Appearance of venous malformations on magnetic resonance imaging

1988 ◽  
Vol 69 (4) ◽  
pp. 535-539 ◽  
Author(s):  
Daniele Rigamonti ◽  
Robert F. Spetzler ◽  
Burton P. Drayer ◽  
W. Michel Bojanowski ◽  
John Hodak ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Signal Intensity ◽  
Cavernous Malformation ◽  
Venous Malformation ◽  
Venous Drainage ◽  
Venous Malformations ◽  
Mr Images ◽  
Content Type ◽  
Venous Angiomas ◽  
The Brain

✓ The magnetic resonance (MR) imaging appearance of venous malformations, all angiographically verified, was evaluated in 11 patients. A venous malformation is characteristically depicted as a tubular area of decreased signal intensity in the white matter of the brain. In one patient, a histologically verified cavernous malformation was also present with a characteristic mixed signal-intensity core on the T2-weighted MR images. Care should be used when evaluating venous angiomas to exclude the presence of a lesion with associated prominent venous drainage, such as a glioma.

Rathke cleft cyst intracystic nodule: a characteristic magnetic resonance imaging finding

2005 ◽  
Vol 103 (5) ◽  
pp. 837-840 ◽  
Author(s):  
Mandy J. Binning ◽  
Oren N. Gottfried ◽  
Anne G. Osborn ◽  
William T. Couldwell
Keyword(s):  
Magnetic Resonance ◽  
Signal Intensity ◽  
Imaging Finding ◽  
Magnetic Resonance Imaging Finding ◽  
High Signal ◽  
Cystic Lesions ◽  
Mr Images ◽  
Content Type ◽  
Imaging Characteristics ◽  
Fine Print

Object. The fluid content of Rathke cleft cysts (RCCs) displays variable appearances on magnetic resonance (MR) images and can appear indistinguishable from other intrasellar or suprasellar cystic lesions. Intracystic nodules associated with individual RCCs have been noted, but to date their significance has not been fully explored. Methods. The authors retrospectively reviewed MR imaging studies obtained in patients harboring intrasellar or suprasellar lesions that were consistent with RCCs to identify the presence and imaging characteristics of intracystic nodules. An intracystic nodule was present in nine (45%) of 20 patients with an RCC. All intracystic nodules were clearly visible and displayed a characteristic low signal intensity on T2-weighted MR images. The nodule was only visualized on T1-weighted images in four cases, in which it exhibited a consistent high signal intensity similar to that of the cyst fluid. The nodules did not enhance following the intravenous administration of a contrast agent. Conclusions. Although it is difficult to differentiate RCCs from other sellar cystic lesions because of the variable signal intensities displayed on MR images, the intensity of the intracystic nodule seems consistent on T1- and T2-weighted images, and the nodule is always clearly visible on T2-weighted images. With a nonenhancing cystic lesion that does not cause significant symptoms in the patient, the identification of an intracystic nodule with a characteristic signal intensity will aid in the diagnosis of RCC and the selection of conservative management.

Association of venous and true arteriovenous malformation: a rare entity among mixed vascular malformations of the brain

1995 ◽  
Vol 83 (1) ◽  
pp. 141-144 ◽  
Author(s):  
Bernhard Meyer ◽  
Armin P. Stangl ◽  
Johannes Schramm
Keyword(s):  
Arteriovenous Malformation ◽  
Vascular Malformations ◽  
Venous Malformation ◽  
Rare Entity ◽  
Venous Malformations ◽  
Content Type ◽  
Hemorrhagic Infarction ◽  
The Brain ◽  
Cerebrovascular Malformation ◽  
Fine Print

✓ In this article the authors report the case of a mixed cerebrovascular malformation in which a true arteriovenous malformation (AVM), harboring a nidus, is associated with a venous malformation that serves as the draining vein for the nidus. Despite the authors' preoperative rationale for exclusive extirpation of the AVM, an inadvertent injury and the obliteration of the venous malformation generated delayed postoperative neurological deterioration, which could clearly be attributed to venous hemorrhagic infarction. Because this is only the second instance of this type of mixed vascular malformation of the brain reported, which also underscores the concept of nonsurgical treatment of venous malformations, the authors discuss the diverse literature regarding mixed vascular malformations and the treatment of venous malformations.

