• Journal of Korean Neurosurgical Society
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• v.43 no.5
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• pp.250-252
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• 2008

Meningiomas frequently invade cerebral venus sinuses, especially parasagittal meningioma to superior sagittal sinus. However, most invasions do not reach internal jugular vein. We present a case of parasagittal meningioma extending into the internal jugular vein through the sinuses. Radiological investigation revealed that the tumor was invading the sagittal, transverse, sigmoid sinus and junction of the internal jugular vein to subclavian vein, which was filled with tumor. The histopathological examinations revealed that both the cerebral tumor and mass in the internal jugular vein contributed to the transitional meningioma. This is a rare case of a meningioma extending into the internal jugular vein through the sinuses. According to this case, the frontal parasagittal meningioma could invade directly the internal jugular vein. The significance of this association to cerebral venus sinuses and internal jugular vein are discussed.

• Journal of Yeungnam Medical Science
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• v.10 no.2
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• pp.475-484
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• 1993

In order to evaluate the safe ligation time and sites of dural venous sinuses during neurosurgical operation, systemic arterial pressure(SAP), cerebral perfusion perssure(CPP), intracranial pressure (ICP) and intrasinal pressure(ISP) were measured in cats through neuromonitor before and after obstruction of anterior 1/3, middle 1/3, posterior 1/3 of the superior sagittal sinus and the results were as follows. There were no significant increases of pressures after obstruction of anterior 1/3 of the superior sagittal sinus. In the obstructed middle 1/3 of the superior sagittal sinus group, significant increases were seen un the m-SAP within 2, 4 and 6 minutes, the m-ICP within 2-7 minutes, the m-ISP within 1-4 minutes after obstruction. In the obstructed posterior 1/3 of the superior sagittal sinus group, there were significant increases of m-SAP within 2, 4 and 6 minutes, the m-ICP within 2-7 minutes, the m-ISP within 1-3 minutes. In the obstructed Torcular Herophili group, there were significant increases of the m-SAP within 1-2 and 4-7 minutes, the m-ICP within 3-6 minutes and the m-ISP within 1-7 minutes and less significant dercreases of the m-CPP within 5-7 minutes after obstruction. In the obstructed right transverse sinus group, significant increases of the m-ICP and the m-ISP were seen within 1-7 minutes after obstruction, there were no remarkable changes in the obstructed left transverse sinus group.

• Journal of the Korean Society of Radiology
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• v.82 no.6
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• pp.1619-1627
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• 2021

Central venous stenosis is a relatively common complication in hemodialysis patients; however, jugular venous reflux (JVR) and increased intracranial pressure are rare, and associated progressive visual disturbance was reported in only a few cases. Here, we report a case of JVR with visual disturbance and increased intracranial pressure. Notably, the MRI was accompanied by a dilatation of the superior ophthalmic vein, which was mistaken for a cavernous sinus dural arteriovenous fistula (CSdAVF). The patient had JVR on time-of-flight MR angiography (TOF-MRA) and severe stenosis of the left brachiocephalic vein on conventional angiography. After balloon angioplasty for central venous stenosis, he was discharged after improvement of his visual disturbance. Although JVR due to central venous stenosis and CSdAVF might show similar symptoms, treatment plans are different. Therefore, it is important to distinguish radiologically based on a thorough review of MRI and TOF-MRA and confirm the central venous stenosis on cerebral angiography for the accurate diagnosis.

• Investigative Magnetic Resonance Imaging
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• v.16 no.2
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• pp.152-158
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• 2012

Purpose : To compare the arterial and venous detection sites of triggering methods in contrast-enhanced-MR-venography (CE-MRV) for the evaluation of intracranial venous system. Materials and Methods: 41 healthy patients underwent CE-MRV with autotriggering at either the cavernous segment of internal carotid artery with an inserted time-delay of 6 seconds (n = 20) or the superior sagittal sinus without any timedelay (n = 21). 0.1 mmol/kg gadolinium-based contrast material ($Magnevist^{(R)}$, Schering, Germany) was intravenously injected by hand injection. A sagittal fast-spoiled-gradient-echo-sequence ranging from one ear to the other was performed (TR/TE5.2/1.5, Matrix $310{\times}310$, 124 sections in the 15-cm-thick volume). 17 predefined venous structures were evaluated on all venograms by two neuroradiologists and defined as completely visible, partially visible, or none visible. Results: The rate of completely visible structures were 272 out of 323 (84%) in the arterial triggering CE-MRV and 310 out of 340 (91%) in the venous triggering CE-MRV. The venous triggering CE-MRV demonstrated an overall superior visualization of the cerebral veins than the arterial triggering CE-MRV (Fisher exact test, p < 0.006). Conclusion: CE-MRV using venous autotriggering method provides higher-quality images of the intracranial venous structures compared to that of arterial.

