Stereotactic radiosurgery offers a broad spectrum armamentarium for the safe treatment of various lesions within the central nervous system. Radiosurgery uses stereotactic targeting methods to precisely deliver highly focused, large doses of radiation to small intracranial tumors and arteriovenous malformations (AVMs). It is widely used for the treatment of metastatic brain tumors, non-resectable tumors, residual or recurrent benign and malignant tumors as well as for the treatment of AVMs, functional diseases, and pain disorders. Although radiosurgery has the potential to produce complications, the majority of patients experience clinical improvement with less morbidity and mortality than those occur in surgical resection.
Arteriovenous Malformations ; Brain Neoplasms ; Central Nervous System ; Humans ; Intracranial Arteriovenous Malformations ; Meningioma ; Neoplasm, Residual ; Neuroma, Acoustic ; Radiosurgery ; Trigeminal Neuralgia

Humans ; Microcephaly ; Pedigree ; Nervous System Malformations ; Glucose

Dural arteriovenous malformations are rare, accounting for 10-15% of all intracranial arteriovenous malformation and are thought to be acquired lesion caused by dural sinus thrombosis. The authors report a rare case of extrasinusal dural arteriovenous fistula in the right middle fossa adjacent to the superior orbital fissure. During the preceding 17 years, this 31-year-old female had complained of proptosis and ocular pain in the right eye. Computed tomography and magnetic resonance imaging showed a retrobular intraconal mass in the right orbit; Angiography revealed an extrasinusal dural arteriovenous fistula in the right middle fossa adjacent to the superior orbital fissure, which drains into the superior ophthalmic and inferior temporal vein. After embolization of the fistula by injection of N-butylcyanoacrylate(NBCA), we intended to remove the retrobulbar intraconal mass seen on CT and MRI by means of a unilateral partial orbitotomy on the supraorbital rim and orbital roof, and to this end, explored the right orbit. We were unable, however, to locate any mass lesion in the orbital cavity, and postoperative CT and MRI showed no such lesion. We were of the opinion that the mass shown on preoperative CT and MRI was a dilated intraorbital vein structure which disappeared after embolization, operative ligation and cutting of the dural arterivenous fistula. Finally, proptosis and ocular pain disappeared, and the patient recovered with any no neurologic deficit.
Adult ; Angiography ; Arteriovenous Malformations* ; Central Nervous System Vascular Malformations ; Exophthalmos ; Female ; Fistula ; Humans ; Intracranial Arteriovenous Malformations ; Ligation ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Orbit ; Sinus Thrombosis, Intracranial ; Veins

Dural arteriovenous fistula (DAVF) is an uncommon condition. However, it is important for otologists because it is the most common cause of pulsatile tinnitus and may also present with intracranial hemorrhage and neurological disturbance. Many therapeutic approaches, such as surgery and endovascular techniques, have been proposed to obliterate the lesions. Surgery may be accompanied by massive blood loss. Transarterial embolization seldom obliterates transverse-sigmoid sinus DAVFs completely and permanently. In recent years, several authors have reported the effect of transvenous embolization of transverse-sigmoid sinus DAVFs in English literature. We recently experienced a case of sigmoid DAVF treated by transvenous embolization and report it with a review of the literature.
Arteriovenous Fistula ; Central Nervous System Vascular Malformations* ; Colon, Sigmoid ; Endovascular Procedures ; Intracranial Hemorrhages ; Tinnitus

The approach to ethmoidal dural arteriovenous fistulas (eDAVFs) is usually via a pterional or a frontal craniotomy. However, the transfrontal sinus is a more direct route to the fistula. The aim of this report is to describe our experience and associated complications occurring as a result of flow diversion in the transfrontal sinus approach for eDAVFs. In this report, we discuss visual field defects occurring after a transfrontal sinus operation. This approach is most direct for surgical treatment of an eDAVF, enabling preservation of neural structures with minimal to no negative effects on the brain. Although the surgery was uneventful, the patient presented with a left side visual field defect. An ophthalmologic exam detected an arterial filling delay in the choroidal membrane and ischemic optic neuropathy was highly suspected. The patient is currently recovering under close observation with no special treatment. The transfrontal sinus approach provides the most direct and shortest route for eDAVFs, while minimizing intraoperative bleeding. However, complications, such as visual field defects may result from a sudden flow diversion or eyeball compression due to scalp traction.
Brain ; Central Nervous System Vascular Malformations* ; Choroid ; Craniotomy ; Fistula ; Frontal Sinus ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations ; Membranes ; Optic Neuropathy, Ischemic ; Scalp ; Traction ; Visual Fields*

Since March 1992, total 200 patients who visited our hospital as functional or organic lesions of central nervous system were treated by gamma knife stereotactic radiosurgery for 27 months. Thirty-nine patients of total cases was diagnosed as cerebral arteriovenous malformation. The rate of magnificantion of X-ray film was reduced by cutting fixation adaptor from 1.6 to below 1.45 times. In order to treat the deep- and lateral-seated cerebral arteriovenous malformation, we slightly modified the angiographic indicator, the commercial leksell system, by cutting each inner sides about 5mm. We performed the more distinction fo the scales by adapting 0.5mm or 1mm copper filter to angiographic indicator. The center point of indicator(X=100mm, Y=100mm, z=100mm) is corrected by adjusting scales of X-, Y-, Z- axis to each inner 100 and outer 100 point within 1-2mm by repeated exposure of X-ray on films in trial-and-errors. We have developed the "GKANGIO" programmed as the Fortran-77 in Microvax -3100, which can save treatment planning time and perform accurate pretreatment planning using the theoretical target metrix center form accurate pretreatment planning using the theoretical target metrix center. The theoretical description of the simplified method is presented for the reduction of experimental and numerical errors in treatment planning of radiosurgery.
Axis, Cervical Vertebra ; Central Nervous System ; Copper ; Humans ; Intracranial Arteriovenous Malformations* ; Radiosurgery* ; Weights and Measures ; X-Ray Film

