Giant Varix Research Articles

Republished: Primary intraventricular haemorrhage due to rupture of giant varix of the basal vein of Rosenthal in a patient with long-standing direct CCF: angiographic features and treatment considerations

Direct carotid cavernous fistulae (CCF) are often detected early and treated promptly resulting in a paucity of literature regarding its long-term evolution. We present a case of high flow post-traumatic...

Primary intraventricular haemorrhage due to rupture of giant varix of the basal vein of Rosenthal in a patient with long-standing direct CCF: angiographic features and treatment considerations

Direct carotid cavernous fistulae (CCF) are often detected early and treated promptly resulting in a paucity of literature regarding its long-term evolution. We present a case of high flow post-traumatic...

Pial arteriovenous fistula with giant venous varix and dilation of vein of Galen, treated with surgical clipping

Pial arteriovenous fistula with giant venous varix and dilation of vein of Galen, treated with surgical clipping

Internal cerebral veins varix due to midline arteriovenous malformation: how much is the risk of bleeding?

We report a case of 40-year-old sportsman admitted to our department for a generalized seizure associated with bladder and bowel incontinence occurred during exercise. The patient quickly regained consciousness without postcritical deficits. Neurological examination appeared completely normal. A head computer tomography (CT) scan showed a midline arteriovenous malformation (AVM) without the evidence of bleeding (Fig. 1a, b). A digital subtraction angiography revealed a dysplastic nidus fed by branches of bilateral internal–external carotid and vertebrobasilar arteries, and draining both in the superficial and deep venous system, which showed varicose dilatation with Galen’s vein stenosis (Fig. 1c–g). Cerebral varix is defined as an ectasia which doubles vein diameter. It can be due to an arteriovenous shunt and appears more common in patients with direct fistulas, than in cerebral AVM with dysplastic nidi [1]. Differently from those associated with Galen’s vein fistulae, huge intracranial varix associated with cerebral AVMs were seldom reported. Headache, bruit, focal mass effect and hydrocephalus are common presentation symptoms [2]. Intracranial haemorrhage has been instead less often reported at clinical onset [3]. In the most of the cases of giant varix, direct arteriovenous communications in the context of nidus were observed, especially between feeding arteries and the varicose veins [4]. This discrete angiographic finding separate these vascular malformations from the classical and more common AVMs in which an abnormal vascular network is identified between the arterial feeders and draining veins [4]. Venous hypertension with retrograde drainage often results in focal neurological deficits and seizures [1]. Although it is commonly assumed that venous ectasia increases the bleeding risk, varix haemorrhagic presentation has been rarely reported [4]. It is may be due to the progressive thickening of the arterialized veins wall, with intimal proliferation of synthetic smoothmuscle cells and disappearance of the internal elastic lamina, that make arterialized veins not greatly prone to rupture [1, 4]. On the other hand, instead, the presence of venous varix on the draining veins has been recognized as a factor increasing the risk of haemorrhage in dural arteriovenous fistulae [5]. In the case reported here, the presence of multiple feeders causing high flow shunt rate, direct drainage in a cisternal venous system, and an impaired venous outlet due to the Galen’s vein stenosis, may have contributed to the varix formation. Prolonged sporting activity, instead, has not been a factor influencing AVM rupture.

巨大静脈瘤を伴ったpial AVFに対する血管内治療の１例：症例報告

【目的】巨大静脈瘤を伴うintracranial pial arteriovenous fistula（pial AVF）の１例を報告する．【症例】17歳男性．左不全麻痺とふらつきが主訴で，諸精査により，右中大脳動脈を流入動脈としたSylvian fissure内に巨大静脈瘤を伴ったpial AVFを認めた．経動脈的にfistulaを通過し静脈瘤に到達し，静脈瘤から中大脳動脈の正常分枝より末梢側までをコイルとNBCAを用いて合併症なく完全閉塞した．【結論】巨大静脈瘤を伴う外科的治療が困難と考えられるpial AVFに対しては血管内治療が有用である．治療に際しては流入動脈から分岐する正常分枝の把握と温存が重要である．

Surgical management of a pial arteriovenous fistula with giant varix in an infant

A seven-month-old infant presented with a generalized seizure. The radiological evaluation revealed a large arteriovenous fistula in the left sylvian region. The fistula connected the left middle cerebral artery and the vein of Trolard. A giant varix was present at the venous end. The child underwent craniotomy, complete disconnection of the fistula and excision of the varix. Except for recurrent seizures, which were eventually controlled on anticonvulsants, the child's neurological development has been good on long-term follow-up of three years. Pial arteriovenous fistulae are rare intracranial vascular malformations. Though significant operative risks exist, they can be successfully managed surgically with good long-term prognosis.