Radiosurgery for venous angiomas

1993 ◽  
Vol 78 (4) ◽  
pp. 531-536 ◽  
Author(s):  
Christer Lindquist ◽  
Wan-Yio Guo ◽  
Bengt Karlsson ◽  
Ladislau Steiner
Keyword(s):  
Venous Drainage ◽  
The Other ◽  
Minimal Risk ◽  
Venous Angioma ◽  
Content Type ◽  
Complete Obliteration ◽  
Effects Of Radiation ◽  
Venous Angiomas ◽  
The Brain ◽  
Fine Print

✓ Radiosurgical treatment with the gamma knife for venous angiomas was used as an alternative to microsurgical removal in order to avoid abrupt cessation of venous drainage, which may be shared by the venous angioma and important parts of the brain. Thirteen cases of venous angioma were treated between 1977 and 1991. In two cases cavernous angiomas were also present and in one case a distant arteriovenous malformation (AVM) was also found. In two cases the angioma shared the venous drainage with an adjoining AVM; this is the first description of such pathology. For venous angiomas irradiation was prescribed to cover at least the convergence of the medullary veins. For AVM's close to a venous angioma the treatment was exclusively prescribed to the AVM nidus. After treatment, complete obliteration of the venous angioma was observed in one case, partial obliteration was observed in three cases, and five venous angiomas were unaffected by the treatment. Undue effects of radiation occurred in four cases: one focal edema and three radionecroses. Extirpation of the radionecrotic tissue 6 months after radiosurgery was necessary in one case. In the other three cases, the venous angioma was observed to be completely or partially obliterated, or unaffected by the treatment (one case each). In two cases of combined AVM and venous angioma, complete obliteration of the treatment AVM nidus was obtained. It is concluded that radiosurgery for venous angioma, although conceptually attractive, still does not fulfill the rigid criteria of minimal risk which must be set for the treatment of a lesion with a benign natural history.

Epidermoid cysts of the brain stem

1991 ◽  
Vol 74 (1) ◽  
pp. 123-128 ◽  
Author(s):  
William G. Obana ◽  
Charles B. Wilson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Stem ◽  
Signal Intensity ◽  
Contrast Material ◽  
Communicating Hydrocephalus ◽  
Resonance Imaging ◽  
Content Type ◽  
Epidermoid Cysts ◽  
The Brain

✓ The authors report the cases of three patients with epidermoid cysts which insinuated themselves into the brain stem. In all three patients, the tumor occupied the pons, although in one it was predominantly located in the medulla. The cyst contents and nonadherent tumor capsule were removed in all three patients, but no attempt was made to remove tumor densely adherent to the brain stem. One patient's cyst was removed in one operation, but maximal resection in the other two required two operations. After surgery, sixth nerve function completely returned in one patient; another patient had a stable pontine gaze palsy but developed new facial weakness; and the third patient had stable cranial nerve deficits with a diminished hemiparesis. The last patient developed a pseudomeningocele and communicating hydrocephalus, and required a lumboperitoneal shunt. In all three patients, computerized tomography scans demonstrated hypodense tumors not enhanced by contrast material. Magnetic resonance imaging was performed on two patients; in both, the tumors showed increased signal intensity relative to brain on T1-weighted images and decreased signal intensity relative to brain on T2-weighted studies. Magnetic resonance imaging, the most accurate modality for localizing these lesions and determining their extent, was also invaluable for postoperative monitoring and follow-up evaluation. Safe and adequate resection includes decompression of cyst contents and removal of nonadherent portions of the cyst capsule. Cyst wall adherent to the brain stem, however, should not be removed.

