Superior sagittal sinus dural arteriovenous fistulas: navigating the complexity of treatment strategies and outcomes.

Background And Purpose: Superior sagittal sinus (SSS) dural arteriovenous fistulas (DAVFs) are sinus-type fistulas with shunting point(s) centered on the sinus or parallel parasinus wall, while its counterpart parasagittal DAVFs are non-sinus-type fistulas with shunting point(s) centered on the junctional zone of the bridging vein and the SSS. SSS DAVFs can be challenging to treat due to the widespread shunting zone, eloquence of the involved venous structure and their rarity. We explore the clinical data, imaging characteristics, endovascular treatment modalities and treatment outcomes of SSS DAVF, with the aim of identifying the ideal treatment strategies.

Glymphatics in neurovascular diseases.

The glymphatic system is a brain-wide waste clearance mechanism that mimics lymphatic functions and facilitates the removal of amyloid aggregates. It is supposed to be essential for maintaining homeostasis within the central nervous system including nutrient delivery, waste removal, and consistency of the ionic microenvironment. While its dysfunction has been implicated in a variety of neurodegenerative disorders, its neurovascular implications are only slowly emerging.

The Glymphatic System and Its Role in Neurovascular Diseases.

Over the past decade, clinicians and researchers have increasingly recognized the significance of the glymphatic system. Evidence demonstrates that this system-named for its reliance on astrocyte endfeet of glial cells and its lymphatic-like waste clearance function from the brain-is essential for regulating the accumulation and removal of amyloid aggregates and other interstitial waste products that may cause cognitive decline if not removed. Its activity is highly regulated, with flow driven by arterial wall pulsatility linked to the cardiac cycle, facilitating perivascular cerebrospinal fluid (CSF) influx into the brain interstitium and its efflux into the venous system.

Management of Anterior Choroidal Artery Aneurysms: A Retrospective Cohort Study.

Anterior choroidal artery (AChoA) aneurysms pose a challenge for both endovascular and clipping procedures. The eloquent territory supplied by the parent vessel has limited collateralization and its compromise can lead to significant morbidity. This study aims to analyze the clinical outcomes and procedure-related complications of clipping and endovascular treatment of AChoA aneurysms to aid physician decision making.

A potential VEGF-driven hypothesis of calvarial centripetal proliferation in cerebral proliferative angiopathy.

Cerebral proliferative angiopathy (CPA) is a rare subtype of cerebral arteriovenous malformation, characterized by unique angiographic features and clinical presentations. Although the clinical and angiographic characteristics of CPA have been well described, their impact on the surrounding tissues remains underexplored. Herein, we investigated the presence of calvarial thickening in patients with CPA, and discuss its potential pathogenesis.

Comparison between ruptured anterior choroidal artery aneurysms and ruptured intracranial aneurysms in other locations in relation to aneurysm dimensions at rupture.

Purpose: It was noticed that anterior choroidal artery (AChoA) aneurysms appear to rupture at relatively smaller sizes compared with aneurysms in other intracranial locations, based on anecdotal clinical experience. We therefore aimed to compare ruptured AChoA aneurysms with other ruptured aneurysms in other intracranial locations, pertaining to aneurysm dimensions. This may help in finding out if the rupture risk stratification, based on the amalgamation of aneurysms of multiple locations in one group, precisely estimates aneurysm rupture risk.

Recognition of dural to pial supply in high-grade dural arteriovenous fistula: A technical note.

High-grade dural arteriovenous fistulas (DAVFs) are known to demonstrate classical dural supply and can demonstrate pre-existing dural supply and 'pure' arterial supply from pial branches. The latter two are examples of congenital versus acquired pial to dural shunting, respectively. We describe the recognition of dural to pial supply during combined transarterial and transvenous embolization of a high-grade DAVF with holocephalic venous reflux, stressing the importance of careful assessment of this condition with micro catheter injections.

Treatment of an intracranial aneurysm in the setting of fenestration of cranial division of the internal carotid artery: Technical considerations and a literature review.

Although rare, cerebral arterial fenestration may present challenges in diagnosis and treatment. Here we present a case of a supraclinoid internal carotid artery (ICA) fenestration adjacent to an ICA aneurysm, successfully treated with balloon-assisted coil embolization. A female in her 50's presented with an acute subarachnoid hemorrhage from a ruptured left ICA-ophthalmic artery (OA) aneurysm.

Atypical telencephalic reflux pattern in a cavernous sinus dural AV fistula related to an anatomical variation of the basal vein of Rosenthal.

Cavernous sinus dural arteriovenous fistula can cause cerebral edema and hemorrhage due to cortical venous reflux and congestion. Understanding complex venous reflux and drainage routes is crucial for treatment planning. Here, we present a case of a cavernous sinus dural arteriovenous fistula with cortical venous reflux via two separate terminations of the telencephalic veins caused by an aplastic basal vein of Rosenthal.

