Commentary: Role of Surgical Intervention for Intracranial Dural Arteriovenous Fistulae With Cortical Drainage in an Endovascular Era: A Case Series

2021 ◽  
Vol 20 (5) ◽  
pp. E391-E392
Author(s):  
Dimitri Benner ◽  
Christoph J Griessenauer
Keyword(s):  
Surgical Intervention ◽  
Case Series ◽  
Arteriovenous Fistulae ◽  
Intracranial Dural Arteriovenous Fistulae

Surgical Treatment of Intracranial Dural Arteriovenous Fistulae: Role of Venous Drainage

Neurosurgery ◽  
2000 ◽  
Vol 47 (1) ◽  
pp. 56-67 ◽  
Author(s):  
Massimo Collice ◽  
Giuseppe D'Aliberti ◽  
Orazio Arena ◽  
Consuelo Solaini ◽  
Romero A. Fontana ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Venous Drainage ◽  
Arteriovenous Fistulae ◽  
Intracranial Dural Arteriovenous Fistulae

Intracranial and Orbital Complications of Sinusitis: A Case Series and Review of Literature

2011 ◽  
Vol 4 (2) ◽  
pp. 87-92 ◽  
Author(s):  
Kishore Shetty ◽  
Vinay Vaidyanathan
Keyword(s):  
Surgical Intervention ◽  
Case Series ◽  
Interesting Case ◽  
Sinus Surgery ◽  
Intracranial Extension ◽  
Review Of Literature ◽  
Neurosurgical Technique ◽  
Orbital Complications ◽  
Late Recognition

ABSTRACT Complications of paranasal sinus infection most often involve the orbit and periorbita. Because of widespread use of antibiotics, intracranial extension of paranasal sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the potential of these complications, as late recognition of this condition and delay in treatment can increase morbidity and mortality rates. An interesting case series of sinusitis with orbital and intracranial complication is presented, which was radiologically evaluated, and was managed by endoscopic sinus surgery with drainage of subdural empyema by appropriate neurosurgical technique. The radiological tools played a very important role in both assessment and timing of surgical intervention. Unparallel role of radiological investigations cannot be overemphasized. The key to successful treatment is aggressive management and the timing for surgical intervention should not be deferred. The patients made full recovery at the time of discharge.

scholarly journals Progressive Neurological Decline with Deep Bilateral Imaging Changes: A Protean Presentation of Dural Arteriovenous Fistulae

2018 ◽  
Vol 7 (5) ◽  
pp. 256-264
Author(s):  
Rene A. Colorado ◽  
Marcelo Matiello ◽  
Hyun-Sik Yang ◽  
James D. Rabinov ◽  
Aman Patel ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Case Series ◽  
Endovascular Embolization ◽  
Behavioral Changes ◽  
Neoplastic Disease ◽  
High Morbidity ◽  
Cerebral Vasculature ◽  
Arteriovenous Fistulae ◽  
Intracranial Dural Arteriovenous Fistulae ◽  
Variable Clinical Presentation

Intracranial dural arteriovenous fistulae (DAVF) within the deep cerebral vasculature are diagnostically challenging because of their variable clinical presentation and typical bilateral neuroimaging findings mimicking inflammatory, infectious, and metabolic processes. Increasingly, reports have emerged highlighting the diagnostic and treatment challenges of these lesions and their associated high morbidity and rapid clinical deterioration when untreated. We describe here a case series of 4 patients with deep cerebral DAVF who presented with impaired arousal or memory and behavioral changes. In all patients, the initial differential diagnosis included metabolic, inflammatory, infectious, or neoplastic disease, with an eventual correct diagnosis obtained after catheter angiography had demonstrated arterialization of the deep venous structures, including the vein of Galen. All patients were successfully treated with endovascular embolization, with 1 patient requiring additional surgical treatment. We review the contemporary diagnostic evaluation and management of DAVF within the deep cerebral vasculature. With rapid diagnosis and treatment, a favorable outcome is possible.

scholarly journals A systematic review of the management of acute pyogenic flexor tenosynovitis

