Embolization of anterior cranial fossa dural arteriovenous fistula

Dural arteriovenous fistulas (DAVFs) are abnormal connections between branches of the intracranial arteries and dural veins or sinuses. Advancements in the technique of endovascular embolization has made it the treatment of choice for DAVFs. The goal of treatment is to completely occlude the fistula orifice while maintaining the normal cerebral venous drainage. Depending on the site of the DAVF, endovascular treatment has its own challenges to the performing physician. In this case report, we will discuss complex anterior cranial fossa DAVFs, treatment approaches, and complications of the treatment.

Embolization of anterior cranial fossa dural arteriovenous fistula

Dural arteriovenous fistulas (DAVFs) are abnormal connections between branches of the intracranial arteries and dural veins or sinuses. Advancements in the technique of endovascular embolization has made it the treatment of choice for DAVFs. The goal of treatment is to completely occlude the fistula orifice while maintaining the normal cerebral venous drainage. Depending on the site of the DAVF, endovascular treatment has its own challenges to the performing physician. In this case report, we will discuss complex anterior cranial fossa DAVFs, treatment approaches, and complications of the treatment.

Cerebral venous drainage through internal jugular vein

Internal jugular veins (IJVs) are the largest veins in the neck and are considered the primary cerebral venous drain for the intracranial blood in supine position. Any reduction in their flow could potentially results an increase in cerebral blood volume and intracranial pressure (ICP). The right internal jugular vein communicates with the right atrium via the superior vena cava, in which a functional valve is located at the union of the internal jugular vein and the superior vena cava. The atrium aspiration is the main mechanism governing the rhythmic leaflets movement of internal jugular vein valve synchronizing with the cardiac cycle. Cardiac contractions and intrathoracic pressure changes are reflecting in Doppler spectrum of the internal jugular vein. The evaluation of the jugular venous pulse provides valuable information about cardiac hemodynamics and cardiac filling pressures. The normal jugular venous pulse wave consists of three positive waves, a, c, and v, and two negative waves, x and y. A normal jugular vein gradually reduces its longitudinal diameter, as described in anatomy books; it is possible to segment IJV into three different segments J3 to J1, as it proposed in ultrasound US studies and CT scan. In this review, the morphology and methodology of the cerebral venous drainage through IJV are presented.

Color Doppler Ultrasound Evaluation of Internal Jugular Vein Before Radical Neck Dissection

Objective: There is a great controversy about whether the internal jugular vein (IJV) should be retained during radical neck dissection. In this study, the right and left IJV under different body position were observed by color Doppler ultrasound, in order to provide a experimental basis for the preservation of IJV in neck dissections. Methods: A total of 40 patients with thyroid cancer undergoing radical neck dissection were examined in this study. The hemodynamic data such as section area, velocity, and volume of blood flow were measured by Doppler in supine and sitting position under quiet breath. Results: In supine position, the cross sectional area, the velocity and the blood flow volume in the right side were 58%, 23% and 91% more than left side respectively. The right side advantage, symmetrical, and left side advantage of IJV was in 65%, 25%, and 10% of patients. The blood flow of bilateral IJV was 74% of total cerebral outflow. The IJV predominate, balanced type, and no-IJV predominate cerebral venous drainage was in 73%, 23% and 5% of patients. In sitting position, the section area, the velocity and the blood flow volume in the right side were 29%, 35% and 56% more than left side respectively. The right side advantage, symmetrical, and left side advantage of IJV was in 45%, 45%, and 10% of patients. The blood flow of bilateral IJV was 23% of total cerebral outflow. The balanced type and no-IJV predominate cerebral venous drainage was in 23% and 78% of patients. Conclusions: There are side advantage of IJV. With quiet breathing, IJV is not the main pathway of cerebral venous drainage in sitting position. The preoperative ultrasound is useful to design the individualized surgical approach for the radical neck dissections.

Efektifitas Elevasi Kepala 300 Dalam Meningkatkan Perfusi Serebral Pada Pasien Post Trepanasi di Rumah Sakit Mitra Surabaya

Head trauma often causes cerebral perfusion disturbances that can cause some problems. Conditions of hypoxia, hypercapnia, hypotension and cerebral edema can cause further effect is increased intracranial pressure due to an increase in a confined space, reduced cerebral perfusion. so necessary actions to improve perfusion is by setting position of the head elevation 300 to increase cerebral venous drainage. The purpose of this study was to analyze the effectiveness of a 30° head-up positionin the post trepanation head injury patients in improving cerebral perfusion. This study used anonqui valent control group design. Post-op patient population trepanation head trauma in Hospital Mitra Keluarga Surabaya at 1 month Desember 2012 – 10 February 2013. The sample of the study15 patients with post-op trepanation head trauma. Sampling was done by purposive sampling technique. The variables of this study is the head-up 300 in patients post-op trepanation head trauma and cerebral perfusion. The results showed that the average MAP was100 mmHg and average GCS was 12.4. Based on the test paired t-test with significance level α=0.005 obtained P= 0.000 means there is influence the effectiveness of the head-up 300 against cerebral. Perfusionin patients with post-op trepanation after 8 hours. Head up to 300 can improve cerebral perfusion in patients with head trauma post op trepanation. This research needs to be recommended to the health practitioner, specializing in nursing to provide ahead-up position 300 to increase cerebral perfusion. Keywords: Flat Position, Head Up 300, Post Op Trepanation Head Trauma and Cerebral Perfusion.

Critical Review of Clinical Aspects and Treatment Strategies of Cranial Dural Arteriovenous Malformations

The authors discuss the treatment strategies for dural arteriovenous fistulas, considering anatomical features such as the presence of cortical venous reflux (CVR) and patterns of cerebral venous drainage. Illustrative cases are presented with the different clinical and angiographic features, focusing on patterns of arterial and venous anatomy, normal cerebral venous drainage and the presence of cortical venous reflux. A review of the pathophysiology and current classifications are presented. The treatment strategies are discussed, focusing on the endovascular procedures available. Dural arteriovenous fistulas should be treated considering the significant risks of hemorrhage related to the presence of CVR. Treatment strategies should aim angiographic and clinical cure, achieved with low risk of complications when using a multidisciplinar approach, after carefull understanding of the venous drainage, respecting the anatomy of the lesion and the normal cerebral venous drainage.