Dural Sinus Malformation Research Articles

Embolization of cerebral arteriovenous shunts in infants weighing less than 5 kg.

Endovascular treatment in children, especially neonates, can be more challenging than analogous procedures in adults. This study aimed to describe the clinical and radiological findings, type and timing of endovascular treatment, and early outcomes in children who present with neurovascular malformations, who are treated with embolization, and who weigh less than 5 kg. The authors carried out a retrospective review of all consecutively treated children weighing less than 5 kg with neurovascular arteriovenous malformations (AVMs) at a single institution over a 10-year period. Fifty-two patients were included in the study. Thirty-eight had a vein of Galen aneurysmal malformation, 3 a pial AVM, 6 a pial arteriovenous fistula, and 5 a dural sinus malformation. The endovascular treatment goals were control of cardiac failure or hydrocephalus in cases of nonhemorrhagic malformations or to prevent new bleeding in cases of previous hemorrhage. A hemorrhagic complication occurred in 12 procedures and an ischemic complication in 2. Both complication types were correlated with the age of the infant (age cutoff at 3 months) (p = of 0.015 and 0.049, respectively). No correlation was found with the weight of the infant or the duration of the procedure. The embolization of AVMs in these patients prevented adverse cardiac effects, hydrovenous disorders, and rebleeding. The risk of major cerebral complications seems mainly correlated with age, with a threshold at 3 months. A multidisciplinary team involved in the treatment of these children may help to improve treatment success and management.

Dystrophic Intracranial Calcification Accompanying Varix of the Dural Sinus and Arteriovenous Malformation

Dystrophic Intracranial Calcification Accompanying Varix of the Dural Sinus and Arteriovenous Malformation

EP08.19: Typical and atypical dural sinus malformation imaging in the fetus: based on four cases

EP08.19: Typical and atypical dural sinus malformation imaging in the fetus: based on four cases

Prenatal ultrasound diagnosis of dural sinus malformation with thrombosis on second trimester of gestation

A case of prenatal ultrasound diagnosis of dural sinus malformation with thrombosis at 21–22 weeks of gestation is presented. Pregnancy terminated for medical reasons. Prenatal ultrasound diagnosis and perinatal outcome of dural sinus thrombosis based on previously published cases are discussed.

Dural Sinus Malformation Imaging in the Fetus: Based on 4 Cases and Literature Review

This study aims to describe the imaging characteristic of dural sinus malformation in 4 fetuses with different locations. We report a series of 4 fetuses with dural sinus malformation in Hubei Maternal and Children's Hospital from July 2013 to February 2016. All the mothers undertook the prenatal magnetic resonance (MRI) imaging because of the intracranial space-occupying lesions discovered by prenatal ultrasound. Two of the 4 cases demonstrated typical MRI of dural sinus malformation with thrombosis in the vicinity of torcular herophili (also known as sinus confluence), whereas the other 2 cases showed lesions in the superior sagittal sinus and transverse sinus separately. Three pregnancies were terminated, whereas the other one was delivered in the local hospital. Sonographer should realize the sign of dural sinus malformation. Atypical location of the dural sinus malformation, such as superior sagittal sinus and transverse sinus, should be paid special attention to. Further, prenatal MRI is necessary to identify the lesion.

Imaging features and prognostic factors in fetal and postnatal torcular dural sinus malformations, part I: review of experience at Boston Children’s Hospital

BackgroundEven for the most common dural sinus malformation (DSM), the torcular DSM (tDSM), generalizable statements about etiology and prognosis are difficult because neurosurgeons/neuroradiologists and obstetrical imagers have focused on different...

Imaging features and prognostic factors in fetal and postnatal torcular dural sinus malformations, part II: synthesis of the literature and patient management

BackgroundTorcular dural sinus malformations (tDSMs) are described as slow flow dural arteriovenous fistulae with frequently poor outcomes in the neuroangiographic literature, but other etiologies have been proposed in the obstetric...

P09.02: Typical and atypical dural sinus malformation imaging in the fetus: based on 4 cases

To describe the atypical imaging characteristic of dural sinus malformation in fetuses by ultrasound and MRI. We report a series of four fetuses with dural sinus malformation in Hubei Maternal and children's hospital from July, 2013 to February 2016. All the mothers undertook the prenatal MR imaging because of the intracranial space occupying lesions discovered by prenatal ultrasound. In all four cases, two of them represented the typical MR imaging of dural sinus ectasia with thrombosis in the vicinity of torcular Herophili (also known as sinus confluence), while in the other two cases lesions located mainly in superior sagittal sinus and transverse sinus separately. Two pregnancies were terminated, while the outcomes of other two cases were not available. Atypical location of the dural sinus malformation, such as superior sagittal sinus and transverse sinus, should be paid special attention to. Sonographer should realise the atypical sign of dural sinus malformation, and prenatal MRI is necessary to identify the lesion.

Endovascular treatment of pediatric intracranial arteriovenous shunt.

