CRANIAL DURAL ARTERIOVENOUS FISTULAE Strom, Russell G; Botros, James A; Refai, Daniel ...
Neurosurgery,
02/2009, Letnik:
64, Številka:
2
Journal Article
Recenzirano
Abstract
OBJECTIVE
Cranial dural arteriovenous fistulae (dAVF) with cortical venous drainage (CVD) (Borden Types 2 and 3) are reported to carry a 15% annual risk of intracranial hemorrhage (ICH) or ...nonhemorrhagic neurological deficit (NHND). The purpose of this study was to compare the clinical course of Type 2 and 3 dAVFs that present with ICH or NHND with those that do not.
METHODS
Twenty-eight patients with Type 2 or 3 dAVFs were retrospectively evaluated. CVD was classified as asymptomatic (aCVD) if patients presented incidentally or with pulsatile tinnitus or orbital phenomena. CVD was classified as symptomatic (sCVD) if patients presented with ICH or NHND. Occurrence of new ICH or new or worsening NHND between diagnosis and disconnection of CVD or last follow-up (if not disconnected) was noted. Overall frequency of events was compared using Fisher's exact test. Cumulative, event-free survival was compared using Kaplan-Meier analysis with log-rank testing.
RESULTS
Of 17 patients with aCVD, 1 (5.9%) developed ICH and none experienced NHND or death during the median 31.4-month follow-up period. Of 11 patients with sCVD, 2 (18.2%) developed ICH and 3 (27.3%) experienced new or worsened NHND over the median 9.7-month follow-up period. One of these patients subsequently died. Overall frequency of ICH or NHND was significantly lower in patients with aCVD versus sCVD (P = 0.022). Respective annual event rates were 1.4 versus 19.0%. aCVD patients had significantly higher cumulative event-free survival (P = 0.0016).
CONCLUSION
Cranial dAVFs with aCVD may have a less aggressive clinical course than those with sCVD.
Etiology of strokes in children with sickle cell anemia DEBAUN, Michael R; DERDEYN, Colin P; MCKINSTRY, Robert C
Mental retardation and developmental disabilities research reviews,
2006, Letnik:
12, Številka:
3
Journal Article
At present, carotid imaging is performed to identify the presence and measure the degree of atherosclerotic stenosis, in order to select appropriate candidates for surgical endarterectomy (strong ...evidence). Several different imaging strategies may be employed in symptomatic patients: Catheter angiography (CA) may be used for this purpose (strong evidence). Doppler ultrasound (DUS), magnetic resonance angiography (MRA), and computed tomography angiography(CTA), or some combination, if adequately validated, may be used to screen patients (those with less than 50% stenosis) prior to CA (moderate evidence). Doppler ultrasound, MRA, and CTA, or some combination, if adequately validated, may be used to identify patients with severe stenosis (greater than 80%) for surgical endarterectomy (moderate evidence). Screening of asymptomatic patients with noninvasive methods and highly specific thresholds may be cost-effective in certain high-risk populations, such as patients with known atherosclerotic disease in other circulations or the presence of bruit over the carotid artery on physical examination (moderate evidence). More information regarding the safety and efficacy of angioplasty and stenting relative to surgical endarterectomy is expected in the near future. As treatment may be incorporated into the diagnostic catheter angiographic procedure, these recommendations may be revised. Physiologic imaging tools identify higher-risk subgroups in patients with atherosclerotic carotid stenosis and occlusion (strong evidence). The use of these physiologic imaging tools to improve guide therapy and improve outcome is unproven (insufficient evidence). A randomized clinical trial is underway for surgical revascularization of carotid occlusion in patients selected by positron emission tomography (PET).
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