Progression of multiple cryptic vascular malformations associated with anomalous venous drainage

1994 ◽  
Vol 81 (3) ◽  
pp. 477-481 ◽  
Author(s):  
Samuel F. Ciricillo ◽  
William P. Dillon ◽  
Matthew E. Fink ◽  
Michael S. B. Edwards
Keyword(s):  
Magnetic Resonance ◽  
Vascular Malformations ◽  
Venous Malformation ◽  
Venous Drainage ◽  
Magnetic Resonance Images ◽  
Venous Hypertension ◽  
Complete Excision ◽  
Content Type ◽  
Drainage Patterns ◽  
Anomalous Venous Drainage

✓ The case of a young girl with a pericallosal venous malformation associated with multiple cryptic vascular malformations (CVM's) is described. The presenting cryptic malformation, which hemorrhaged, was completely excised, but the venous malformation was not. Routine follow-up magnetic resonance images obtained over the past 9 years have documented the development of multiple new cryptic malformations along the radicles of the venous malformation. Magnetic resonance imaging and cerebral angiography revealed venous outflow obstruction at the junction of the venous malformation with the straight sinus. The association of CVM's with anomalous venous drainage patterns and the role of venous hypertension in the pathogenesis of cryptic malformations are discussed. This case suggests that CVM's associated with a venous malformation may recur and new ones may develop if the venous malformation is not excised, particularly if venous hypertension is also present. The likelihood of a surgical cure in these patients may depend on complete excision of both anomalies, which is rarely feasible because of the potentially devastating results of resecting a venous malformation. Alternative treatments for patients with both types of lesions are discussed.

Clinical implications of associated venous drainage in patients with cavernous malformation

2005 ◽  
Vol 102 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Takashi Kamezawa ◽  
Jun-Ichiro Hamada ◽  
Masaki Niiro ◽  
Yutaka Kai ◽  
Koichi Ishimaru ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Cavernous Malformation ◽  
Venous Drainage ◽  
Venous Malformations ◽  
Cavernous Malformations ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Risk Of Hemorrhage ◽  
Fine Print

Object. The authors reviewed angiograms obtained in patients with cavernous malformations to identify and characterize coexisting venous drainage. Methods. Fifty-seven patients with cavernous malformations treated at the authors' institutions between 1994 and 2002 were classified into three groups according to the venous system adjacent to the malformation on angiography studies. In Group A patients (23 patients) the malformations had no venous drainage; in Group B patients (14 patients) the lesions were associated with typical venous malformations; and in Group C patients (20 patients) the lesions had atypical venous drainage (AVD). The risk of hemorrhage based on the type of associated venous drainage was analyzed, and the usefulness of magnetic resonance (MR) imaging compared with digital subtraction (DS) angiography in demonstrating associated AVD was determined. Fifty-seven patients harbored 67 cavernous malformations: Group A patients had 29 cavernous malformations with no associated venous drainage; Group B patients had 17 lesions associated with venous malformations; and Group C patients harbored 21 lesions, 20 of which manifested AVD. Symptomatic hemorrhage was present in 10 (43.5%) of 23 Group A patients and in 28 (82.4%) of 34 Groups B and C patients. Although high-resolution MR imaging revealed the presence of associated venous malformations in 11 (78.6%) of 14 Group B patients, such studies demonstrated AVD in only two (10%) of 20 Group C patients. Conclusions. Patients harboring cavernous malformations plus venous malformations or AVD are more likely to present with symptomatic hemorrhage than are patients with cavernous malformation alone. The actual incidence of associated venous drainage may be underestimated when MR imaging alone is used rather than combined with DS angiography.

