Downloaded 485 times
More Related Content
Similar to Dural arteriovenous fistula & AVM
Dural arteriovenous fistula & AVM
- 1. Dural arteriovenous fistula &AV malformation Dr.Aftab Qadir
- 2. Vascular malformations involvingthe brain are divided into • arteriovenous malformations (AVM) • developmental venous anomalies (DVA) • cavernous malformations • capillary telangiectasia.
- 8. Angiography • Selective :evaluation of AVM and entire cerebral circulation • Super selective : Microcatheters advanced into distal aspect of arterial feeders to study anatomical structure
- 9. Angiography • Demonstrating thenidus • Multiple arterial feeders • Thrombosed dural sinus • Flow reversal in sinus and cortical vein
- 12. • Arterial territoriessupplying the AVM • Feeding pedicles • High flow arteriopathy(stenose,ectasia,aneyrysm) • Venous drainage(territories,deep,superficial) • Individual draining veins • High flow venous angiopathy (dural sinuses,venous stenoses,occlusions ) • Venous drainage of normal brain parenchyma Goals selective angiography
- 13. Nidus • Fistulous-Large calibredirect AV connection • Plexifom-conglomerulate of multipe small vascular channels supplied by one or more arterial feeders and draining veins
- 14. Dural arteriovenous fistula •Dural arteriovenous fistulas (AVF) are pathologic abnormal vascular connections between dural arteries with the venous sinuses or cortical veins
- 16. Schematic overview ofthe Borden system of classification for DAVFs
- 22. Location • transverse /sigmoid sinus most common • cavernous sinus (indirect caroticocavernous fistula) • superior sagittal sinus • straight sinus • other venous sinuses • anterior cranial fossa • tentorium
- 23. Clinical presentation • Pulsatiletinnitus • cranial nerve palsies • orbital symptoms • raised intracranial pressure • focal neurological deficits
- 24. Complications • haemorrhage • subduralhaemorrhage (SDH) • intracranial haemorrhage (ICH) • subarachnoid haemorrhage (SAH) • intracranial hypertension • venous congestion and oedema
- 26. Imaging a) CT scan b)MRI c) Cerebral angiogram
- 27. CT • NECT: usuallynormal • CECT: Normal /small tortous dural feeders Enlarged dural sinuses Enlarged superior opthalmic vein in CCF Enlarged cortical draining veins Curvilinear subcortical calcifications
- 30. Curvilinear subcortical calcificationscan be seen at CT in patients with long-standing cortical venous reflux, possibly due to chronic venous congestion
- 31. MRI • TIWI andT2WI- Flow voids and thrombosed sinus • T2 & Flair-Hyperintensities due to venous congestion/ischemia • T1C+ diffuse dural enhancement • MRV- Occluded sinus and collateral flow • 3D PC MRA with low velocity encoding- identify feeding arteries,fistula and flow reversal in draining veins
- 35. Angiography • Subtraction selectiveangiography of internal and external cartotid arteries or both
- 39. -dAVF second mostcommon site -Abnormal communication between carotid artery & cavernous sinus -Shunt between the meningeal branches of internal or external carotid and dural veins near the cavernous sinus Carotid Cavernous Fistula (CCF)
- 41. CT & MRI CT: •– Marked dilation & enhancement of cavernous sinus • – May see prominent SOV MRI: • – Abnormal flow voids in cavernous sinus • – Enlargement of cavernous sinus
- 44. AVM • Brain arteriovenousmalformations (AVMs) are abnormal vascular connections within the brain that are congenital Diagnostic criteria: • Presence of nidus • early venous drainage
- 45. High and Lowflow malformations High flow • arteriovenous malformation (AVM) • parenchymal AVM • dural arteriovenous fistula (DAVF) • mixed AVM Low flow • capillary telangiectasia • cavernous haemangioma • venous malformations • developmental venous anomaly (DVA) (venous angiomas) • vein of Galen malformation (can be high flow as well)
- 47. CT • NECT:Iso/Hyperdense serpentinevessels • calcificationin 25-30% • Variable hemorrahage • CECT: Strong enhancement
- 49. MRI • Variable • Punctateappearance on T2 due to single void • Large arteries and veins are characteristic • Intracerebral hematoma with high signal on T1 • Surrounding halo –hyposignal on T2 indicating hemosidrren • Post contrast not facilitate detactability like CECT
- 52. VEIN OF GALENMALFORMATION • Arteriovenous fistula involving a neurysmal dilatation of median prosencephalic vein (MPV) • Most common extracardiac cause of high-output congestive heart failure in newborns • < 1% of cerebral vascular malformations
- 57. Venous angiomas • aberrantvenous drainage of one or both cerebral hemispheres. • They are shown on MRI as a slightly curvilinear structure traversing cerebral substance, representing a single draining vein into which numerous cerebral veins converge. • They are often incidental findings, but may be associated with (parenchyma) haemorrhage or focal brain damage
- 61. Telangiectasia • Shown onMRI as small lesion • Hypointense on T1 • T1 C+ (GAD) : may demonstrate ill defined focal enhancement • Hyperintense on T2
- 63. cavernous hemangioma • Slowflow lesions • Accounts for 10-15% • No intervening brain • No mass effect on imaging • CT usually normal if small lesion or in absence of calciication and hemorrgage • Characteristic feature is hypointense rim because of hemosiderin
- 64.
- 70. 15-year-old boy whopresented with sudden onset of headaches followed by seizures
- 72.
Editor's Notes
- #71 Spetzler-Martin grade 1 temporal brain AVM in a 15-year-old boy who presented with sudden onset of headaches followed by seizures. Axial CT scan reveals A small hyperattenuating lesion in the right temporal lobe, compatible with a small intraparenchymal hematoma.(b) Lateral right internal carotid angiogram Demonstrates a small(<3-cm) brain AVM supplied mainly by the temporal branches of the right MCA, with superficial drainage into the right vein of Labbe.