples. Analysis of somatic mutations will broaden the understanding of AVM pathogenesis. This study was carried out in accordance with the Declaration of Helsinki's tenets and approved by the National Center of Biotechnology 's ethics committee (№9, 7 November 2023, ) Astana). Based on clinical data, the age range of the patients at the onset of the disease also encompassed 25 to 40 years. To confirm the diagnosis, MRI and CAG data were used to validate the diagnosis. Each patient completed a specially designed questionnaire with medical information (such as age of debut and type of course) and demographic data (such as age, gender, and nationality). Three patients were classified as having a Spetzler-Martin grade II, while one patient was categorized as grade III. The sizes of arteriovenous malformations (AVMs) varied from 0 to 3 mm in one patient (grade II) to 3 to 6 mm in three patients (grades II-III). AVM tissue specimens were obtained during clinically necessary procedures. Brain AVM tissues were collected during surgery, which involved trepanation and excision of the AVM. Blood samples were also collected from these patients. Both DNA and RNA were isolated from these tissue and blood samples for subsequent exome sequencing an. Qubit 2.0 fluorometer was employed for more precise determination of DNA concentration, given that the nucleic acids will be utilized in future whole exome sequencing analysis. Whole exome sequencing was performed on six samples (blood and tissue) by Novaseq 6000 (Illumina). The annotated results were analyzed for the presence of single-nucleotide polymorphisms (SNP) and insertion-deletion mutations (Indels) between DNAs from the AVM tissue sample and blood. The GATK workflow was used for the analysis and annotation of the raw data, and vcf files were generated. Then, the variants were filtered for a quality ≥ 30 in Excel 1st blood 117554, 1st tissue 114715; 2nd blood 112972, 2nd tissue 116022; 3rd blood 112859, 3rd tissue 117168 and genotype differences between tissue and blood DNA samples 1st blood 114512, 1st tissue 111682; 2nd blood 110614, 2nd tissue 111982; 3rd blood 110564, 3rd tissue 112805. After selecting only non-synonymous, frameshift insertions and deletions variants with different genotypes in the blood and tissue samples, 1st blood 279, 1st tissue 277; 2nd blood 279, 2nd tissue 271; 3rd blood 275, 3rd tissue 268 variations were observed. Analysis of whole-exome data continues.

Deep venous outflow as a surrogate for collaterals in late-window patients with successful revascularization from the DEFUSE 3 cohort.

Deep venous outflow (VO) may be an important surrogate marker of collateral blood flow in acute ischemic stroke patients with a large vessel occlusion (AIS-LVO). Researchers have yet to determine the relationship between deep VO status in late-window patients and imaging measures of collaterals, which are key in preserving tissue. We performed a multicenter retrospective cohort study on a subset of DEFUSE 3 patients recruited across 38 centers between May 2016 and May 2017 who underwent successful thrombectomy revascularization. Internal cerebral vein opacification was scored on a scale of 0-2. This metric was added to the cortical vein opacification score to derive the comprehensive VO (CVO) score from 0 to 8. Patients were stratified by favorable (ICV+) and unfavorable (ICV-) ICV scores, and similarly CVO+ and CVO-. Analyses comparing outcomes were primarily conducted by Mann-Whitney U and χ2 tests. Forty-five patients from DEFUSE 3 were scored and dichotomized into CVO+, CVO-, ICV+, and ICV- categories, with comparable demographics. Hypoperfusion intensity ratio, a marker of tissue level collaterals, was significantly worse in the ICV- and CVO- groups (p = 0.005). ICV- alone was also associated with a larger perfusion lesion (138 ml vs 87 ml; p = 0.023). No significant differences were noted in functional and safety outcomes. Impaired deep venous drainage alone may be a marker of poor tissue level collaterals and a greater degree of affected tissue in AIS-LVO patients presenting in the late-window who subsequently undergo successful revascularization.

Cerebral venous sinus thrombosis: An underdiagnosed red flag disease in Ophthalmology

Cerebral venous sinus thrombosis is a disease characterised by thrombosis of the cerebral veins and the dural sinuses. It has a variable presentation. It is common in any condition that leads to a prothrombotic state. It leads to cerebrospinal fluid outflow obstruction, thus leading to raised intra-cranial pressure. Management requires a multi-disciplinary approach. Mainstay therapy is with anticoagulants, fibrinolytics. Ophthalmologist play a vital role in the diagnosis and management of this life-threatening condition.

Cerebral Vein Thrombosis and Direct Oral Anticoagulants: A Review.

