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Related Concept Videos

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The coronary arteries, originating from the ascending aorta, bifurcate from two sinuses located within the ascending aorta. Positioned just above the aortic semilunar valve, these sinuses house essential aortic baroreceptors and chemoreceptors, crucial for maintaining cardiac function. The left coronary artery and the right coronary artery branch off from the left posterior and anterior aortic sinuses, respectively.
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There are hollow fluid-filled cavities known as ventricles deep inside the human brain. There are two lateral ventricles, one in each cerebral hemisphere, and each has three different projections — the anterior, inferior, and posterior horns visible from the lateral side. A thin membrane called the septum pellucidum separates the two lateral ventricles. The slender third ventricle in the diencephalon is connected to each lateral ventricle via a channel called the interventricular foramen.
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Related Experiment Video

Updated: Jun 2, 2025

Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
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Triple spinal dural arteriovenous fistula.

Davide Boeris1, Martina Giordano2, Giacomo Petrella3

  • 1Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy davide.boeris@ospedaleniguarda.it.

BMJ Case Reports
|January 14, 2025
PubMed
Summary

Multiple spinal dural arteriovenous fistulas (SDAVFs) are rare. This case and literature review suggest uncontrolled fluid shifts, not surgery itself, may cause postoperative hematomas in patients with multiple SDAVFs.

Keywords:
NeuroimagingNeurological injurySpinal cord

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Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Radiology

Background:

  • Spinal dural arteriovenous fistulas (SDAVFs) are the most common spinal vascular malformations.
  • Multiple SDAVFs, occurring synchronously or metachronously, are considered unusual.
  • Postoperative complications like hematoma formation can occur following SDAVF treatment.

Purpose of the Study:

  • To report an unusual case of a patient with three distinct SDAVFs treated surgically in one setting.
  • To review the literature on outcomes of patients with multiple SDAVFs.
  • To investigate potential causes of postoperative hematoma formation in multiple SDAVF cases.

Main Methods:

  • Case report of a patient with three SDAVFs undergoing simultaneous surgical treatment.
  • Comprehensive literature review of patients with multiple SDAVFs.
  • Analysis of surgical outcomes and postoperative complications in collected cases.

Main Results:

  • The reported patient experienced repeated, unexplained hematoma formation post-surgery.
  • Literature review identified 19 patients with 41 distinct SDAVFs.
  • Only two patients in the review had all SDAVFs treated in a single surgical procedure.
  • Contemporary surgery was not identified as a direct cause of hemorrhage.

Conclusions:

  • Uncontrolled fluid shifts (deliquoration) are hypothesized as a potential cause for postoperative hematoma in multiple SDAVF cases.
  • Management strategies for multiple SDAVFs may need to consider fluid dynamics during and after surgery.
  • Further research is needed to elucidate the pathophysiology of hematoma formation in these complex cases.