Dural malformation

Intraorbital tumor Caroticocavernous fistula Retinal migraine Intracranial dural malformation Paraneoplastic retinopathy Reversible diabetic cataract Uveitis-glaucoma-hyphema syndrome... 

Thus, acute, subacute, or chronic impairment of spinal blood supply can result from a deficient arterial supply and from venous circulatory problems (Mull and Thron 2004). Spinal vascular malformations like spinal dural arteriovenous (AV) fistulas and AV malformations (AVM) of the perimedullary fistula type are the typical disorders associated with venous congestion of the spinal cord. On the other hand, AVM of the glomerular type are seldom combined with a venous outflow disorder. 

Rosenblum B, Oldfield EH, Doppman JL, Di Chiro G (1987) Spinal arteriovenous malformations a comparison of dural arteriovenous fistulas and intradural AVM s in 81 patients. J Neurosurg 67 795-802 Rosenkranz M, Grzyska U, Niesen W, Fuchs K, Schummer W, Weiller C, Rother J (2004) Anterior spinal artery syndrome following periradicular cervical nerve root therapy. J Neurol 251 229-231... 

Intracranial vascular malformations are uncommon, probably congenital, and sometimes familial (Byrne 2005). Those in the dura, draining into the sinuses rather than cerebral veins, can also be caused by skull fracture, craniotomy or dural sinus thrombosis. The overall intracranial vascular malformations detection rate is approximately 3 per 100 000 population per annum and the prevalence is about 20 per 100 000 (Brown et al. 1996). 

Fig. 7.5. Arteriovenous malformation, A T2-weighted MRI (a) and cerebral angiogram (b) showing a dural arteriovenous malformation (arrows) at the right cerebellopontine angle, causing tinnitus.

Human cadaveric dermis (AlloDerm ) has been used in a variety of neurosurgical procedures. In a prospective multicenter study by Bejjani et al., ° porcine small intestinal submucosa (SIS) was used to replace dura matter resected during neurosurgery in 59 patients 18 of the patients underwent tumor resection and 32 patients underwent decompression of a Type I Chiari malformation. A water-tight seal was achieved in all 59 cases interoperatively. Mean follow-up was 7.3 months and both CSF leak rate (1.7%) and wound infection rate (3.4%) were comparable to rates reported in the literature for other materials in dural repair. There were no adverse reactions to the graft and SIS was deemed by the authors to be suitable for use in dural repair. 

Parker, S.R., Harris, P., Cummings, T.J., George, T., Fuchs, H., Grant, G., 2011. Complications following decompression of Chiari malformation Type I in children dural graft or sealant J. Neurosurg. Pediatr. 8, 177-183. 

Hereditary hemorrhagic telangiectasia (Rendu-Osler disease) is not associated with cerebral capillary telangiectasia, but with other forms of cerebral vascular malformations (Maher et al. 2001), mainly true pial arteriovenous malformations, dural arteriovenous malformations, and, rarely, cavernomas. 

Dural arteriovenous malformations (DAVM) are abnormal shunts between the arterial and the venous side of the vascular tree that are located within the dura, most frequently within the wall of or immediately around the venous sinuses. 

Fig. 4.3. Typical locations of intracranial dural arterial malformations. 1, anterior fossa 2, cavernous sinus 3, transverse sinus 4, sigmoid sinus 5, confluens sinuum 6, foramen magnum 7, tentorial incisura 8, base of the tentorium 9, straight sinus and vein of Galen...

Table4.1. Venous drainage pathways of intracranial dural arteriovenous malformations in different locations...

Table 4.3. Classification of intracranial dural arteriovenous malformations (DAVMs) in relation to venous drainage pattern...

Fig. 4. 15a-c. Venous drainage patterns of spinal dural arteriovenous malformations. (NR, nerve root RA, radicular artery DM, dura mater M, medulla). Meningeal branch of the radicular artery feeds arteriovenous shunt located on the dura (small arrow), a Venous drainage by epidural veins (arrow), b Venous drainage via epidural veins and aperimedullary vein (arrow) into the coronal venous plexus (arrowheads), c Exclusive venous drainage by perimedullary vein (arrow) and the coronal venous plexus (arrowheads)... 

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