PURPOSE: To evaluate the role of rotational angiography in the diagnosis, characterization, and postoperativeassessment of aneurysm, and in the analysis of arteriovenous malformation(AVM). MATERIALS AND METHODS: Between May1995 and February 1997, 31 patients who had undergone DSA and rotational angiography were retrospectivelyevaluated. Rotational angiographic and lateral DSA images were compared by two radiologists, and in 22 patientswith aneurysmal clipping, location, visibility of the aneurysmal neck, vascular branch anatomy, and projection andshape of the aneurysm were evaluated. The presence or absence of residual aneurysmal neck was evaluated in eightpostoperative patients, and the anatomy of feeder artery and intranidal aneurysm were evaluated in five AVMpatients. RESULT: Twenty-seven aneurysms were found in 22 of 26 patients in whom DSA had indicated thispossibility. Rotational angiography was superior to conventional DSA in the assessment of neck(67%), vascularbranch anatomy(41%), and projection(22%), location(19%), and shape(15%) of the aneurysm. Rotational angiographyhelped confirm the absence of aneurysm at 11 sites, and was also superior to conventional DSA for confirming theabscence of residual neck in four of eight postoperative patients, and to evaluate feeder artery in four of fiveAVM patients. CONCLUSION: Rotational angiography is better than conventional DSA for the evaluation of aneurysmand AVM.
Aneurysm ; Angiography* ; Arteries ; Arteriovenous Malformations* ; Diagnosis ; Humans ; Intracranial Aneurysm* ; Neck

Hemangioblastomas (HBMs) in the cerebellopontine angle (CPA) have rarely been reported. When they are within the CPA, they may be misdiagnosed as vestibular schwannoma (VS) or cystic meningioma. Therefore, differential diagnosis is important for the safe treatment of the lesion. Large solid HBMs, similar to intracranial arteriovenous malformations (AVMs), are difficult to surgically remove from an eloquent area because of their location and hypervascularity. We report a case of an HBM in the CPA, which manifested as a hearing impairment or VS. Similar to AVM surgery, the tumor was widely opened and removed en bloc without a new neurological complication using the modified transcondylar fossa approach without resection of the jugular tubercle. Accurate diagnosis, pre-operative embolization, and a tailored approach were essential for the safe treatment of the HBM in the CPA.
Cerebellopontine Angle* ; Diagnosis ; Diagnosis, Differential ; Hearing Loss ; Hemangioblastoma* ; Intracranial Arteriovenous Malformations ; Meningioma ; Neuroma, Acoustic

Aneurysm of the vein of Galen is a very rare disease. The authors present a case of secondary aneurysm of the vein of Galen which was confirmed by characteristic clinical symptoms, brain CT and angiographic findings. The patient was a 14-year-old right handed girl with intermittent headache, nausea, vomiting, dysphasia and gait disturbance. Neurologic examination revealed dysarthria, nasal voice, blurring of both margins of optic discs, truncal ataxia and dysdiadochokinesia. Sensory function was normal but right hemiparesis was seen. Roentgenogram of the skull revealed diffuse thinning of the calvarium, widening of sella turcica and erosion of clinoid processes. Computed tomogram of the brain showed dilatation of all ventricles and round hyperdense mass behind the third ventricle in the midline. The lesion was enhanced markedly and homogeneously. Left and right internal carotid angiograms showed arteriovenousmal-formation with drainage to the aneurysm of the vein of Galen.
Adolescent ; Cerebral Angiography ; Cerebral Veins/radiography ; Female ; Humans ; Intracranial Arteriovenous Malformations/*diagnosis ; Tomography, X-Ray Computed

Adult ; Dura Mater ; blood supply ; Humans ; Intracranial Arteriovenous Malformations ; complications ; diagnosis ; Male ; Tinnitus ; etiology

This report concerns a 4-month-old infant with progressive prominent and redness of his left eye since birth. This report concerns a 4-month-old infant with progressive prominent redness of his left eye since birth. Angiography revealed a congenital pial arteriovenous fistula between the temporal branch of the left posterior cerebral artery and left cavernous sinus through the sphenoparietal sinus, a condition not reported in the literature. The fistula was successfully occluded with two micro-coils by vertebrobasilar approach.
Arteriovenous Fistula/*diagnosis/therapy ; *Cavernous Sinus/radiography ; Embolization, Therapeutic/methods ; Humans ; Infant ; Intracranial Arteriovenous Malformations/*diagnosis/therapy ; Magnetic Resonance Imaging ; Male ; Posterior Cerebral Artery ; Temporal Lobe/blood supply

OBJECTIVESTo summarize the characteristics of interventional treatment of dural arteriovenous fistulae (DAVFs) and improve clinical curative effects.

METHODSThe clinical data from 135 patients with DAVFs were analyzed retrospectively.

RESULTSSeventy-four patients were cured, 53 were significantly improved, 8 unchange, and 1 died of intracranial haemorrhage.

CONCLUSIONSClinical presentations and prognosis of DAVF depend on the types of venous drainage. Compression of the affected carotid artery and endovascular embolization are safe and effective.