• Journal of Trauma and Injury
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• v.35 no.1
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• pp.43-45
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• 2022

Epidural hematoma (EDH) can sometimes be life-threatening, although small-volume EDHs can resolve spontaneously like other intracranial hematomas. However, in rare cases, EDH can transform into a chronic form instead of disappearing. In contrast to subdural hematoma, there is no agreed-upon definition or treatment of chronic EDH. A 41-year-old male patient with acute EDH in the bilateral paravertical area due to partial rupture of the sagittal sinus was operated first, and then remnant contralateral hematoma was treated conservatively. One month after surgery, he showed hemiparesis, and brain imaging revealed chronic EDH at the location of the remnant acute hematoma. We performed surgery again to treat chronic EDH through a large craniotomy. Although many cases of EDH are self-limited, clinicians must keep in mind that some cases of EDH, especially those of venous origin and arising in young people, can become chronic and require surgical treatment.

• Investigative Magnetic Resonance Imaging
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• v.21 no.3
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• pp.192-194
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• 2017

Giant arachnoid granulations have been reported to be associated with headaches, which can be acute or chronic in presentation. In some cases, idiopathic intracranial hypertension, previously called pseudotumor cerebri, may occur. The pathophysiology of these enlarged structures seen as filling defects on imaging is not clearly defined, although they are presumed to cause symptoms such as headache via pressure resulting from secondary venous sinus obstruction. We present a unique presentation of secondary headache in a 39-year-old man with no prior history of headaches found to have giant arachnoid granulations, presenting as migraine with aura.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.260-263
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• 2011

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous connections that lie within the dura. Intraosseous DAVFs involving diploic venous system are extremely rare. A 46-year-old woman presented with headache and right pulsatile tinnitus for three weeks. The tinnitus started after yelling. Digital subtraction angiography revealed DAVF within the basal portion of right parietal bone along the middle meningeal artery (MMA) groove. The fistula was fed by frontal branch of right MMA and drained into right transverse sigmoid sinus junction through dilated middle meningeal vein. The intraosseous DAVF involving diploic vein was successfully obliterated with Onyx embolization via transarterial route.

• Journal of Korean Neurosurgical Society
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• v.30 no.11
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• pp.1263-1270
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• 2001

Objective : To analyze the radiosurgical results of intracranial meningiomas after Gamma Knife radiosurgery (GKS) and to assess the possible factors related to the outcome and complications in treating meningiomas. Patients and Methods : We retrospectively reviewed the clinical and radiological data in 179 patients(194 lesions) treated with GKS for intracranial meningiomas between May 1992 and October 2000. Radiosurgical responses were categorized as shrinkage, stasis and enlargement, and we defined the shrunken and static group as a radio-logical control. A Cox proportional hazards model was used to evaluate the correlation between the radiosurgical outcomes and various factors such as location and size of tumor, age and gender of patients, relation to venous sinus, pre-GKS degree of edema, treatment modality, radiosurgical parameters, and pathologic findings. Results : Patients were grouped into skull base meningiomas(57.7%), non-skull base tumor including convexity, parasagittal, and falx meningiomas(37.1%), and others(5.2%) according to the location of tumors. The mean maximum dose and the margin dose of tumor was 30.0Gy(19-45Gy) and 15.1Gy(9.5-24.5Gy), respectively. The mean volume of the tumors was 9.4cc(0.003-45.0cc). The radiologic control rate was 97.1%. The radiation induced imaging change with or without neurologic deficit was the most common complication(23.6%). There were seen mostly in convexity, parasagittal, and falx meningiomas which were deeply embedded in cortex. Conclusion : GKS for intracranial meningioma seems to be safe and effective treatments. However, GKS should be considered very cautiously in non-skull base tumor such as convexity, parasagittal, or falx meningiomas with regards to patient's age and general condition, size and location of tumor, pattern of embedding into cortex, presenting symptoms and patient's preference.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.672-680
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• 2023

Objective : We evaluated the diagnosis, treatment, and long-term results of patients with dural arteriovenous fistula (dAVF), which is a very rare cause of posterior fossa hemorrhage. Methods : This study included 15 patients who underwent endovascular, surgical, combined, or Gamma Knife treatments between 2012 and 2020. Demographics and clinical features, angiographic features, treatment modalities, and outcomes were analyzed. Results : The mean age of the patients was 40±17 years (range, 17-68), and 68% were men (11/15). Seven of the patients (46.6%) were in the age group of 50 years and older. While the mean Glasgow coma scale was 11.5±3.9 (range, 4-15), 46.3% presented with headache and 53.7% had stupor/coma. Four patients (26.6%) had only cerebellar hematoma and headache. All dAVFs had cortical venous drainage. In 11 patients (73.3%), the fistula was located in the tentorium and was the most common localization. Three patients (20%) had transverse and sigmoid sinus localizations, while one patient (6.7%) had dAVF located in the foramen magnum. Eighteen sessions were performed on the patients during endovascular treatment. Sixteen sessions (88.8%) were performed with the transarterial (TA) route, one session (5.5%) with the transvenous (TV) route, and one session (5.5%) with the TA+TV route. Surgery was performed in two patients (14.2%). One patient (7.1%) passed away. While there were nine patients (64.2%) with a Rankin score between 0 and 2, the total closure rate was 69.2% in the first year of control angiograms. Conclusion : In the differential diagnosis of posterior fossa hemorrhages, the differential diagnosis of dAVFs, which is a very rare entity, should be considered, even in the middle and elderly age groups, in patients presenting with good clinical status and pure hematoma. The treatment of such patients can be done safely and effectively in a multidisciplinary manner with a good understanding of pathological vascular anatomy and appropriate endovascular treatment approaches.