Cerebral venous thrombosis (CVT) is a rare type of cerebrovascular event in which the thrombosis occurs in a vein of the cerebral venous system. The diagnosis could be challenging due to the great clinical variability, but the outcome is favourable in most cases, especially in the case of early diagnosis. Anticoagulant therapy is the core of CVT management and currently consists of heparin in the acute phase followed by vitamin K antagonists (VKAs) in the long term. The ideal duration of anticoagulant therapy is still unclear, and the same criteria for the treatment of extracerebral venous thromboembolism currently apply. In this paper, we reviewed the literature regarding the use of direct oral anticoagulants (DOACs) in CVT since in recent years a considerable number of studies have been published on the use of these drugs in this specific setting. DOACs have already been shown to be equally effective with VKAs in the treatment of venous thromboembolism. In addition to efficacy, DOACs appear to have the same safety profile, being, on the other hand, more manageable, as they do not require close monitoring with continuous personalised dose adjustments. In addition, a further advantage of DOACs over VKAs is the possibility of anticoagulant prophylaxis using a reduced dosage of the drug. In conclusion, although the use of DOACs appears from preliminary studies to be effective and safe in the treatment of CVT, additional studies are needed to include these drugs in the treatment of CVT.

Convexity dural arteriovenous fistula with Sylvian-Labbé collateral pattern: A case report.

Convexity dural arteriovenous fistula (dAVF) is associated with high-grade dAVF and is usually presented with aggressive clinical presentation. Precise diagnosis and understanding the pathogenesis are important to achieving successful treatment without complications. We report a case of dAVF with Sylvian-Labbé collateral pattern, concerning embryological development that was thought to be involved in the vascular architecture and pathogenesis of dural AVF. Thus, a 60-year-old man was presented with sudden onset of seizure with no history of trauma. Magnetic Resonance Imaging (MRI) showed cortical hemorrhage in the left precentral gyrus. Digital subtraction angiography (DSA) showed the convexity dural arteriovenous fistula (dAVF) involving a vein that appeared to be the vein of Labbé, the drainer was anastomosed with superior middle cerebral vein (SMCV) and formed the varix. With the successful treatment with trans-arterial embolization (TAE), obliteration of dAVF was achieved with no neurological deficits. This case highlights convexity dAVF with the complex relationship between embryological development and the arcade of venous drainage route, wherein the anomaly might be acquired and caused by elevated venous pressure in a vein that appeared to be the vein of Labbé. Gaining knowledge of the embryological basis may aid in a deeper understanding of acquired pathologies.

Examining postpartum anticoagulation practices: An international survey of healthcare providers

BackgroundThe risk of venous thromboembolism (VTE) is 15 to 35-fold higher in the postpartum period compared to non-pregnant individuals. Clinical practice guidelines recommend the use of postpartum thromboprophylaxis with low molecular weight heparin (LMWH) for 6 weeks in individuals at high risk of developing VTE. However, a marked reduction in the risk of VTE risk occurs beyond the third week of the postpartum period. ObjectiveWe sought to characterize practice patterns of clinicians who manage postpartum individuals at high risk of VTE. MethodsWe conducted a cross-sectional study using a self-administered electronic questionnaire. The survey explored the use of postpartum thromboprophylaxis in high-risk individuals. Descriptive statistics were used to summarize survey responses. ResultsOf the 113 participants that responded to the initial invitation, 78 completed the survey (Europe (53.9 %); North America (23.2 %); Australia and New Zealand (19.0 %)). For individuals with a prior unprovoked or provoked deep venous thrombosis or pulmonary embolism, cerebral vein thrombosis and splanchnic vein thrombosis, 97.4 %, 93.5 %, 91.0 % and 88.5 % of the respondents recommended six weeks of postpartum thromboprophylaxis using LMWH, respectively. The recommendation for 6 weeks of thromboprophylaxis in patients with sickle cell disease and obstetric APS was comparatively lower (70.5 and 78.2 % respectively). Respondents with higher practice volumes and more years of experience in clinical practice were more likely to recommend a shorter duration of thromboprophylaxis. ConclusionOur study highlights the variability in clinician recommendations and the acceptability of treatment durations for postpartum thromboprophylaxis in high-risk conditions. Prospective studies are needed to determine optimal duration and establish evidence-based management.