Intracranial arteriovenous shunts (ICAVS) in young children are characterized by frequent high-flow fistulas. In association with high-flow fistulas and the physiological condition of the developing brain and heart, each ICAVS type tends to present at a certain age with unique symptoms. Vein of Galen aneurysmal malformation (VGAM) and dural sinus malformation with arteriovenous (AV) shunt tend to present in the neonate with high output cardiac failure. In infancy, VGAM, pial arteriovenous fistula (AVF) and infantile dural AVF (DAVF) tend to present with hydrodynamic disorder such as macrocephaly, ventriculomegaly, prominent facial veins, and developmental delay. Pial AVF, AV malformation, and infantile DAVF can present with focal neurological signs such as seizure or hemorrhage at older ages. Endovascular treatment is currently the first choice of treatment for most pediatric ICAVS. The treatment goal should be defined on a patient-by-patient basis, according to the unique physiological condition of the child.

Atretic encephalocele with dural venous sinus malformation – A case report

Atretic encephalocele with dural venous sinus malformation – A case report

Different outcomes in two cases of Dural Sinus Malformation

Fetal Dural Sinus Malformation (DSM) is a rare condition with massive dilation of dural sinuses due to an arteriovenous shunt. It most frequently involves the confluence sinuum above the cerebellum in the posterior fossa [1,2]. Clinical courses range from intrauterine demise (IUD) to live birth with normal neurological outcome depending on associate factors like sufficient collateral venous drainage, absence of additional structural abnormalities, brain insult, infarction, ventricular hemorrhage and cardiac failure.

Therapeutic progress in pediatric intracranial dural arteriovenous shunts: A review.

Pediatric dural arteriovenous shunts (dAVSs) are a rare form of vascular disease: Fewer than 100 cases are reported in PubMed and the understanding of pediatric dAVS is limited. For this study, we searched in PubMed, reviewed and summarized the literature related to pediatric dAVSs. Our review revealed that pediatric dAVSs have an unfavorable natural history: If left untreated, the majority of pediatric dAVSs deteriorate. In a widely accepted classification scheme developed by Lasjaunias et al., pediatric dAVSs are divided into three types: Dural sinus malformation (DMS) with dAVS, infantile dAVS (IDAVS) and adult-type dAVS (ADAVS). In general, the clinical manifestations of dAVS can be summarized as having symptoms due to high-flow arteriovenous shunts, symptoms from retrograde venous drainage, symptoms from cavernous sinus involvement and hydrocephalus, among other signs and symptoms. The pediatric dAVSs may be identified with several imaging techniques; however, the gold standard is digital subtraction angiography (DSA), which indicates unique anatomical details and hemodynamic features. Effectively treating pediatric dAVS is difficult and the prognosis is often unsatisfactory. Transarterial embolization with liquid embolic agents and coils is the treatment of choice for the safe stabilization and/or improvement of the symptoms of pediatric dAVS. In some cases, transumbilical arterial and transvenous approaches have been effective, and surgical resection is also an effective alternative in some cases. Nevertheless, pediatric dAVS can have an unsatisfactory prognosis, even when timely and appropriate treatment is administered; however, with the development of embolization materials and techniques, the potential for improved treatments and prognoses is increasing.

Neuro-Interventions for the Neonates with Brain Arteriovenous Fistulas: With Special Reference to Access Routes.

Neonatal neuro-intervention is challenging. The purpose of this article is to report the neuro-intervention for the neonates with brain arteriovenous fistulas (AVFs), with special reference to access routes. Fifteen neonates (12 boys and 3 girls) who underwent neuro-intervention within the first 14 days of life were included. Their diagnoses included vein of Galen aneurysmal malformation (6), dural sinus malformations with arteriovenous (AV) shunts (6), pial AVF (2), and epidural AVF (1). Birth weight ranged from 1,538 g to 3,778 g (mean 2,525 g). Neuro-interventions, especially access routes, in the neonatal periods (< 1 month) were retrospectively reviewed. All neonates presented with severe cardiac failure. In total, 29 interventions (mean 1.9) were performed within 1 month. Although 12 neonates with birth weight more than 2,700 g could be treated through transfemoral arterial routes, 3 neonates with birth weight less than 2,200 g could not be treated successfully by femoral arterial routes. Interventions were performed through 19 femoral arterial, 3 femoral venous, 2 umbilical arterial, 3 umbilical venous, 3 transcardiac, and 2 direct carotid routes. Their overall outcomes were six good recovery, one moderate disability, two severe disabilities, one vegetative state, and five deaths with a mean follow-up period of 7 years 2 months. Neuro-intervention for the neonates with birth weight more than 2,700 g can be performed by femoral arterial routes using a 4F sheath. For those with birth weight less than 2,200 g, however, alternative access routes are required.

