Stroke and Transient Ischemic Attacks of the Brain and Eye
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in 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 Injury
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
Typically, extradural haematoma (EDH) may arise after a mild injury and more than half the patients with this complication are under the age of 20 years; it is rare after the age of 40 years (Figure 12.3). It is also rare before the age of two years when trauma tends to indent the more pliable skull and dura together so damage tends to occur to the brain and haematomas are subdural. In infants, the large head size relative to the body means that the volume of the extradural space is large in relation to the blood volume, so hypovolaemia may be the primary presenting feature with an EDH. In an adult, the blow causes the dura to become separated from the skull immediately below the point of impact and this is where the clot forms. They most commonly occur in the temporal region. Bleeding commonly arises from a torn middle meningeal artery but may also be venous. EDH is rare, with only 0.5 per cent of head-injured patients admitted to hospital developing the condition.
Cheryl
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner in The Integrated Nervous System, 2017
The outermost layer of the meninges is the dura, a thick, strong sheet of connective tissue. Within the cranial cavity, the dura and the skull bones adhere somewhat to one another, leaving a potential gap, the epidural space (Figure 9.3a). Bleeding from the large artery that supplies the meninges, the middle meningeal artery, occurs between the skull and dura (Figure 9.3b) and is appropriately called an epidural hemorrhage. This is usually caused by trauma to the side of the head in the temporal region of the skull. The dura is composed of two layers, the periosteal and the meningeal.
Middle meningeal artery embolisation for chronic subdural haematomas: the first prospective UK study
Published in British Journal of Neurosurgery, 2022
Saffwan Mohamed, Alvaro Villabona, Oliver Kennion, Rajeev Padmananbhan, Aslam Siddiqui, Shahid Khan, Manjunath Prasad, Nitin Mukerji
The formation of CSDH is thought to be venous in origin, due to rupture of bridging veins traversing the subdural space.4 However, the sustenance and propagation of the collection appear to be more complex. Following the initial haemorrhage, the inflammation cascade and subsequent influx of inflammatory mediators and cells lead to formation of inner and outer membranes in the subdural space. Neovascularisation in the outer membrane layer leads to formation of small, fragile vessels that are susceptible to recurrent rupture and haemorrhage. This contributes to the growth and propagation of the CSDH.5 These vessels are seen as small ‘blushes’ in the terminal branches of the Middle Meningeal artery (MMA) on catheter angiography in patients with CSDH.6 Moreover, studies have shown engorgement of the MMA on MR Angiography in patients with CSDH.7 These observations have led to the utilisation of MMA embolisation as treatment for CSDH. It is hypothesised that cessation of blood flow to the subdural space by MMA embolisation leads to ischaemia and shifts the cascade towards absorption and repair.5
Persistent facial nerve palsy after middle meningeal artery embolization for subdural hematoma: a case report
Published in Brain Injury, 2023
Ally Ferber, Yi Zhou, Brian Greenwald
Chronic subdural hematomas (cSDHs) are predicted to be the most prevalent cranial neurosurgical condition by 2030, with approximately 60,000 new cases each year in the United States(1). Subdural hematomas (SDHs) occur due to shearing of bridging veins that travel to the dural venous sinuses (2). Most cases of cSDH occur in patients over the age of 60 or in patients with brain atrophy (1). The standard of care for cSDH includes clinical observation for small hematomas or surgery for hematoma evacuation and decompression, however, there is a high recurrence rate of 15–20% (1,2). Embolizing the branches of the middle meningeal artery (MMA) that supply the hematoma promotes hematoma resolution and significantly decreases the recurrence rate to approximately 4% (2). Regarding risks of MMA embolization, certain branches of the MMA should theoretically be avoided due to the risk of injury to cranial nerve VII, blindness, and stroke although there is no literature of such complications (2). We review the pathophysiology of SDH, the use of MMA embolization in SDH, and discuss a case of a patient with recurrent SDH who developed persistent facial nerve palsy after MMA embolization.
Three-dimensional multimodality fusion imaging as an educational and planning tool for deep-seated meningiomas
Published in British Journal of Neurosurgery, 2018
Mitsuru Sato, Kensuke Tateishi, Hidetoshi Murata, Taichi Kin, Jun Suenaga, Hajime Takase, Tomohiro Yoneyama, Toshiaki Nishii, Ukihide Tateishi, Tetsuya Yamamoto, Nobuhito Saito, Tomio Inoue, Nobutaka Kawahara
A 67-year-old woman presenting with a one-year history of progressive right visual impairment was referred to our hospital. A right anterior clinoidal meningioma 40 mm in diameter was detected by MRI. In 2DI, MR imaging showed encasement by the tumor of the internal carotid artery, middle cerebral artery, and posterior communicating arteries. However, the encased anterior choroidal arteries (AchAs), lenticulostriate arteries (LSAs), and displaced optic nerve were not clearly identified (Figure 2(A,B) in 2DIs. In contrast, fusion of the DRIVE and CE-THRIVE images clearly depicted the optic nerve (Figure 2(C)), and allowed its 3D reconstruction (Figure 2(D)). The feeding arteries were mainly from the recurrent meningeal branch of the ophthalmic artery and the middle meningeal artery, as determined by conventional DSA. Interestingly, 3D-MFI additionally detected one AchA, three LSAs, one elongated anterior temporal artery, and one premammillary artery, which were also encased within the tumor (Figure 2(E,F). In addition, three feeding arteries, the posterior ethmoidal artery, artery of the foramen rotundum, and accessory meningeal artery, were identified (Figure 2(G,H)). Based on these findings, a surgical strategy was developed from a simulation for resecting this tumor as described above (see “3D-MFI validation “); this strategy included strategies needed to preserve perforators, veins, and nerves. The simulation of the surgery was performed, and the actual surgery was performed based on the simulation. During the surgery, we confirmed the arteries and optic nerve represented in the simulation (Figs 2(l–M)), and finally achieved near-total resection without damaging these perforating arteries or the optic nerve.
Related Knowledge Centers
- Anterior Ethmoidal Artery
- Foramen Spinosum
- Infratemporal Fossa
- Maxillary Artery
- Skull
- Calvaria
- Dura Mater
- Posterior Meningeal Artery
- Pterion
- Epidural Hematoma