Giant azygos vein varix mimicking posttraumatic pseudoaneurysm

We present the case of an isolated giant varix of the azygos vein, simulating a posttraumatic pseudoaneurysm, in a patient with a history of chest trauma. Dynamic computed tomography (CT) showed a right paratracheal mass strongly enhanced, suggesting a vascular structure closely related to the azygotic arch. Thoracotomy revealed an azygos vein varix and excluded the possibility of post-traumatic lesion.

Rendu-Osler-Weber disease with a giant intracerebral varix secondary to a high-flow pial AVF: case report

Background Intracranial varices are rare and most are associated with vein of Galen arteriovenous malformations (AVM) or fistulas (AVF). Description A 43-year-old left-handed man presented with right hemihypesthesia and spastic gait. Neuroradiological examination revealed a spinal AVF and a giant intracerebral varix associated with a high-flow pial AVF. He had recurrent episodes of nasal bleeding, which were also confirmed in his mother's medical history, and telangiectases in the tip of his tongue and fingers. He was diagnosed with Rendu-Osler-Weber disease. After resection of the spinal AVF that produced his symptoms, we surgically exposed and obliterated the giant varix and AVF under intra- and postoperative hypotension and mild barbiturate therapy. The arteriovenous shunt was completely obliterated without hyperperfusion of the surrounding brain. Conclusion This is an extremely rare case of Rendu-Osler-Weber disease with a giant intracerebral varix secondary to a high-flow pial AVF that did not involve the vein of Galen.

Traumatic arteriovenous fistula of the posterior inferior cerebellar artery treated with endovascular coil embolization: case report

Background High-flow intracranial arteriovenous (AV) fistulas associated with giant varices are rare lesions. These varices can present with symptoms from mass effect, spontaneous hemorrhage, and seizures to cardiac failure. Direct AV fistulas of the posterior inferior cerebellar artery (PICA) are extremely rare lesions, with only two cases reported in the literature. Case description The authors present an unusual case of a 25-year-old male with a direct AV fistula of the PICA that resulted from a fracture of the occipital condyle. This high-flow AV fistula drained into a giant varix of the vein of the lateral recess that compressed the brainstem, resulting in a Wallenberg syndrome. The patient underwent embolization of the proximal PICA feeding the fistula with a Guglielmi detachable coil (GDC), which resulted in thrombosis of the varix. A postembolization angiogram showed occlusion of the PICA AV fistula and draining varix. A computed tomography (CT) scan performed at a 10-month follow-up visit showed dramatic decompression of the brainstem. Although the patient continued to have some sensory changes secondary to Wallenberg syndrome, he was otherwise doing well neurologically. Conclusion The treatment of this lesion is difficult because of its location near the brainstem. Postocclusion edema or hemorrhage can result in mass effect and life-threatening brainstem compression. Our patient, whose AV fistula was caused by trauma, was treated effectively with GDC embolization.

Successful endovascular treatment of cerebral arteriovenous fistula

Childhood intracranial varix is rare and has been associated mostly with vein of Galen fistula or arteriovenous malformation. We present one patient with intracranial arteriovenous fistula with concomitant giant varix in a child. We treated the patient with endovascular embolization and obtained complete closure of fistula without morbility and mortality. The main radiologic and pathophysiologic features of this unusual entity, as well as the available therapeutic options, are discussed.

Giant intracranial varix arising from an arteriovenous fistula

A case of a giant intracranial varix arising from an arteriovenous (AV) fistula is reported. This 16 year old boy presented with a sudden onset of headache and dizziness. The patient had suffered from intermittent seizure attacks since the age of 4. Brain computed tomography (CT), taken 2 years prior to admission, showed compression of the quadrigeminal plate by a suspicious mass lesion. His brain CT, magnetic resonance imaging (MRI), and cerebral angiography on admission demonstrated a giant varix with evidence of haemorrhage in the cerebellum. The varix was fed from branches of the posterior cerebral artery and drained through a dilated vein into the vein of Galen. It was resected surgically. Surgery and/or endovascular obliteration of the AV fistula is required because the varix which develops from an AV fistula can enlarge and rupture.

Orbital varices: a tricky diagnosis in MRI

Orbital varix (OV) is a rare condition causing intermittent positional exophthalmos. Because of low venous pressure, OVs tend to collapse, being frequently undetectable in routine CT or MRI examinations. We describe one case of giant intraorbital varix studied with CT and MRI techniques.

Intracerebral hemorrhage from a middle meningeal arteriovenous fistula with a giant venous varix

A patient with a congenital arteriovenous fistula between the middle meningeal artery and a cortical vein with a giant venous varix is described. The patient presented with an intracerebral hemorrhage that had been evacuated. Permanent cure of the fistula was achieved without morbidity by embolization with Ivalon particles.