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Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
The most common are subpial AVMs located in the subpial space within the cortex and/or white matter. The afferent arteries are principally the branches from the intradural network of the carotid and/or vertebrobasilar circulation. Superficial pial AVMS are rare and mostly found in children. They are composed of an almost direct shunt (true fistula) and thus high-flow venous dilation with a high risk of bleeding. Dural AVMs, which constitute 10–15% of intracranial AVMs, have a nidus located within the dural wall of venous sinuses, commonly the sigmoid sinus. They are acquired following a triggering event such as CVT (e.g. mastoiditis, cranial trauma, or surgery) that has caused venous hypertension. The arterial supply is from the dural branches of the external carotid artery (e.g. middle meningeal artery, occipital artery, ascending pharyngeal artery) and vertebral (posterior meningeal artery) or, less commonly, dural branches of the intracranial network.
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The arterial supply to the dura mater consists of Anterior meningeal arteries which are branches of the ethmoidal arteryMiddle and accessory meningeal arteries arising from the maxillary arteryPosterior meningeal artery which is a branch of the ascending pharyngeal arteryMeningeal branches from the occipital artery and vertebral artery
Abnormal Skull
Published in Swati Goyal, Neuroradiology, 2020
The posterior cranial fossa (PCF) or skull base (PSB) is formed by the posterior part of the temporal bone and the occipital bone. Due to bone-induced beam-hardening artifacts on images, the evaluation of the PCF is often compromised. The foramen magnum, part of occipital bone, is the largest foramen of the skull, which transmits vertebral arteries, anterior/posterior spinal arteries, and the spinal accessory nerve.The jugular foramen, at the posterior end of the petro-occipital suture, is divided by a fibrous or bony septum into anteromedial pars nervosa and posterolateral pars vascularis. The right jugular foramen, being larger than the left in most of the population, is a normal variant, and occasionally both cranial nerves IX and X pass through the pars nervosa.The pars nervosa is smaller than the pars vascularis, and the glossopharyngeal nerve (IX), with its tympanic branch (Jacobson’s nerve), and the inferior petrosal sinus, are transmitted through it. The pars vascularis is larger and the internal jugular vein, the vagus nerve (X), with its auricular branch (Arnold’s nerve), the accessory nerve (XI), and the posterior meningeal artery, are transmitted through it.The hypoglossal canal transmits the hypoglossal nerve (cranial nerve XII).The internal acoustic meatus lies within the petrous part of the temporal bone (posteriorly). The facial nerve [VII], the vestibulocochlear nerve [VIII], and the labyrinthine artery traverse through it.
Successful embolization of an upper cervical spinal dural fistula despite anterior spinal artery anastomosis
Published in British Journal of Neurosurgery, 2023
Anthony Nguyen, Ken Maynard, William Coggins, Karthikram Raghuram
A female in her 40s presented with a complaint of severe headache, nausea, vomiting, and tightness and limited mobility of the neck and bilateral upper extremities lasting a few days. A computed tomography (CT) head demonstrated minimal subarachnoid hemorrhage in the occipital horns and at the foramen of Magendie. A subsequent CT angiogram (CTA) revealed a mid-cervical SDAVF located at C2–C3. Interventional radiology performed a diagnostic angiogram to better visualize the lesion in order to optimize treatment. The angiogram revealed a fistula supplied by a C2–C3 radicular artery and right posterior meningeal artery, with both draining into the same medullary vein (Figure 1). However, a branch of the radicular artery proximal to the fistula feeder anastomosed with the ASA.
Resolution of hypoglossal nerve palsy after coil embolization of an anterior condylar confluence fistula
Published in British Journal of Neurosurgery, 2021
Donald K. E. Detchou, Gregory Glauser, Omar A. Choudhri
Here, we present the case of a 69-year-old female with a 2-year history of slurred speech, left-sided pulsatile tinnitus, and a left-sided hypoglossal nerve palsy, with tongue deviation and atrophy (Figure 1(A)). MRI and CT Angiography imaging demonstrated increased vascularity at the left hypoglossal canal. Cerebral angiography showed a left anterior condylar confluence fistula, supplied bilaterally by the ascending pharyngeal artery, as well as the posterior meningeal artery (Figure 1(B,C)). For this patient, the treatment plan included a transvenous coil embolization of the left condylar fistula pocket (Figure 2). Subsequent to receiving therapeutic endovascular treatment, the patient had complete resolution of her symptoms (Figure 3).