title: The role of percutaneous embolization techniques in the management of dural sinus malformations with atypical angioarchitecture in neonates: report of 2 cases.
abstract: Dural sinus malformations (DSMs) are rare congenital malformations that can be midline or lateral in location. Midline DSMs have been reported to have a worse prognosis than lateral DSMs and have traditionally been more difficult to manage. The authors report 2 unusual manifestations of midline DSMs and their management with percutaneous transfontanelle embolization. The first patient (Case 1) presented at 21 days of life with a large midline DSM and multiple highflow dural and pial arteriovenous shunts. The child developed congestive cardiac failure and venous congestion with intracranial hemorrhage and seizures within a few weeks. The second patient (Case 2) presented with a large midline DSM found on prenatal imaging that was determined to be a purely venous malformation on postnatal evaluation. This large malformation resulted in consumptive coagulopathy and apneic episodes from brainstem compression. The patient in Case 1 was treated initially with endovascular embolization and eventually with curative percutaneous-transfontanelle embolization. The patient in Case 2 was treated with percutaneous transfontanelle embolization in combination with posterior fossa decompression and cranial expansion surgery.
authors.affiliation: Department of Radiology.|Department of Neurosurgery, and.
authors.forename: Bharathi D
authors.initials: BD
authors.lastname: Jagadeesan
authors.affiliation: Department of Radiology.|Department of Neurosurgery, and.|Department of Neurology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Grande
authors.affiliation: Department of Neurosurgery, and.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Guillaume
authors.affiliation: Department of Radiology.
authors.forename: David R
authors.initials: DR
authors.lastname: Nascene
authors.affiliation: Department of Radiology.|Department of Neurosurgery, and.|Department of Neurology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Ramachandra P
authors.initials: RP
authors.lastname: Tummala
mesh_terms: D020785:Central Nervous System Vascular Malformations / Q000628:therapy*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000002:abnormalities*; D055762:Cranial Fontanelles; D003392:Cranial Sinuses / Q000002:abnormalities*; D004388:Dura Mater / Q000002:abnormalities* / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016896:Treatment Outcome
keywords: AV = arteriovenous; CCA = common carotid artery; DSA = digital subtraction angiography; DSM = dural sinus malformation; MMA = middle meningeal artery; MVP = midline venous pouch; NBCA = N-butyl cyanoacrylate; SSS = superior sagittal sinus; VA = vertebral artery; arteriovenous fistula; dural sinus malformation; pediatric arteriovenous malformation; percutaneous embolization; vascular disorders