2015 ◽  
Vol 40 (7) ◽  
pp. 720-728 ◽  
Author(s):  
A. M. Giladi ◽  
S. Malay ◽  
K. C. Chung
Keyword(s):  
Surgical Intervention ◽  
Case Series ◽  
Antibiotic Use ◽  
Closed Space ◽  
Therapeutic Level ◽  
Level Of Evidence ◽  
Space Infection ◽  
Pyogenic Flexor Tenosynovitis ◽  
Flexor Tenosynovitis

Pyogenic flexor tenosynovitis (PFT) is an aggressive closed-space infection that can result in severe morbidity. Although surgical treatment of pyogenic flexor tenosynovitis has been widely described, the role of antibiotic therapy is inadequately understood. We conducted a literature review of studies reporting on acute pyogenic flexor tenosynovitis management. A total of 28 case series articles were obtained, all of which used surgical intervention with varied use of antibiotics. Inconsistencies among the studies limited summative statistical analysis. Our results showed that use of antibiotics as a component of therapy resulted in improved range of motion outcomes (54% excellent vs. 14% excellent), as did using catheter irrigation rather than open washout (71% excellent vs. 26% excellent). These studies showed benefits of early treatment of pyogenic flexor tenosynovitis and of systemic antibiotic use. As broad-spectrum antibiotics have changed the management of other infectious conditions, we must more closely evaluate consistent antibiotic use in pyogenic flexor tenosynovitis management. Level of Evidence: Therapeutic, Level III

scholarly journals A case series of intracranial dural arteriovenous fistulae mimicking cervical myelitis: a diagnosis not to be missed

2021 ◽  
Author(s):  
Daniel Whittam ◽  
Saif Huda ◽  
Emily Gibbons ◽  
Richard Pullicino ◽  
Tom Solomon ◽  
...  
Keyword(s):  
Case Series ◽  
Cervical Cord ◽  
Retrospective Case ◽  
Diagnostic Features ◽  
Arteriovenous Fistulae ◽  
Exact Test ◽  
Life Threatening ◽  
Mri Sequences ◽  
Male Patients ◽  
Intracranial Dural Arteriovenous Fistulae

Abstract Objective To describe the diagnostic features of intracranial dural arteriovenous fistulae (DAVF) presenting with cervical cord or brainstem swelling. Methods Retrospective case note and neuroimaging review of patients with angiographically confirmed DAVF diagnosed during January 2015–June 2020 at a tertiary neuroscience centre (Walton Centre NHS Foundation Trust, Liverpool, UK). Results Six intracranial DAVF causing cervical cord or brainstem oedema (all males aged 60–69 years) and 27 spinal DAVF (88% thoracolumbar) were detected over a 5.5-year period. Significantly more patients with intracranial DAVF received steroids for presumed inflammatory myelitis than those with spinal DAVF (5/6 vs 1/27, p = 0.0001, Fisher’s exact test). Several factors misled the treating clinicians: atypical rostral location of cord oedema (6/6); acute clinical deterioration (4/6); absence (3/6) or failure to recognise (3/6) subtle dilated perimedullary veins on MRI; intramedullary gadolinium enhancement (2/6); and elevated CSF protein (4/5). Acute deterioration followed steroid treatment in 4/5 patients. The following features may suggest DAVF rather than myelitis: older male patients (6/6), symptomatic progression over 4 or more weeks (6/6) and acellular CSF (5/5). Conclusion Intracranial DAVF are uncommon but often misdiagnosed and treated as myelitis, which can cause life-threatening deterioration. Neurologists must recognise suggestive features and consider angiography, especially in older male patients. Dilated perimedullary veins are an important clue to underlying DAVF, but may be invisible or easily missed on routine MRI sequences.

scholarly journals The role of angiogenesis in dural arteriovenous fistulae: the story so far

2018 ◽  
Vol 24 (4) ◽  
pp. 450-454 ◽  
Author(s):  
Pervinder Bhogal ◽  
Leonard L Yeo ◽  
Hans Henkes ◽  
Timo Krings ◽  
Michael Söderman
Keyword(s):  
Natural History ◽  
Clinical Symptoms ◽  
Human Studies ◽  
Arteriovenous Fistulae ◽  
The Past ◽  
Growing Body ◽  
Intracranial Dural Arteriovenous Fistulae ◽  
Underlying Pathogenesis

Intracranial dural arteriovenous fistulae are a commonly encountered pathology that can present with a variety of different clinical symptoms. Although there is a significant body of work relating to the natural history and treatment of dural arteriovenous fistulae the exact underlying pathogenesis remains elusive. Various different pathogenetic models have been put forward but there is now a growing body of evidence implicating angiogenesis and the involvement of angiogenetic factors. In this review we attempt to show how the various animal and human studies performed over the past two decades have contributed to the proposed hypothesis on the development of dural arteriovenous fistulae.

