Transcranial endovascular obliteration of intracranial arteriovenous dural fistulae

We present a female patient with left eye hiperemia at 8 months. There was no prior history of trauma neither other complaints or symptons associated. The neurologic examination was normal except for marked hiperemia at left eye. There was no bruit. The CT scan revealed tortuous and dilated vascular structures at cortical surface of left temporal lobe. The digital subtraction angiography (DSA) revealed dural fistulae (DF) of the cavernous sinus type IV, with reflux through the superficial middle cerebral vein (SMCV) and venous ectasia, without drainage through superior oftalmic vein (SOV). Since there was no conventional endovascular access to the fistula, catetherization of SMCV by direct puncture and endovascular treatment was proposed. The procedure was performed under general anesthesia and the cranial drainage was completely excluded. The drainage became through the SOV and a small fistular component remained. One week later the treatment was completed, with obliteration of arterial afferents and functional exclusion of the DF.Escola Paulista Med, UNIFESP, Neurovasc Sector, BR-04023 Sao Paulo, BrazilEscola Paulista Med, UNIFESP, Neurovasc Sector, BR-04023 Sao Paulo, BrazilWeb of Scienc

Stereotactic biopsy guidance in adults with supratentorial nonenhancing gliomas: role of perfusion-weighted magnetic resonance imaging

Object. the diagnosis of low-grade glioma (LGG) cannot be based exclusively on conventional magnetic resonance (MR) imaging studies, and target selection for stereotactic biopsy is a crucial issue given the high risk of sampling errors. the authors hypothesized that perfusion-weighted imaging could provide information on the microcirculation in presumed supratentorial LGGs.Methods. All adult patients with suspected (nonenhancing) supratentorial LGGs on conventional MR imaging between February 2001 and February 2004 were included in this study. Preoperative MR imaging was performed using a dynamic first-pass gadopentate dimeglumine-enhanced spin echo-echo planar perfusion-weighted sequence, and the tumors' relative cerebral blood volume (rCBV) measurements were expressed in relation to the values observed in contralateral white matter. in patients with heterogeneous tumors a stereotactic biopsy was performed in the higher perfusion areas before resection. Among 21 patients (16 men and five women with a mean age of 36 years, range 23-60 years), 10 had diffuse astrocytomas (World Health Organization Grade II) and 11 had other LGGs and anaplastic gliomas. On perfusion-weighted images demonstrating heterogeneous tumors, areas of higher rCBV focus were found to be oligodendrogliornas or anaplastic astrocytomas on stereotactic biopsy; during tumor resection, however, specimens were characterized predominantly as astrocytomas. Diffuse astrocytomas were associated with significantly lower mean rCBV values compared with those in the other two lesion groups (p < 0.01). the rCBV ratio cutoff value that permitted better discrimination between diffuse astrocytomas and the other lesion groups was 1.2 (80% sensitivity and 100% specificity).Conclusions. Perfusion-weighted imaging is a feasible method of reducing the sampling error in the histopathological diagnosis of a presumed LGG, particularly by improving the selection of targets for stereotactic biopsy.Universidade Federal de São Paulo, Ctr Med Diagnost Fleury, BR-01333391 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Neurol, BR-01333391 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Neurosurg, BR-01333391 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Pathol, BR-01333391 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Ctr Med Diagnost Fleury, BR-01333391 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Neurol, BR-01333391 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Neurosurg, BR-01333391 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Pathol, BR-01333391 São Paulo, SP, BrazilWeb of Scienc