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KMID : 0378620000160000134
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Baptist Hospital Medical Journal
2000 Volume.16 No. 0 p.134 ~ p.140
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Radiologic Findings of Deep Seated Cerebral Arteriovenous Malformation with Nonvisualization of Straight Sinus : Focused on Angiogram
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원종부/Jong Boo Won
박성호/홍종원/김유경/신미정/백승국/최한용/김봉기/Sung Ho Park/Jong Won Hong/Yoo Kyoung Kim/Mi Jeong Shin/Seung KukBaik/Han Yong Choi/Bong Gi Kim
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Abstract
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Purpose : To analyze the radiologic-expecially angiographic-findings of deep seated cerebral arteriovenous
malformation(AVM) involving nonvisualized straight sinus.
Materials and Methods : In six patients aged between 15 and 53 years with deep seated cerebral AVM.
CT and MR images were retrospectively analyzed with regard to the following features: the presence of
straight sinus, the location of AVM, and the occurrence of hemorrhage Angiograms were analyzed for
venous drainage routes of AVM, the appearance of veins, the presence of falcine sinus and venous
drainage from normal deep brain parenchyme. In four patients who had undergone intravascular
embolization therapy, pre-and post-embolization angiograms were compared.
Results : CT and MR images showed neither straight sinus nor thrombosis. AVMs were deeply seated in
the brain, and in all cases there was cerebral hemorrhage. Angiograms disclosed that venous drainage of
all AVMs occurred via the vein of Galen. In one case, venous flow via falcine sinus to superior sagittal
sinus was noted, but in others, retrograde flow in the deep venus system was observed. Marked collateral
routes followed in response to the obstruction of straight sinus included the basal vein of Rosenthal, the
internal occipital, internal cerebral, and cerebellar hemispheric veins (which are Galenic afferents), and the
inferior sagittal sinus. In all patients, contralateral routes were partially involved. Venous drainage from
normal deep parenchyme through the transcerebral veins to superficial venous system was noted, and in
one case, straight sinus which had been observed on an angiogram five years earlier was no longer
present.
Conclusion : Angiography offers effective evaluation of the dynamic aspect of venous flow in cases
involving deep-seated AVM and of normal deep parenchyme in cases in which AVM involves
nonvisualized straight sinus. Before intravascular treatment of AVM, venous flow must be carefully
analyzed.
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