Diagnostic ImagingSoftcover Edition

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Contents I

MEDICAL RADIOLOGY Diagnostic Imaging

Softcover Edition

Editors:

A. L. Baert, Leuven K. Sartor, Heidelberg

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Contents III

M. Forsting (Ed.)

Intracranial Vascular

Malformations and Aneurysms

From Diagnostic Work-Up to Endovascular Therapy

With Contributions by

C. Cognard · A. Dörﬂ er · M. Forsting · W. Küker · L. Pierot · L. Spelle · I. Szikora I. Wanke

Foreword by

K. Sartor

With 157 Figures in 587 Separate Illustrations, 16 in Color and 9 Tables

123

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IV Contents

Michael Forsting, MD Professor of Neuroradiology

Institute of Diagnostic and Interventional Radiology Department of Neuroradiology

University of Essen Hufelandstrasse 55 45122 Essen Germany

Medical Radiology · Diagnostic Imaging and Radiation Oncology Series Editors: A. L. Baert · L. W. Brady · H.-P. Heilmann · M. Molls · K. Sartor Continuation of Handbuch der medizinischen Radiologie

Encyclopedia of Medical Radiology

ISBN 3-540-26250-4 Springer-Verlag Berlin Heidelberg New York ISBN 978 3-540-26250-3 Springer-Verlag Berlin Heidelberg New York

Library of Congress Cataloging-in-Publication Data

Intracranial vascular malformations and aneurysms : from diagnostic work-up to endovascular therapy / M. Forsting (ed.) ; with contributions by C. Cognard ... [et al.] ; foreword by K. Sartor.

p. ; cm. -- (Medical radiology)

Includes bibliographical references and index.

ISBN 354042430X (hardcover; alk. paper) ISBN 3540262504 (softcover; alk. paper) 1. Intracranial aneurysms. 2. Subarachnoid hemorrhage. 3. Diagnostic Imaging. I.

Forsting, M. (Michael), 1960- II. Cognard, C. (Christophe) III. Series.

[DNLM: 1. Intracranial Arteriovenous Malformations--diagnosis. 2. Diagnostic Imaging. 3. Intracranial Aneurysms--diagnosis. 4. Intracranial Aneurysm--therapy. 5.

Intracranial Arteriovenous Malformations--therapy. WL 355 I615 2003]

RD594.2 .I586 2003

616.1’33--dc21 2002075766

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The use of general descriptive names, trademarks, etc. in this publication does not imply, even in the absence of a speciﬁ c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

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Cover-Design and Typesetting: Verlagsservice Teichmann, 69256 Mauer Printed on acid-free paper - 21/3151xq – 5 4 3 2 1

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Contents V

The radiology of vascular malformations and aneurysms is intimately related to the evolution of magnetic resonance (MR) imaging, digital subtraction angiography (DSA) and catheter-based endovascular therapy. Prior to the advent of MR imaging radiologists knew little of so-called venous angiomas (today: developmental venous anomalies), cavernous hemangiomas (cavernomas) or capillary teleangiectasias, as most of these angiodysplasias could not be diagnosed reliably by computed tomography (CT) or invasive angiography, let alone the earlier encephalographic techniques with positive or negative contrast. But only after MR imaging at ﬁ eld strengths of 1 T or higher had become standard did it become clear how common these aberrations of vascular devel- opment actually are, in particular cavernomas and developmental venous anomalies.

This surprised even the pathologists and again required the radiologists to learn more about these anomalies and abnormalities, such as their pathogenesis, histopathology, epidemiology, genetics, and natural history, including their propensity to bleed. It also required them to be able to differentiate these angiodysplastic lesions from non-vascular lesions of potentially graver signiﬁ cance.

Advanced knowledge regarding vascular malformations and aneurysms is now there, but the interested radiologist is still forced to gather it from multiple sources, mostly original articles in journals, treatises on speciﬁ c topics, and other publications of a more or less limited scope. This is why Michael Forsting, a neuroradiological “all-rounder”

with a strong bent towards and considerable experience in minimally invasive endovascular therapy of intracranial vascular abnormalities, has put great effort into producing a book that condenses the existing information in one handy volume. In doing so he has been helped by members of his department at University of Essen as well as by friends and colleagues from leading neuroradiologic institutes in several European countries.

