Pulse-synchronous Bruit Research Articles

Alternative route to a hypoglossal canal dural arteriovenous fistula in case of failed jugular vein approach.

Hypoglossal canal dural arteriovenous fistulas (HC-DAVF) involve the anterior condylar vein (ACV) and anterior condylar confluence (ACC). They often present with tinnitus, bruit, and hypoglossal nerve palsy. The most common treatment in HC-DAVFs is transvenous embolization using coils and the most direct transvenous route is the trans-internal jugular vein access. When this approach is not feasible, a treatment attempt is possible through alternative routes. We report 2 patients with DAVFs involving the anterior condylar confluence. The first patient presented with pulsatile tinnitus and hypoglossal nerve palsy, and was treated by a standard transjugular approach. The second patient presented with pulse-synchronous bruit. Following an unsuccessful attempt of the transjugular approach, the fistulous point was reached via the deep cervical vein and complete occlusion was achieved by coil deployment. Both patients had complete regression of symptoms. Endovascular therapy is the elective treatment for HC-DAVFs and the transjugular approach is the most commonly used. The deep cervical vein (DCV) can be an alternative transvenous route when the transjugular approach fails.

Endovascular treatment of posterior condylar canal dural arteriovenous fistula

Posterior condylar canal dural arteriovenous fistulas (PCC DAVFs) are rare lesions that may present with pulse-synchronous bruit. In cases with venous reflux there is a risk of haemorrhage or even...

Pulssynchrones Ohrgeräusch, Lidschwellung, Exophthalmus, Chemose und Diplopie drei Wochen nach Schädel-Hirn-Trauma

Traumatic carotid-cavernous sinus fistulas represent an uncommon complication of a head trauma. The consequences of a delayed diagnosis are progressive ocular complications such as visual loss, extraocular muscle palsy, progressive proptosis, conjuctival chemosis, retinal vein occlusion and secondary glaucoma. Moreover, severe epistaxis, intracerebral and subarachnoidal hemorrhage may occur. We present a patient who developed a carotid-cavernous sinus fistula within three weeks after a craniocerebral injury. Despite initial exclusion of an arteriovenous fistula using duplex sonography, angiography later demonstrated the carotid-cavernous sinus fistula that was successfully occluded be means of catheter intervention. The patient's symptomatology consisting of pulse synchronous bruit, red, swollen and painful eye, diplopia, chemosis, pulsating exophthalmos, ocular hypertension and progressive visual loss allowed various differential diagnoses. Apart from inflammatory, mechanical, autoimmune, vascular and tumorous disorders, a traumatic cause was highly probable considering the patient's history of craniocerebral injury. A rapid elimination of such a fistula is necessary in order to prevent long-term damage. However it is important to consider the possible complications due to the intervention, in our case the risk of a hyperperfusion syndrome with a consecutive cerebral hemorrhage.

Selective Transvenous Embolization of Dural Arteriovenous Fistulas Involving the Hypoglossal Canal

The hypoglossal canal contains a venous plexus that connects the inferior petrous sinus, condylar vein, jugular vein and paravertebral plexus. The venous plexus is one of the venous drainage routes of the posterior skull base. Only a few cases of dural arteriovenous fistulas (AVFs) involving the hypoglossal canal have been reported. We describe three cases (a 62-year-old female, a 52-year-old male, and an 83-year-old male) of dural AVFs involving the hypoglossal canal. Symptoms were pulse-synchronous bruit in two cases and proptosis/chemosis in one. All dural AVFs were mainly fed by the ipsilateral ascending pharyngeal artery. Two of three dural AVFs involving the hypoglossal canal mainly drained through the anterior condylar confluence into the inferior petrosal sinus retrogradely with antegrade drainage through the lateral condylar vein. The other one drained through the lateral and posterior condylar veins into the suboccipital cavernous sinus. All dural AVFs were completely occluded by selective transvenous embolization without any complications, and the symptoms disappeared within one week in all cases. Dural AVFs involving the hypoglossal canal can be successfully treated by selective transvenous embolization with critical evaluation of venous anatomy in each case.

Treatment of Dural Arteriovenous Malformations and Fistulas

Dural arteriovenous fistulas (DAVFs) or malformations consist of pathological vascular channels located within the substance of the dura mater and usually involve the walls of a dural sinus or adjacent cortical vein. DAVFs can affect a variety of cerebral venous structures and can present at various clinical stages. Although some fistulas can spontaneously thrombose, the clinical course usually involves progression from venous sinus pressurization to occlusion and retrograde cortical venous drainage. The spectrum of clinical presentation ranges from an irritating pulse-synchronous bruit to a disabling neurologic ischemic deficit or life-threatening intracranial hemorrhage from venous hypertension. The authors present their clinical experience in the radiographic diagnosis and endovascular treatment of these potentially dangerous lesions.