Surgical Treatment of Intracranial Dural Arteriovenous Fistulae: Role of Venous Drainage

Neurosurgery ◽  
2000 ◽  
Vol 47 (1) ◽  
pp. 56-67 ◽  
Author(s):  
Massimo Collice ◽  
Giuseppe D’Aliberti ◽  
Orazio Arena ◽  
Consuelo Solaini ◽  
Romero A. Fontana ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Venous Drainage ◽  
Arteriovenous Fistulae ◽  
Intracranial Dural Arteriovenous Fistulae

Neurological Recovery in Traumatic Spinal Cord Injury Patient with Delayed Surgical Intervention

2018 ◽  
Vol 1 (2) ◽  
pp. 34
Author(s):  
Mochamad Targib Alatas
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Intervention ◽  
Case Series ◽  
Spinal Cord Injury Patient ◽  
Traumatic Spinal Cord Injury ◽  
Best Interest ◽  
Score Improvement ◽  
Cord Injury ◽  
Injury Patient

Early surgical treatment for traumatic spinal cord injury (SCI) patients has been proven to yield better improvement on neurological state, and widely practiced among surgeons in this field. However, it is not always affordable in every clinical setting. It is undeniable that surgery for chronic SCI has more challenges as the malunion of vertebral bones might have initiated, thus requires more complex operating techniques. In this case series, we report 7 patients with traumatic SCI whose surgical intervention is delayed due to several reasons. Initial motoric scores vary from 0 to 3, all have their interval periods supervised between outpatient clinic visits. On follow up they demonstrate significant neurological development defined by at least 2 grades motoric score improvement. Physical rehabilitation also began before surgery was conducted. These results should encourage surgeons to keep striving for the patient’s best interest, even when the injury has taken place weeks or even months before surgery is feasible because clinical improvement for these patients is not impossible. 

Fascicular torsions of the anterior and posterior interosseous nerve in 4 cases: neuroimaging methods to improve diagnosis

2020 ◽  
Vol 132 (6) ◽  
pp. 1925-1929 ◽  
Author(s):  
Jennifer Kollmer ◽  
Paul Preisser ◽  
Martin Bendszus ◽  
Henrich Kele
Keyword(s):  
Magnetic Resonance ◽  
Surgical Intervention ◽  
Case Series ◽  
Diagnostic Methods ◽  
Posterior Interosseous Nerve ◽  
Nerve Ultrasound ◽  
Magnetic Resonance Neurography ◽  
Surgical Exploration ◽  
Hyperintense Signal ◽  
Emergency Surgical Intervention

Diagnosis of spontaneous fascicular nerve torsions is difficult and often delayed until surgical exploration is performed. This case series raises awareness of peripheral nerve torsions and will facilitate an earlier diagnosis by using nerve ultrasound (NUS) and magnetic resonance neurography (MRN). Four patients with previously ambiguous upper-extremity mononeuropathies underwent NUS and 3T MRN. Neuroimaging detected proximal torsions of the anterior and posterior interosseous nerve fascicles within median or radial nerve trunks in all patients. In NUS, most cases presented with a thickening of affected nerve fascicles, followed by an abrupt caliber decrease, leading to the pathognomonic sausage-like configuration. MRN showed T2-weighted hyperintense signal alterations of fascicles at and distal to the torsion site, and directly visualized the distorted nerves. Three patients had favorable outcomes after being transferred to emergency surgical intervention, while 1 patient with existing chronic muscle atrophy was no longer eligible for surgery. NUS and MRN are complementary diagnostic methods, and both can detect nerve torsions on a fascicular level. Neuroimaging is indispensable for diagnosing fascicular nerve torsions, and should be applied in all unclear cases of mononeuropathy to determine the diagnosis and if necessary, to guide surgical therapies, as only timely interventions enable favorable outcomes.

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