Cavernous malformations of the brain stem

1991 ◽  
Vol 75 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Richard S. Zimmerman ◽  
Robert F. Spetzler ◽  
K. Stuart Lee ◽  
Joseph M. Zabramski ◽  
Ronald W. Hargraves
Keyword(s):  
Brain Stem ◽  
Cavernous Malformation ◽  
Venous Malformation ◽  
Neurological Status ◽  
Shunt Infection ◽  
Neurological Deficits ◽  
Cavernous Malformations ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ Once they become symptomatic, cavernous malformations of the brain stem appear to cause progressive morbidity from repetitive hemorrhage, and can even be fatal. Twenty-four patients with long-tract and/or cranial nerve findings from their cavernous malformations of the brain stem were seen for initial evaluation or surgical consultation and thereafter received either surgical or continued conservative treatment. The decision to operate was based on the proximity of the cavernous malformation to the pial surface of the brain stem, the patient's neurological status, and the number of symptomatic episodes. Sixteen patients were treated by definitive surgery directed at excision of their malformation. In four patients, associated venous malformations influenced the surgical approach and their recognition avoided the risk of inappropriate excision of the venous malformation. Although some of the 16 patients had transient, immediate, postoperative worsening of their neurological deficits, the outcome of all except one was the same or improved. Only one patient developed recurrent symptoms: a new deficit 2½ years after surgery required reoperation after regrowth of the cavernous malformation. She has been neurologically stable since the second surgery. One patient died 6 months postoperatively from a shunt infection and sepsis. The eight conservatively treated patients are followed with annual magnetic resonance imaging studies. One has a dramatic associated venous malformation. Seven patients have either minor intermittent or no symptoms, and the eighth died from a hemorrhage 1 year after his initial presentation. Based on these results, surgical extirpation of symptomatic cavernous malformations of the brain stem appears to be the treatment of choice when a patient is symptomatic, the lesion is located superficially, and an operative approach can spare eloquent tissue. When cavernous malformations of the brain stem are completely excised, cure appears permanent.

Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence

2004 ◽  
Vol 100 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Vaijayantee Kulkarni ◽  
Vedantam Rajshekhar ◽  
Lakshminarayan Raghuram
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Imaging Study ◽  
Degenerative Changes ◽  
Adjacent Segment ◽  
Mr Images ◽  
Short Term ◽  
Content Type ◽  
Fine Print

Object. The authors studied whether cervical spine motion segments adjacent to a fused segment exhibit accelerated degenerative changes on short-term follow-up magnetic resonance (MR) imaging. Methods. Preoperative and short-term follow-up (mean duration 17.5 months, range 10–48 months) cervical MR images obtained in 44 patients who had undergone one- or two-level corpectomy for cervical spondylotic myelopathy were evaluated qualitatively and quantitatively. The motion segment adjacent to the fused segment and a segment remote from the fused segment were evaluated for indentation of the thecal sac, disc height, and sagittal functional diameter of the spinal canal on midsagittal T2-weighted MR images. Thecal sac indentations were classifed as mild, moderate, and severe. New indentations of the thecal sac of varying severity (mild in 17 patients [38.6%], moderate in 10 [22.7%], and severe in six [13.6%]) had developed at the adjacent segments in 33 (75%) of 44 patients. The degenerative changes were seen at the superior level in 11 patients, inferior level in 10 patients, and at both levels in 12 patients and resulted from both anterior and posterior element degeneration in the majority (23 [69.6%]) of patients. The remote segments showed mild thecal sac indentations in seven patients and moderate indentations in two patients (nine [20.5%] of 44). Compared with the changes at the remote segment, the canal size was significantly decreased at the superior adjacent segment by 0.9 mm (p = 0.007). No patient sustained a new neurological deficit due to adjacent-segment changes. Conclusions. On short-term follow-up MR imaging, levels adjacent to the fused segment exhibited more pronounced degenerative changes (compared with remote levels) in 75% of patients who had undergone one- or two-level central corpectomy.