Transumbilical arterial embolization of a large dural arteriovenous fistula in a low-birth-weight neonate with congestive heart failure

The purpose of this study was to report transumbilical arterial embolization of a large dural arteriovenous fistula (AVF) in a low-birth-weight neonate with congestive heart failure (CHF). A female neonate was delivered by cesarean section at 31 weeks of gestation. Her birth weight was 1538 g and Apgar scores were 6 at both 1 and 5 min. Because of dyspnea and retracted respiration immediately after birth, she required mechanical ventilation. Ultrasound revealed right cardiac overload and a large cystic mass at the posterior brain. Magnetic resonance imaging on day 1 showed a large dural AVF (dural sinus malformation with arteriovenous (AV) shunts) at the torcular herophili. Umbilical artery and vein catheterization were performed on the same day for neurointervention. CHF prompted emergency embolization on day 8. The transfemoral arterial route could not be used because of its small size and compromised femoral artery blood flow. Transumbilical arterial embolization shrank the AV shunts markedly, resulting in clinical improvement, thus requiring no further intervention. Follow-up angiography at 4 months confirmed no residual AVF. Her growth and development were normal at the last follow-up at age 4 years. This patient apparently was the lowest birth weight neonate with a large AVF successfully treated by embolization, which is usually performed through the transfemoral arterial route. The transumbilical arterial route is an alternative for neonates with birth weight <2000 g and very small femoral arteries.

Pediatric central nervous system vascular malformations.

Pediatric central nervous system (CNS) vascular anomalies include lesions found only in the pediatric population and also the full gamut of vascular lesions found in adults. Pediatric-specific lesions discussed here include infantile hemangioma, vein of Galen malformation and dural sinus malformation. Some CNS vascular lesions that occur in adults, such as arteriovenous malformation, have somewhat distinct manifestations in children, and those are also discussed. Additionally, children with CNS vascular malformations often have associated broader vascular conditions, e.g., PHACES (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, eye anomalies and sternal anomalies), hereditary hemorrhagic telangiectasia, and capillary malformation-arteriovenous malformation syndrome (related to the RASA1 mutation). The treatment of pediatric CNS vascular malformations has greatly benefited from advances in endovascular therapy, including technical advances in adult interventional neuroradiology. Dramatic advances in therapy are expected to stem from increased understanding of the genetics and vascular biology that underlie pediatric CNS vascular malformations.

Dural arteriovenous shunts in children

Dural arteriovenous shunts (dAVF) in children can be classified as dural sinus malformations, infantile dural arteriovenous shunts, and adult-type dural arteriovenous shunts. All subtypes can result in neurologic morbidity as a result of venous or intracranial hypertension and its sequelae. Prognostication and appropriate management is incumbent depends upon understanding both the subtype of dural arteriovenous shunt and its relevant anatomy. When treatment is indicated, endovascular embolization is the mainstay. Surgical treatment may be used adjunctively, though its primary indication is for adult-type dAVF with direct leptomeningeal venous drainage, which cannot be easily accessed by endovascular means. Although radiosurgery has been used successfully in adults with dAVF, its utility for pediatric patients remains largely unexplored.

P05.19: Dural sinus malformation and giant lake with partial thrombosis at mid‐gestation

<scp>P</scp>05.19: Dural sinus malformation and giant lake with partial thrombosis at mid‐gestation

Thrombosis of torcular herophili: diagnosis, prenatal management, and outcome.

The objective of this article is to describe and assess prenatal imaging findings, fetal and postnatal outcomes of thrombosis of torcular herophili, and to determine diagnostic features, pathophysiology, prognosis, and optimal management. Over a decade, we compiled the largest single-center retrospective study of outcomes. Fetal magnetic resonance imaging (MRI) was used to confirm the sonographic suspicion and monitor thrombosis of torcular herophili. We noted prenatal and postnatal imaging specifications, pregnancy outcomes, and clinical and radiological pediatric monitoring. Analysis of findings and review of the literature allowed us to define prognostic factors. In eight cases of prenatal diagnosis of thrombosis of torcular herophili, MRI outcomes were specific. There were five deliveries at full term, two terminations of pregnancy, and one fetal demise in utero. Neonates had a good clinical and radiological outcome. Factors of poor prognosis were deep venous sinus thrombosis, enduring mass effect, brain parenchymal injury, and heart failure related to dural arteriovenous shunt. Among dural sinus malformations, thrombosis of torcular herophili with or without extension at the posterior segment of the longitudinal sinus frequently has a good prognosis. It is urgent to wait because the prognosis can only be ascertained over time by means of ultrasound scan and MRI monitoring.

E-066 Pathogenesis of Dural Sinus Malformations as Demonstrated by Fetal Imaging: A Decision-Making Crucible for Parents and Clinicians

IntroductionTwo recent concurrent and contrasting cases of dural sinus malformation (DSM), followed at serial time points in utero by ultrasound and MR at the Boston Children’s Hospital Advanced Fetal Care...

P-023 Transfontanelle and Transcardiac Veno-arterial Approaches for Embolization of Complex Pediatric Intra-cranial Vascular Malformations

IntroductionTrans-arterial endovascular embolization using liquid embolics for the treatment of intra-cranial vascular lesions can be challenging in neonates and infants due to difficulties with arterial access. This is particularly true...