Dural Arteriovenous Fistulas of the Marginal Sinus

Literature Abstracts: Literature Abstracts-The American Journal of Neuroradiology, 1997: Interventional Neuroradiology: PDF Only

Grading venous restrictive disease in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus

Dural arteriovenous fistulas of the transverse/sigmoid sinus usually cause pulse-synchronous bruit but may present catastrophically. Current systems for classifying these vascular malformations do not consider obstruction of venous outflow, which increases the risk of intracranial hemorrhage due to retrograde flow via cortical veins. The authors have developed a grading system based on the severity of venous restrictive disease determined by superselective angiography. In a retrospective analysis of 25 patients with dural arteriovenous fistulas of the transverse/sigmoid sinus treated between 1988 and 1990, the grade of venous restrictive disease reflected the clinical presentation. Visual symptoms and central nervous system hemorrhage were more common in patients with cortical venous drainage and more severe distal venous occlusion (Grade 3: 31% and 31%, respectively; Grade 4: 67% and 100%, respectively) than in patients with cortical venous drainage and mild-to-moderate venous restrictive disease (Grade 2: 13% and 0%, respectively) or those without venous outflow (Grade 1: 0% and 0%, respectively). These preliminary results suggest that this grading system may be useful for predicting the risk of catastrophic clinical presentation and for guiding therapeutic decision-making in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus. A prospective study of a larger number of patients is needed to validate the predictive value of this new grading system.

The clinical significance of the tentorial artery after operative treatment of congenital arteriosinus fistulas.

In 3 patients with a pulse synchronous bruit, arteriosinus fistulas of the posterior cranial fossa were demonstrated. A short time after operative ligation of the feeder vessels the bruit recurred. These patients then showed arteriographically an extremely dilated tentorial artery, which had not been visualised at the previous examination. Magnification angiography permitted demonstration of these tentorial arteries in their total extent.

Dural arteriovenous malformation in the posterior fossa.

Arteriovenous malformations that involve the dura of the posterior fossa are rare, and they are therefore seldom considered in the differential diagnosis of posterior fossa lesions. Such malformations may involve the tentorium and the dura that covers the remainder of the posterior fossa. Their presence and extent can be evaluated accurately only by angiography. The purpose of this report is to present the clinical and angiographic features of 16 patients with dural arteriovenous malformations of the posterior fossa. These patients were studied either at the University of California Medical Center at San Francisco or Los Angeles or at the Karolinska Hospital in Stockholm, Sweden. Clinical Features The clinical features of the 9 males and 7 females are summarized in Table I. The ages ranged from one to sixty-eight years. In 11 patients a pulse-synchronous bruit was audible either at the vertex or over the mastoid region. Of these patients, 7 complained of hearing a pulsatile buzzing sound. Both the bruit and the subjective buzzing sound could usually be stopped or markedly diminished by compression of the carotid artery. The arteriovenous malformation was manifested externally in 5 patients. These external findings included dilated scalp and facial veins in 2 patients, pulsatile masses behind the ear in 2 others, and an enlarged head in the fifth. In addition, 2 of these patients had unilateral proptosis. Neurologic abnormalities were observed in 8 patients. Three complained of headaches, and 1 gave a history of convulsions. Visual complaints, visual field defects, or both were noted in 3 patients and papilledema in another 3. Motor and sensory deficits were present in 3 patients. Subarachnoid hemorrhage was a presenting sign in only 2. An asymptomatic small dural arteriovenous malformation was an incidental finding in 1 patient studied because of suspected cerebrovascular insufficiency. Roentgen Findings Plain roentgenograms of the skull showed evidence of increased vascular markings in 5 patients (Cases I, IV–VI, and IX) and localized bony thinning in one of these (Case IV). The angiographic features are summarized in Table II. In each patient we noted enlargement of one or more of the meningeal arteries that supplied the arteriovenous malformation. Enlarged tentorial branches of the internal carotid artery supplied a portion of the malformation in 11 patients (Figs. 1, A-C, 2, A, 3, A, and 4, A and B). The posterior branches of the middle meningeal artery were involved in 9 patients. In 2 of these, both the right and left middle meningeal arteries were enlarged (Figs. 1, D and E, and 2, B and D). Hypertrophy of the meningeal branches of the occipital artery was noted in 13 patients (Figs. 3, B, 5, A and C, and 6, A) and enlargement of the posterior meningeal branches of the vertebral artery in 5 (Fig. 1, F).