Endovascular treatment of wide-neck bifurcation aneurysms using pCONUS2 HPC bridging device with single antiplatelet: A Case Series.

Rationale: Wide neck bifurcation aneurysms (WNBA) are technically challenging for both surgical and endovascular treatments. Endovascular treatment for WNBA often requires dual antiplatelet therapy (DAPT) post stent insertion. Novel devices such as the pCONUS2 HPC neck bridging device have an HPC coating which reduces the device thrombogenicity.

Parasagittal and Superior Sagittal Sinus Dural Arteriovenous Fistulas: Clinical Presentations, Imaging Characteristics, and Treatment Strategies.

Background And Purpose: Parasagittal and superior sagittal sinus (SSS) dural arteriovenous fistulas (DAVFs) are often inappropriately classified. We explore the clinical presentations, imaging characteristics, and endovascular treatment strategies of these 2 DAVF subtypes.

Materials And Methods: Clinical and imaging data of 19 patients with SSS or parasagittal sinus DAVFs who underwent endovascular treatment in our institution between 2017 and 2022 were retrospectively analyzed.

Transarterial Embolization of Dural Arteriovenous Fistulas: Conventional, Pressure Cooker, and Microballoon Catheter Embolization Techniques.

Background And Objectives: Dural fistulas are abnormal connections between dural arteries and intracranial veins treated mainly endovascularly in most settings. The aim was to examine a single-institution experience of microballoon catheter transarterial embolization (TAE) of dural arteriovenous fistulas (dAVFs) and compare it with other TAE techniques.

Methods: We retrospectively identified all dAVFs treated at our institution between 2017 and 2022 with microballoon, conventional, and pressure cooker TAE.

A Tale of Two Organ Systems: Imaging review of diseases affecting the thoracic and neurological systems. Part 1.

In an era of rapidly expanding knowledge and sub-specialization, it is becoming increasingly common to focus on one organ system. However, the human body is intimately linked, and disease processes affecting one region of the body not uncommonly affect the other organ systems as well. Understanding diseases from a macroscopic perspective, rather than a narrow vantage point, enables efficient and accurate diagnosis.

A Tale of Two Organ Systems: Imaging Review of Diseases Affecting the Thoracic and Neurological Systems. Part 2.

In an era of rapidly expanding knowledge and sub-specialization, it is becoming increasingly common to focus on one organ system. However, the human body is intimately linked, and disease processes affecting one region of the body not uncommonly affect the other organ systems as well. Understanding diseases from a macroscopic perspective, rather than a narrow vantage point, enables efficient and accurate diagnosis.

Cryptic asymptomatic parasellar high signal on time-of-flight MR angiography: how to resolve the clinical conundrum.

Purpose: Hyperintense parasellar signal on time-of-flight MR angiography (TOF-MRA) in asymptomatic patients may be due to a variety of nonpathological causes and mimic parasellar high flow signal in pathological arteriovenous shunts at the cavernous sinus (CSAVS). This creates a clinical conundrum between diagnosing an aggressive yet asymptomatic CSAVS subtype against exposing patients without CSAVS to potential complications of an invasive angiographic evaluation. We reviewed common nonpathological causes of hyperintense parasellar signal and contrast their imaging features against those of pathological CSAVS and proposed a systemic approach to resolve such conundrum.

Large solitary lytic skull vault lesions in adults: radiological review with pathological correlation.

The diagnosis of a large solitary lytic skull vault lesion in adults is a challenge due to variable aggressiveness and overlapping features. The purpose of this article is to demonstrate the use of an imaging approach to narrow the differential diagnosis when a large solitary lytic skull vault lesion is encountered. The initial imaging assessment using computed tomography (CT) is invaluable in determining lesion aggressiveness based on bony margins and skull tables involvement.

Correction to: Extracerebral anatomic blind spots in computed tomography (CT) head: a pictorial review of non-traumatic findings.

The original version of this article contains an error. The author name Raphael Shih Zhu Yiin was incorrectly listed as Raphael Shih Zhu Yin. The correct spelling is presented above.

Extracerebral anatomic blind spots in computed tomography (CT) head: a pictorial review of non-traumatic findings.

CT head has been increasingly performed in the Emergency Department for patients presented with trauma, acute neurological or psychological symptoms. Most of the emergency physicians and radiologists have undergone dedicated training and are capable of identifying and interpreting life-threatening cerebral pathologies. However, as most attention is directed to the brain, the extracerebral non-traumatic pathologies on CT head can easily be overlooked, and some of them harbour clinically significant pathologies.