Abnormal flow void signs and gadolinium enhancement of vascular lesions for the early diagnosis of angiographically occult dural arteriovenous fistulas at the craniocervical junction: A case report

Craniocervical junction dural arteriovenous fistulas (dAVFs) are rare vascular lesions with a potentially dangerous natural history due to the onset of neurological deficit secondary to intracranial hemorrhage or myelopathy due to venous congestion. Despite advances in endovascular techniques, many dAVFs located in this area continue to require surgical treatment as embolization is often not feasible or safe. In this video, the authors illustrate a patient with a symptomatic craniocervical junction dAVF who had undergone attempted Onyx embolization at another institution. Because of persistent filling of the fistula and worsening myelopathy after the previous attempt, the patient was referred to the authors’ clinic for definitive surgical treatment. The video illustrates the typical location of the early draining vein in most craniocervical junction dAVFs immediately below the emergence of the vertebral artery from the dura. The patient underwent successful definitive clip ligation of the fistula, which was exposed through a lateral suboccipital craniotomy.The video can be found here: https://youtu.be/Bvg6VKLgwO0.

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De novo multiple dural arteriovenous fistulas and arteriovenous malformation after embolization of cerebral arteriovenous fistula: case report

Child s Nervous System ◽

10.1007/s00381-012-1878-6 ◽

2012 ◽

Vol 28 (11) ◽

pp. 1981-1983 ◽

Cited By ~ 13

Author(s):

Yahui Bai ◽

Chuan He ◽

Hongqi Zhang ◽

Feng Ling

Keyword(s):

Case Report ◽

Arteriovenous Malformation ◽

Arteriovenous Fistula ◽

De Novo ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Cerebral Arteriovenous Fistula

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Study of Dural Arteriovenous Fistula Drains into Leptomeningeal Vein without Sinus Interposition

Interventional Neuroradiology ◽

10.1177/15910199040100s122 ◽

2004 ◽

Vol 10 (1_suppl) ◽

pp. 127-134 ◽

Cited By ~ 6

Author(s):

T. Kawaguchi ◽

M. Nakatani ◽

T. Kawano

Keyword(s):

Emergency Treatment ◽

Superior Sagittal Sinus ◽

Venous Drainage ◽

Craniocervical Junction ◽

Sigmoid Sinus ◽

Arteriovenous Fistulas ◽

Sagittal Sinus ◽

Dural Arteriovenous Fistulas ◽

Cranial Fossa ◽

Venous Ischemia

We evaluated dural arteriovenous fistulas (DAVF) drains into leptomeningeal vein (LMV) without the venous sinus interposition. This type of DAVF contained the extra-sinusal type DAVF and the DAVF with so-called pure leptomeningeal venous drainage (PLMVD). We studied 15 patients with DAVF that flows into LMVD without passing into the sinus. The subjects were 5 patients with DAVF in the anterior cranial fossa, 2 with DAVF in the tentorium cerebelli, and 3 with DAVF in the craniocervical junction as extra-sinusal type DAVF and 3 with DAVF in the transverse sigmoid sinus and 2 with DAVF in the superior sagittal sinus as DAVF with PLMVD. This type appears to take a very aggressive course. The arterial pressure of the shunt is directly applied to LMV, which causes bending and winding of the vein, eventually varices, inducing intracranial haemorrhage or venous ischemia in the LMV reflux area. Emergency treatment should be performed as soon as possible. Although it is recognized that interruption of the draining vein is very effective, treatment methods such as TAE, direct surgery, and g knife treatment, or their combinations should be carefully chosen for each case.

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Variations and management for patients with craniocervical junction arteriovenous fistulas: Comparison of dural, radicular, and epidural arteriovenous fistulas

Surgical Neurology International ◽

10.25259/sni_557_2021 ◽

2021 ◽

Vol 12 ◽

pp. 411

Author(s):

Shunji Matsubara ◽

Hiroyuki Toi ◽

Hiroki Takai ◽

Yuko Miyazaki ◽

Keita Kinoshita ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Elective Surgery ◽

Vascular Diseases ◽

Craniocervical Junction ◽

Vascular Lesions ◽

Imaging Studies ◽

Venous Reflux ◽

Arteriovenous Fistulas ◽

Asymptomatic Patients

Background: Craniocervical junction arteriovenous fistulas (CCJAVFs) are known to be rare, but variations and clinical behaviors remain controversial. Methods: A total of 11 CCJAVF patients (M: F=9:2, age 54–77 years) were investigated. Based on the radiological and intraoperative findings, they were categorized into three types: dural AVF (DAVF), radicular AVF (RAVF), and epidural AVF (EDAVF). Results: There were four symptomatic patients (subarachnoid hemorrhage in two, myelopathy in one, and tinnitus in one) and seven asymptomatic patients in whom coincidental CCJAVFs were discovered on imaging studies for other vascular diseases (arteriovenous malformation in one, intracranial DAVF in two, ruptured cerebral aneurysm in two, and carotid artery stenosis in two). Of these 11 patients, 2 (18.2%) had multiple CCJAVFs. Of 14 lesions, the diagnoses were DAVF in 5, RAVF in 3, and EDAVF in 6 (C1–C2 level ratio =5:0, 2:1, 3:3). Patients with DAVF/RAVF in four lesions with intradural venous reflux underwent surgery, although an RAVF remained in one lesion after embolization/radiation. Since all six EDAVFs, two DAVFs, and one RAVF had neither feeder aneurysms nor significant symptoms, no treatment was provided; of these nine lesions, one DAVF and one RAVF remained unchanged, whereas six EDAVFs showed spontaneous obliteration within a year. Unfortunately, however, one DAVF bled before elective surgery. Conclusion: CCJAVFs have many variations of shunting site, angioarchitecture, and multiplicity, and they were frequently associated with coincidental vascular lesions. For symptomatic DAVF/RAVF lesions with intradural drainage, surgery is preferred, whereas asymptomatic EDAVFs without dangerous drainage may obliterate during their natural course.

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