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Published in Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad, Neurosurgery, 2014
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad
Dural arteriovenous fistula – an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus. The Borden classification of dural arteriovenous malformations or fistulas is based on the venous drainage. Type I: dural arterial supply drains anterograde into venous sinus.Type II: dural arterial supply drains into venous sinus. High pressure in sinus results in both anterograde drainage and retrograde drainage via subarachnoid veins.Type III: dural arterial supply drains retrograde into subarachnoid veins.
Dural venous sinus stenting in patients with idiopathic intracranial hypertension: report of outcomes from a single-center prospective database and literature review
Published in Expert Review of Ophthalmology, 2022
Matthew J Kole, Juan Carlos Martinez-Gutierrez, Francisio Sanchez, Rosa Tang, Peng Roc Chen
A broad differential should be considered when patients present with elevated intracranial pressure, as several conditions can mimic the signs and symptoms of IIH. Intracranial mass lesions can cause elevated intracranial pressure, but these are easily diagnosed with CT or MRI. Venous sinus thrombosis can mimic IIH, with patients presenting with vision loss, headache, and papilledema [52]; the diagnosis is more common in young females, particularly those taking hormone-based oral contraception, or patients with clotting disorders [53]. The clinical presentation may reflect a more sudden course of onset. A patient with a dural arteriovenous fistula (dAVF), an abnormal connection between arteries within the dura and cortical veins and/or venous sinuses, may also present with similar findings as IIH, including pulsatile tinnitus with signs and symptoms of elevated intracranial pressure [54,55]. Noninvasive vascular imaging findings for dAVF are most often nonspecific, and a cerebral angiogram is required to make the diagnosis. Migraines may also mimic the headache and vision components of IIH, but papilledema and elevated opening pressure are absent. Vitamin A overdoses can also mimic IIH [56].
Incidental ethmoidal dural arteriovenous fistula coexisting with a pituitary adenoma exacerbating post-transsphenoidal epistaxis
Published in British Journal of Neurosurgery, 2019
Keisuke Yoshida, Raita Fukaya, Masahito Fukuchi, Yoshihiko Hiraga, Shinya Ichimura, Koji Fuji
Transsphenoidal surgery is a useful operative method for sellar and parasellar lesions, especially pituitary tumours. However, several cases of severe postoperative epistaxis after transsphenoidal surgery have been reported.1,2 Ethmoidal dural arteriovenous fistula (DAVF) is rare and asymptomatic DAVFs can remain unrecognised unless catheter angiography is done. We report a case of postoperative epistaxis that required massive transfusion and endovascular embolisation after an uneventful endoscopic transsphenoidal surgery for pituitary tumour associated with preoperatively-unknown coexisting ethmoidal DAVF.
Radiologic features of vascular pulsatile tinnitus – suggestion of optimal diagnostic image workup modalities
Published in Acta Oto-Laryngologica, 2018
Ah-Ra Lyu, Sung Jae Park, Dami Kim, Ho Yun Lee, Yong-Ho Park
There were several studies demonstrating the causes of pulsatile tinnitus. Waldvogel et al. [10] postulated that the most common lesion was a dural arteriovenous fistula or a carotid-cavernous sinus fistula among the 36 patients with vascular pulsatile tinnitus. On the contrary, Sonmez et al. [11] demonstrated that the most common cause was high jugular bulbs, followed by atherosclerosis, jugular bulb dehiscence, aneurysm of internal carotid artery, dural arteriovenous fistula, aberrant internal carotid artery, jugular diverticulum and glomus tumor. More recently, Bae et al. [2] showed that a high jugular bulb was the most common cause, followed by venous hum from various venous lesions in 65% (37/57) of patients. In our series, we classified the origin of the lesions as venous, arterial or intermediate. Among the 49 patients with vascular pulsatile tinnitus, a venous origin was seen in about 84% (41/49). The most common venous cause were jugular bulb variants (80% in venous lesion, 67% in all lesion) such as high riding jugular bulb, dehiscence and diverticulum, followed by sigmoid sinus variants such as diverticulum and dehiscence. The reason for a slightly higher incidence of venous lesions in our series compared to others may be due to the exclusion of several cases of tumorous condition such as glomus tympanicum and glomus tumor of the jugular bulb. Interestingly, 88% (36/41) of venous lesions were on the right. Although there were few reports about laterality in this condition, there was a report showing that asymmetry of the internal jugular vein (IJV) was noted in 62.5% and the dominant vein was the right in 68% of patients [13]. More recently, another report using ultrasound examination showed that the right IJV was dominant over the left IJV in 72% of patients [14]. This tendency of a right-sided dominant IJV may be one of the reasons why there are more pulsatile tinnitus of venous origin affecting the right side.