REVERSIBLE TONSILLAR PROLAPSE IN VEIN OF GALEN ANEURYSMAL MALFORMATIONS - REPORT OF 8 CASES AND PATHOPHYSIOLOGICAL HYPOTHESIS

被引:55
作者
GIRARD, N
LASJAUNIAS, P
TAYLOR, W
机构
[1] Neuroradiologie Vasculaire Diagnostique et Thérapeutique, Hôpital de Bicêtre, Le Kremlin Bicêtre Cedex, F-94275, 78, Rue du Général Leclerc
关键词
CHIARI I MALFORMATION; VEIN OF GALEN MALFORMATION; EMBOLIZATION; SINUS THROMBOSIS; HYDRODYNAMIC DISORDERS;
D O I
10.1007/BF00301078
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
We report eight cases of vein of Galen aneurysmal malformation (VGAM) associated with a ''Chiari type I malformation.'' In four cases magnetic resonance imaging (MRI) or computed tomography performed in the neonatal period did not demonstrate the posterior fossa anomaly, which appeared on later scans. In the other cases the MRI was performed in infancy and the anomaly was already present. We compared the venous phases of the posterior fossa angiograms and the MRI in these patients. In all eight cases, the angiograms showed a reflux in the cerebellar veins, via the petrous vein, associated with a uni- or bilateral stenosis or thrombosis of the distal posterior dural sinuses. Furthermore, in two cases the posterior fossa returned to normal on MRI following endovascular treatment, while in three cases the herniation of the cerebellar tonsils decreased after the embolization. Tonsillar prolapse becomes irreversible when the venous outlet is incapable of taking the flow even when the VGAM has been treated adequately. In eight additional cases of VGAM for which MRI and angiogram studies were available and in which stenosis or thrombosis of posterior dural sinuses was present without tonsillar prolapse, no reflux into the cerebellar veins was shown. We suggest that the posterior fossa hydrovenous congestion is a result of inadequate venous drainage and that the tonsillar descent is reversible if adequate venous drainage is reconstituted following therapeutic embolization of the fistula. Tonsillar prolapse is not a consequence of mass or raised intraventricular pressure. Our observation suggests that in some other conditions, the ''Chiari I malformations'' may be secondary to early hydrovenous dysfunction of the posterior fossa.
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页码:141 / 147
页数:7
相关论文
共 10 条
[2]  
BARKOVICH AJ, 1990, PEDIATRIC NEUROIMAGI, P77
[3]  
Berenstein A, 1992, SURGICAL NEUROANGIOG, V4, P267
[4]   DEEP VENOUS DRAINAGE IN GREAT CEREBRAL VEIN (VEIN OF GALEN) ABSENCE AND MALFORMATIONS [J].
LASJAUNIAS, P ;
GARCIAMONACO, R ;
RODESCH, G ;
TERBRUGGE, K .
NEURORADIOLOGY, 1991, 33 (03) :234-238
[5]  
LASJAUNIAS P, 1987, AM J NEURORADIOL, V8, P185
[6]  
Lasjuanias P, 1990, SURGICAL NEUROANGIOG, V3, P223
[7]  
QUISLING RG, 1989, AM J NEURORADIOL, V10, P411
[8]   ARTERIOVENOUS ANGIOMA OF THE VEIN OF GALEN CAUSING CARDIAC-FAILURE IN THE NEONATE - REPORT ON CLINICAL AND PATHOLOGICAL FINDINGS IN 2 CASES [J].
SCHWECHHEIMER, K ;
KUHL, G .
NEUROPEDIATRICS, 1983, 14 (03) :184-187
[9]   CONGESTIVE HEART FAILURE SECONDARY TO CEREBRAL ARTERIOVENOUS ANEURYSM IN NEWBORN INFANT [J].
STERN, L ;
RAMOS, AD ;
WIGLESWORTH, FW .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1968, 115 (05) :581-+
[10]   HYDRODYNAMICS IN VEIN OF GALEN MALFORMATIONS [J].
ZERAH, M ;
GARCIAMONACO, R ;
RODESCH, G ;
TERBRUGGE, K ;
TARDIEU, M ;
DEVICTOR, D ;
LASJAUNIAS, P .
CHILDS NERVOUS SYSTEM, 1992, 8 (03) :111-117