The natural history of intracranial venous angiomas

1991 ◽  
Vol 75 (5) ◽  
pp. 715-722 ◽  
Author(s):  
Timothy B. Garner ◽  
O. Del Curling ◽  
David L. Kelly ◽  
D. Wayne Laster
Keyword(s):  
Natural History ◽  
Imaging Techniques ◽  
Venous Drainage ◽  
Vascular Lesion ◽  
Neurological Dysfunction ◽  
Content Type ◽  
History Of ◽  
Clinical Records ◽  
Venous Angiomas ◽  
Fine Print

✓ Cerebral venous angiomas are congenital anomalies of the intracranial venous drainage. Many believe that they are associated with a high risk of hemorrhage and neurological dysfunction, but newer neurodiagnostic imaging techniques are showing not only that they are more common than previously known but also that many have no associated symptoms. In this retrospective study, the natural history of venous angiomas was examined in 100 patients (48 males and 52 females) with radiographically identifiable lesions treated over a 14-year period. Information on the natural history of the lesion was obtained from clinical records and follow-up data. Imaging studies included angiography, computerized tomography, and magnetic resonance imaging. Angioma locations were classified as frontal (42 cases), parietal (24 cases), occipital (4 cases), temporal (2 cases), basal or ventricular (11 cases), cerebellar (14 cases), or brain stem (3 cases); 47 lesions were on the left side. Headache as a presenting symptom was common (36 patients) and often led to other radiographic studies, but this appeared to be related to the vascular lesion in only four patients. Other possibly related complications were hemorrhage in one patient, seizures in five, and transient focal deficits in eight. Fifteen patients had no neurological signs or symptoms. The mean patient age at last contact was 45.3 years (range 3 to 94 years). All patients have been managed without surgery. It is concluded that significant complications secondary to venous angiomas are infrequent and that surgical resection of these lesions and of surrounding brain is rarely indicated.

Lack of agreement between direct magnetic resonance imaging and statistical determination of a subthalamic target: the role of electrophysiological guidance

2002 ◽  
Vol 97 (3) ◽  
pp. 591-597 ◽  
Author(s):  
Emmanuel Cuny ◽  
Dominique Guehl ◽  
Pierre Burbaud ◽  
Christian Gross ◽  
Vincent Dousset ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Functional Response ◽  
Anterior Commissure ◽  
Surgical Techniques ◽  
High Frequency Stimulation ◽  
Mr Images ◽  
Posterior Commissure ◽  
Content Type ◽  
Fine Print

Object. The goal of this study was to determine the most suitable procedure(s) to localize the optimal site for high-frequency stimulation of the subthalamic nucleus (STN) for the treatment of advanced Parkinson disease. Methods. Stereotactic coordinates of the STN were determined in 14 patients by using three different methods: direct identification of the STN on coronal and axial T2-weighted magnetic resonance (MR) images and indirect targeting in which the STN coordinates are referred to the anterior commissure—posterior commissure (AC—PC) line, which, itself, is determined either by using stereotactic ventriculography or reconstruction from three-dimensional (3D) MR images. During the surgical procedure, electrode implantation was guided by single-unit microrecordings on multiple parallel trajectories and by clinical assessment of stimulations. The site where the optimal functional response was obtained was considered to be the best target. Computerized tomography scanning was performed 3 days later and the scans were combined with preoperative 3D MR images to transfer the position of the best target to the same system of stereotactic coordinates. An algorithm was designed to convert individual stereotactic coordinates into an all-purpose PC-referenced system for comparing the respective accuracy of each method of targeting, according to the position of the best target. Conclusions. The target that is directly identified by MR imaging is more remote (mainly in the lateral axis) from the site of the optimal functional response than targets obtained using other procedures, and the variability of this method in the lateral and superoinferior axes is greater. In contrast, the target defined by 3D MR imaging is closest to the target of optimal functional response and the variability of this method is the least great. Thus, 3D reconstruction adjusted to the AC—PC line is the most accurate technique for STN targeting, whereas direct visualization of the STN on MR images is the least effective. Electrophysiological guidance makes it possible to correct the inherent inaccuracy of the imaging and surgical techniques and is not designed to modify the initial targeting.

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