What came out of this joint effort is a well-organized, beautifully illustrated mono- graph that leaves little to be desired: Whenever one is in need of concise, comprehen- sive clinical, diagnostic and (endovascular-) therapeutic information on intracranial vascular malformations and aneurysms – here it is. The book, rich in important facts, numbers and details, impresses perhaps most by its didactic structure and overall style.

For this reason, I believe, it will quickly ﬁ nd a large readership among radiologists and neuroclinicians alike. Possibly quite a number of copies will end up on the desks of clinical pathologists who sometimes do envy us for the possibility to visualize and diagnose most brain lesions in vivo rather than in tabula.

Heidelberg Klaus Sartor

Foreword

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Contents VII

Preface

Why a book about the diagnostic imaging and endovascular therapy of vascular malformations? There is a simple answer: This is a fascinating part of neuroradiology, it has many interdisciplinary aspects and it has become a large ﬁ eld of my and our professional life. The book should have been ready at least one year earlier, but there was always something new that had to be included. Still, I am sure, each reader will miss something he or she has just heard at a meeting or read in the current issue of a journal. On the other hand, there is already a wealth of established basic knowledge about diagnostic imaging and endovascular therapy that will not change fast and justiﬁ es writing a book instead of a review paper.

There are a lot of basics one should know about vascular malformations of the brain, and during our daily practice my colleagues and I see a lot of images and patients that do not have a proper diagnosis or have had a lengthy odyssey before ﬁ nding an expert.

We all hope that our book will ﬁ nd readers who are willing to go into this important aspect of radiology and will enable them to care for their patients in a professional way.

And it is not only written for interventional neuroradiologists: it should be of interest for everybody working in “neuro-disciplines”.

Although we belong to the younger generation of European neuroradiologists – we know that age is a moving target, but never mind – we chose not to write a modern book with colored “memory boxes” or other such aids, but an old-fashioned textbook.

It is something to read at leisure – perhaps on a pleasant evening with a glass of red wine beside you - and memory will be supported by some redundancies and repetitions.

Anyone in a hurry can run through the book just looking at the many images.

We invite all readers to help us improve the next edition. If something is good, let us know! More importantly, if something is not good or even wrong, please give us a call or send us an e-mail!

It was tough work, but ﬁ nally we enjoyed it. We owe a debt of thanks to Ursula Davis of Springer-Verlag, who continuously pushed us to ﬁ nalize it, always friendly and always stimulating.

Last but not least, a lot of people contributed substantially to this book without writing a chapter by themselves. They include my academic teachers Hermann Zeumer (Hamburg), Armin Thron (Aachen) and Klaus Sartor (Heidelberg), who gave the ﬁ rst impulse to write this book. I would like to thank them for supporting me during my whole professional career and for numerous stimulating discussions on vascular prob- lems of the brain.

Essen Michael Forsting

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Contents IX

1 Developmental Venous Anomalies

M. Forsting and I. Wanke . . . 1

1.1 Pathology . . . 1

1.2 Clinical Presentation . . . 2

1.3 Diagnostic Imaging . . . 9

1.4 Therapy . . . 11

2 Cavernomas and Capillary Telangiectasias W. Küker and M. Forsting . . . 15

2.1 Cavernomas . . . 15

2.2 Capillary Telangiectasia . . . 27

3 Pial Arteriovenous Malformations C. Cognard, L. Spelle, and L. Pierot . . . 39

3.1 Introduction . . . 39

3.2 Pathology . . . 40

3.5 Therapy . . . 62

4 Dural Arteriovenous Malformations I. Szikora . . . 101

4.1 Pathology . . . 101

4.4 Therapy . . . 126

5 Intracranial Aneurysms I. Wanke, A. Dörﬂ er and M. Forsting . . . 143

5.1 Pathology . . . 144

5.3 Imaging . . . 162

5.4 Therapy . . . 175

Subject Index . . . 249

List of Contributors . . . 255

Contents