Adolescent ; Adult ; Aged ; Arteriovenous Fistula ; congenital ; diagnosis ; therapy ; Dura Mater ; blood supply ; Embolization, Therapeutic ; Female ; Humans ; Intracranial Arteriovenous Malformations ; diagnosis ; therapy ; Male ; Middle Aged

OBJECTIVE: Although three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA) is used frequently as a follow-up tool to assess the response of arteriovenous malformations (AVMs) after radiosurgery, the diagnostic accuracy of 3D TOF-MRA is not well known. We evaluated the diagnostic accuracy of contrast-enhanced 3D TOF-MRA at 3.0 Tesla for the detection of residual AVMs. MATERIALS AND METHODS:This study included 32 AVMs from 32 patients who had been treated with radiosurgery (males/females: 21/11; average patient age, 33.1 years). The time interval between radiosurgery and MRA was an average of 35.3 months (range, 12-88 months). Three-dimensional TOF-MRA was obtained at a magnetic field strength of 3.0 Tesla after infusion of contrast media, with a measured voxel size of 0.40 x 0.80 x 1.4 (0.45) mm3 and a reconstructed voxel size of 0.27 x 0.27 x 0.70 (0.05) mm3 after zero-filling. X-ray angiography was performed as the reference of standard within six months after MRA (an average of two months). To determine the presence of a residual AVM, the source images of 3D TOF-MRA were independently reviewed, focusing on the presence of abnormally hyperintense fine tangled or tubular structures with continuity as seen on consecutive slices by two observers blinded to the X-ray angiography results. RESULTS: A residual AVM was identified in 10 patients (10 of 32, 31%) on X-ray angiography. The inter-observer agreement for MRA was excellent (kappa= 0.813). For the detection of a residual AVM after radiosurgery as determined by observer 1 and observer 2, the source images of MRA had an overall sensitivity of 100%/90% (10 of 10, 9 of 10), specificity of 68%/68% (15 of 22, 15 of 22), positive predictive value of 59%/56% (10 of 17, 9 of 16), negative predictive value of 100%/94% (15 of 15, 15 of 16) and diagnostic accuracy of 78%/75% (25 of 32, 24 of 32), respectively. CONCLUSION: The sensitivity of contrast-enhanced 3D TOF-MRA at 3.0 Tesla is high but the specificity is not sufficient for the detection of a residual AVM after radiosurgery.
Adult ; Contrast Media ; Female ; Humans ; Intracranial Arteriovenous Malformations/*diagnosis/*surgery ; Magnetic Resonance Angiography/methods/*standards ; Male ; *Radiosurgery ; Sensitivity and Specificity

A 36-year-old man was diagnosed with a right temporal lobe grade II cerebral arteriovenous malformation (cAVM) and was treated with radiosurgery. At nine months after the cAVM radiosurgery, the patient began to develop bilateral focal narrowing at the M1 segments of the bilateral middle cerebral arteries. The narrowing progressively deteriorated as was demonstrated on longitudinal serial follow-up MR imaging. X-ray angiography performed at 51 months after radiosurgery confirmed that the cAVM was cured and a diagnosis of moyamoya disease. To the best of our knowledge, this is the first case of cAVM-associated moyamoya disease that developed after radiosurgery. Given the chronological sequence of disease development and radiation dose distribution of radiosurgery, it is proposed that humoral or unknown predisposing factors, rather than direct radiation effects, are the cause of moyamoya disease associated with cAVM.
Adult ; Humans ; Intracranial Arteriovenous Malformations/diagnosis/*surgery ; Magnetic Resonance Imaging ; Male ; Moyamoya Disease/*etiology ; Postoperative Complications ; Radiosurgery

We report three cases of patient with pleomorphic xanthoastrocytoma(PXA). PXA is a clinicopathologically distinct variant of cerebral astrocytoma which is a low-grade leptomeningeal glioma affecting under the age of 30 years. This tumor has a favorable prognosis, but histological and neuroradiological findings suggest malignant brain tumor. Occasionally these may be confused with malignant gliomas. Clinical features from our three patients were manifestation of increased intracranial pressure and all cases were under the age of 30 years and females. Two patients had superficial location in the right frontal and left temporal respectively, but remaining one(case 2) which was associated with arteriovenous malformation in the left frontal region was in the right lateral ventricle. The intraoperative histological evidence by frozen biopsy suggested glioblastoma or anaplastic astrocytoma in all cases which confirmed to be PXA by postoperative histological examination. Two cases which had been resected subtotally were followed by cranial irradiation without therapeutic efficacy. Optimal management of PXA is primary surgical resection to reduce recurrence of tumor and to secure long-term survival. Therefore, differentiation of PXA from malignant brain tumors and intraoperative diagnosis of PXA is imperative to treat PXA effectively.
Arteriovenous Malformations ; Astrocytoma ; Biopsy ; Brain Neoplasms ; Cranial Irradiation ; Diagnosis ; Female ; Glioblastoma ; Glioma ; Humans ; Intracranial Pressure ; Lateral Ventricles ; Prognosis ; Recurrence

We present a case of developmental venous anomaly associated with arteriovenous fistula supplied by a single arterial feeder adjacent to a large acute intracerebral hemorrhage. The arteriovenous fistula was successfully obliterated by superselective embolization while completely preserving the developmental venous anomaly. Two similar cases, including superselective angiographic findings, have been reported in the literature; however, we describe herein superselective angiographic findings in more detail and demonstrate the arteriovenous shunt more clearly than the previous reports. In addition, a literature review was performed to discuss the association of a developmental venous anomaly with vascular lesions.
Adolescent ; Arteriovenous Fistula/*radiography/*therapy ; Cerebral Angiography ; Cerebral Hemorrhage/*radiography/*therapy ; Diagnosis, Differential ; Embolization, Therapeutic/*methods ; Humans ; Intracranial Arteriovenous Malformations/*radiography/*therapy ; Male ; Tomography, X-Ray Computed/*methods