A case of cerebellar venous angioma incidentally associated with huge intracranial arteriovenous malformation is reported. This 50-year-old male patient was admitted presenting symptoms of subrachnoid hemorrhage. Brain CT and cerebral angiography showed huge AVM in the right parieto-occipital area and also right cerebellar venous angioma draining into the straight sinus. No clinical manifestation was correlated to this venous angioma and no specific treatment was made to this lesion. The AVM was removed totally and the patients is now in follow-up evaluation through OPD with slight left hemiparesis.
Brain ; Central Nervous System ; Cerebral Angiography ; Follow-Up Studies ; Hemangioma* ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Male ; Middle Aged ; Paresis

Brain arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system in the central nervous system. The first symptom of AVM is intracranial hemorrhage, followed by headache and seizure. However, dizziness as a symptom of AVM is very rare. We report a 16-year-old female patient who presented with disequilibrium. She showed down-beating nystamgus on Dix-Hallpike test and falling tendency on Romberg test with eyes open. Magnetic resonance image showed cerebellar AVM.
Adolescent ; Arteries ; Arteriovenous Malformations ; Brain ; Capillaries ; Central Nervous System ; Dizziness ; Female ; Headache ; Humans ; Intracranial Hemorrhages ; Seizures ; Veins

OBJECTIVE: To assess the value of chromosomal microarray analysis (CMA) for the diagnosis of fetuses with anomalies of the central nervous system (CNS) and summarize the outcome of the pregnancies and follow-up. METHODS: A total of 636 fetuses from June 2014 to December 2020 who were referred to the Prenatal Diagnosis Center of Nanjing Drum Tower Hospital due to abnormal CNS prompted by ultrasound were selected as the research subjects. Based on the ultrasound findings, the fetuses were divided into ventricular dilatation group (n = 441), choroid plexus cyst group (n = 41), enlarged posterior fossa group (n = 42), holoprosencephaly group (n = 15), corpus callosum hypoplasia group (n = 22), and other anomaly group (n = 75). Meanwhile, they were also divided into isolated (n = 504) and non-isolated (n = 132) groups based on the presence of additional abnormalities. Prenatal samples (amniotic fluid/chorionic villi/umbilical cord blood) or abortus tissue were collected for the extraction of genomic DNA and CMA assay. Outcome of the pregnancies and postnatal follow-up were summarized and subjected to statistical analysis. RESULTS: In total 636 fetuses with CNS anomalies (including 89 abortus tissues) were included, and 547 cases were followed up. The overall detection rate of CMA was 11.48% (73/636). The detection rates for the holoprosencephaly group, ACC group, choroid plexus cyst group, enlarged posterior fossa group, ventricular dilatation group and other anomaly group were 80% (12/15), 31.82% (7/22), 19.51% (8/41), 14.29% (6/42), 7.48% (33/441) and 9.33% (7/75), respectively. Compared with the isolated CNS anomaly group, the detection rate for the non-isolated CNS anomaly group was significantly higher (6.35% vs. 31.06%) (32/504 vs. 41/132) (χ² = 62.867, P < 0.001). Follow up showed that, for 52 fetuses with abnormal CMA results, 51 couples have opted induced labor, whilst 1 was delivered at full term with normal growth and development. Of the 434 fetuses with normal CMA results, 377 were delivered at full term (6 had developmental delay), and 57 couples had opted induced labor. The rate of adverse pregnancy outcome for non-isolated CNS abnormal fetuses was significantly higher than that of isolated CNS abnormal fetuses (26.56% vs. 10.54%) (17/64 vs. 39/370) (χ² = 12.463, P < 0.001). CONCLUSION Fetuses with CNS anomaly should be tested with CMA to determine the genetic cause. Most fetuses with negative CMA result have a good prognosis, but there is still a possibility for a abnormal neurological phenotype. Fetuses with CNS abnormalities in conjunct with other structural abnormalities are at increased risk for adverse pregnancy outcomes.
Female ; Pregnancy ; Humans ; Holoprosencephaly ; Prenatal Diagnosis/methods* ; Central Nervous System ; Fetus/abnormalities* ; Nervous System Malformations/genetics* ; Microarray Analysis ; Central Nervous System Diseases ; Cysts ; Chromosome Aberrations ; Ultrasonography, Prenatal/methods*

Intracranial hemorrhage is common and is caused by diverse pathology, including trauma, hypertension, cerebral amyloid angiopathy, hemorrhagic conversion of ischemic infarction, cerebral aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistula, vasculitis, and venous sinus thrombosis, among other causes. Neuroimaging is essential for the treating physician to identify the cause of hemorrhage and to understand the location and severity of hemorrhage, the risk of impending cerebral injury, and to guide often emergent patient treatment. We review CT and MRI evaluation of intracranial hemorrhage with the goal of providing a broad overview of the diverse causes and varied appearances of intracranial hemorrhage.
Arteriovenous Malformations ; Central Nervous System Vascular Malformations ; Cerebral Amyloid Angiopathy ; Cerebral Infarction ; Craniocerebral Trauma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hypertension ; Intracranial Aneurysm ; Intracranial Hemorrhages* ; Magnetic Resonance Imaging ; Neuroimaging ; Pathology ; Sinus Thrombosis, Intracranial ; Subarachnoid Hemorrhage ; Vasculitis