The prospective cutoff point of ADC value may be higher in CSVT after head injury with traumatic hematoma. The territory of venous infarction was found to be larger in infants after treatment failure. In infants, CSVT can demonstrate initially cytotoxic brain edema, which is reversible with anticoagulation therapy.
Background Dural arteriovenous fistula of the anterior condylar confluence (ACC-DAVF) is a rare subtype of DAVFs that occurs around the hypoglossal canal. Transvenous embolization (TVE) with coils has been performed for most ACC-DAVFs with a high clinical cure rate. However, some reports call attention to hypoglossal nerve palsy associated with TVE due to coil mass compression of the hypoglossal nerve caused by coil deviation from the ACC to the anterior condylar vein (ACV). Herein, we report a case of ACC-DAVF in which an intraoperative cone-beam computed tomography (CT) contributed to avoiding hypoglossal nerve palsy. Case presentation A 74-year-old man presented with left pulse-synchronous tinnitus. An angiography detected left ACC-DAVF mainly supplied by the left ascending pharyngeal artery and mainly drained through the ACV. The two fistulous points were medial side of the ACC and the venous pouch just cranial of the ACC. We performed TVE detecting the fistulous points by contralateral external carotid angiography (ECAG). The diseased venous pouch and ACC were packed with seven coils but a slight remnant of the DAVF was recognized. Because a cone-beam CT revealed that the coil mass was localized in the lateral lower clivus osseous without deviation to the hypoglossal canal, we finished TVE to avoid hypoglossal nerve palsy. Postoperatively, no complication was observed. No recurrence of symptoms or imaging findings were detected during a five-month follow-up period. Conclusion An intraoperative cone-beam CT contributed to avoiding hypoglossal nerve palsy by estimating the relationship between the coil mass and the hypoglossal canal during TVE of ACC-DAVF.
We investigated why surgery alone provides for a benign clinical course in patients with desmoplastic infantile ganglioglioma and astrocytoma (DIG/A). The clinical course of 4, less than six-month-old girls, surgically treated at our institutions, was evaluated retrospectively. All presented with the clinical symptom of increasing head circumference. CT and MRI scans revealed a solid tumor attached to the dura that was surrounded by large, multiple cysts, in fronto-temporo-parietal lobe. Gross total removal succeeded in all 4 cases because the solid components of the tumor were very firm in contrast to the soft adjacent brain tissue. Microscopically, the surgical specimens consisted almost entirely of dense fibrous connective tissue containing generally elongate cells with inconspicuous cytoplasm. Most of these cells were immunopositive for GFAP. There was no evidence of tumor cells in the cyst wall. In 3 cases, some small neurons were positive for neurofilament immunostain. A high proportion of undifferentiated small cells in a less demoplastic area far from the dura were immunopositive for MIB-1. All of the 4 patients have been free of recurrence for more than five years. In patients with DIG/A, there are 5 reasons for a good clinical course. [1] At surgery, the tumor margin is clearly discernible because of the difference between the solid tumor and the soft adjacent brain tissue. [2] The tumor is located in the superficial cerebral hemisphere. [3] Large, multiple cysts surround the tumor. [4] The growth point appears to be adjacent to the cysts. [5] The cyst walls are free of invading tumor cells.
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