Vascular imaging for Stereoelectroencephalography: A safety and planning study

BackgroundStereoelectroencephalography (SEEG) is a procedure used to localize the epileptogenic zone in patients with medically refractory epilepsy, involving the stereotactic implantation of electrodes into brain parenchyma. Magnetic Resonance Imaging (MRI), Digital Subtraction Angiography, and Computed Tomography have been used preoperatively to prevent Intracranial Hemorrhage (ICH) by identifying electrode-vessel conflicts (EVC’s) on planned electrode trajectories. There is variation in the use of Digital Subtraction Angiography and non-invasive sequences for vascular planning. Digital Subtraction Angiography provides high spatial resolution, but carries risks of arterial dissection, groin and retroperitoneal hematoma, and a 0.5–1.9% risk of stroke. Our group has incorporated Intravenous Cone Beam Computed Tomography (CBCT A/V) Brain into our SEEG workflow, given its effective implementation in other neurosurgical domains. Primary aims include validating the safety of our CBCT A/V sequence for SEEG planning and determining if CBCT A/V is comparable to other modalities in detecting EVC’s. Secondary aims include elucidating the relationship of conflicting vessel calibre with ICH incidence in SEEG using CBCT A/V imaging. MethodsA single-center retrospective study was conducted of 20 patients who underwent preoperative CBCT A/V Brain and MRI Brain with gadolinium enhancement, encompassing 273 electrode implantations from August 2020 − July 2023. The incidence and grade of post-implant, post-explant symptomatic ICH and asymptomatic ICH was noted. The total number of EVC’s identifiable on MRI and CBCT A/V was recorded, along with average diameter of conflicting vessels. ResultsAcross 20 patients and 273 implanted electrodes, there were four ICH events, where two were symptomatic and two were asymptomatic. The mean diameter of EVC’s across all patients was 1.4 mm (±0.5). A significant difference (P < 0.0001) was observed between the number of EVC’s that CBCT A/V could identify (20) compared to MRI (6). Two EVC’s were identified in the region of two symptomatic ICH’s, with the mean diameter of these conflicted vessels being 1.5 mm (±0.4). The two symptomatic ICH-associated EVC’s were observed on CBCT A/V but not MRI. ConclusionsIn our series, CBCT A/V demonstrates an acceptable safety profile for SEEG planning compared to other imaging modalities. CBCT A/V identified significantly more EVC’s compared to MRI, including those contributing to transient symptomatic intracranial hemorrhage. A conflicting vessel calibre of less than 1.2 mm on CBCT A/V did not contribute to ICH in our SEEG series.

Ultra-low-field magnetic resonance angiography at 0.05 T: A preliminary study.

We aim to explore the feasibility of head and neck time-of-flight (TOF) magnetic resonance angiography (MRA) at ultra-low-field (ULF). TOF MRA was conducted on a highly simplified 0.05 T MRI scanner with no radiofrequency (RF) and magnetic shielding. A flow-compensated three-dimensional (3D)gradient echo (GRE) sequence with a tilt-optimized nonsaturated excitation RF pulse, and a flow-compensated multislice two-dimensional (2D) GRE sequence, were implemented for cerebral artery and vein imaging, respectively. For carotid artery and jugular vein imaging, flow-compensated 2D GRE sequences were utilized with venous and arterial blood presaturation, respectively. MRA was performed on young healthy subjects. Vessel-to-background contrast was experimentally observed with strong blood inflow effect and background tissue suppression. The large primary cerebral arteries and veins, carotid arteries, jugular veins, and artery bifurcations could be identified in both raw GRE images and maximum intensity projections. The primary brain and neck arteries were found to be reproducible among multiple examination sessions. These preliminary experimental results demonstrated the possibility of artery TOF MRA on low-cost 0.05 T scanners for the first time, despite the extremely low MR signal. We expect to improve the quality of ULF TOF MRA in the near future through sequence development and optimization, ongoing advances in ULF hardware and image formation, and the use of vascular T1 contrast agents.

Cerebrofacial Venous Metameric Syndrome Mimicking Vein of Galen Aneurysmal Malformation

Cerebrofacial venous metameric syndrome (CVMS) is a complex low-flow vascular malformation affecting bone and soft tissues including brain, dura mater, and eye. We show images of CVMS in an 18-month-old boy presenting facial venous malformations, developmental venous anomalies, dural sinus malformations, and dilated great cerebral vein, suggesting a vein of Galen aneurysmal malformation. Although Sturge-Weber syndrome is the most known form of CVMS, its presentations are variable and include several venous malformations. Recognizing the various manifestations of CVMS is necessary for adequate screening, treatment, and follow-up.