Banca de DEFESA: JOAO FERREIRA DE MELO NETO

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : JOAO FERREIRA DE MELO NETO
DATE: 06/08/2020
TIME: 08:30
LOCAL: DEFESA REMOTA - https://meet.google.com/rdz-hzdu-osu
TITLE:

CEREBRAL VENOUS DRAINAGE IN PATIENTS WITH DURAL ARTERIOVENOUS FISTULAS – CORRELATION WITH CLINICAL PRESENTATION

KEY WORDS:

Cortical venous drainage, Clinical presentation, Dural arteriovenous fistula

PAGES: 24
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Background: Dural arteriovenous fistulas (DAVFs) are abnormal, acquired arteriovenous connections within the dural leaflets.  Symptoms may be mild or severe and are related to the patient’s venous anatomy.

Objective: Our hypothesis is that the patient’s venous anatomy determines development of symptoms. The aim is to identify which venous anatomy elements are important in the development of major symptoms in patients with a DAVF. Methods: Multicenter study based on the retrospective analysis of cerebral angiographies with systematic assessment of brain drainage pathways (including fistula drainage) in patients over 18 years of age with single DAVF. The patients were divided into two groups, with minor  (group 1, n=112) and with major symptoms (group 2, n=89). Group 2 was subdivided into 2a – hemorrhage (n=47) and 2b- severe non-hemorrhagic symptoms (n=42). Results: The prevalence of stenosis in DAVF venous drainage and identification of tiny anastomoses between venous territories was significantly higher in group 2 (32.6% and 19.1%, respectively) when compared to group 1 (2.68% and 5.36%, respectively). Stenosis of DAVF venous drainage was significantly more frequent in group 2a than in group 2b (51.1% vs. 11.9%, p<0.001). Group 2b patients had increased prevalence of shared use of the cerebral main drainage pathway (85.0% vs. 53.2%, p=0.002), absence of an alternative route (45.0% vs. 17.0%, p=0.004) and presence of contrast stagnation (62.5% vs. 29.8%, p=0.002) when compared to group 2a. In patients with high-grade fistula the group with major symptoms had increased prevalence of a single draining direction (31.3% vs. 8.33%, p=0.003), stenosis in the draining vein (35.0% vs. 6.25%, p=0.000), absence of an alternative pathway for brain drainage (31.3% vs. 12.5%, p=0.017) and presence of contrast stagnation (48.8% vs. 22.9%, p=0.004). Conclusions: Major symptoms were observed when normal brain tissue venous drainage was impaired by competition with DAVF (predominance in group 2b) or when DAVF venous drainage had anatomical characteristics that hindered drainage, with consequent venous hypertension on the venous side of the DAVF (predominance in group 2a). The same findings were observed when comparing two groups of patients with high-grade lesions, those with major versus those with minor symptoms.

BANKING MEMBERS:
Externo à Instituição - CARLOS CLAYTON MACEDO DE FREITAS - UNESP
Externo à Instituição - KOSHIRO NISHIKUNI - HSPE
Presidente - 1048067 - ANTONIO MANUEL GOUVEIA DE OLIVEIRA
Externo ao Programa - 2553737 - MARIO EMILIO TEIXEIRA DOURADO JUNIOR
Externo ao Programa - 3108020 - ROBERTO BEZERRA VITAL