Delayed Dural Arteriovenous Fistula at the Transverse-Sigmoid Sinus Secondary to Petroclival Meningioma Surgery Via Far Lateral Approach

AbstractWe report a case of craniocervical junction dural arteriovenous fistula (dAVF) presented with myelopathy and normal pressure hydrocephalus, and was treated with hybrid approach of embolization and surgical disconnection. A 68-year-old gentleman presented with 1 year history of unsteady gait and sphincter disturbance. Magnetic resonance imaging (MRI) showed abnormally enlarged and tortuous vessels over right cerebellomedullary cistern. Digital subtraction angiogram (DSA) showed Cognard's type-V dAVF at craniocervical junction. Catheter embolization was performed via external carotid artery and finally surgical disconnection was done with far lateral approach (Fig. 1). Postoperative DSA showed no more arteriovenous shunting (Fig. 2). Clinically the patient improved after a course of rehabilitation. Dural AVF at craniocervical junction is rare and its clinical presentation can be highly variable from subarachnoid hemorrhage to brainstem dysfunction. Identification of the exact fistula site is essential in surgical planning. Surgery is effective and safe to achieve complete obliteration and good clinical outcome.1 2 3 4 5 6 The link to the video can be found at: https://youtu.be/xI48stSlWpY.

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Far lateral approach for microsurgical ligation of C1 dural arteriovenous fistula: surgical anatomy and technical nuances

Neurosurgical FOCUS ◽

10.3171/2019.2.focusvid.18697 ◽

2019 ◽

Vol 46 (Suppl_2) ◽

pp. V6

Author(s):

Varun R. Kshettry ◽

Nina Z. Moore ◽

Mark Bain

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Lateral Approach ◽

Surgical Anatomy ◽

Drainage Pattern ◽

Mr Image ◽

Far Lateral Approach ◽

Far Lateral

This video demonstrates the diagnosis and surgical ligation of a C1 dural arteriovenous fistula via a far lateral, transcondylar approach. The patient’s dural arteriovenous fistula was identified by MRI signal changes in the spinal cord and a cerebrospinal angiogram demonstrating an abnormal hypertrophied early venous drainage pattern suggestive of a C1 vessel origin. Indocyanine green was used to verify surgical treatment of the fistula intraoperatively. A postoperative angiogram and MR image demonstrate fistula occlusion and resolution of the spinal cord edema. Anatomic details and technical nuances of the approach are demonstrated.The video can be found here: https://youtu.be/zSd0vuov8xk.

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Successful Microsurgical Management of High-Risk Foramen Magnum Dural Arteriovenous Fistula With Cortical Venous Reflex Using Far-Lateral Approach: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opx055 ◽

2017 ◽

Vol 13 (5) ◽

pp. 644-644 ◽

Cited By ~ 2

Author(s):

Amol Raheja ◽

Phil Taussky ◽

William T. Couldwell

Keyword(s):

High Risk ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Foramen Magnum ◽

Lateral Approach ◽

3 Dimensional ◽

Far Lateral Approach ◽

Far Lateral

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Craniocervical Junction Vertebral Artery Dural Arteriovenous Fistula With Cranial and Spinal Venous Reflux: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz213 ◽

2019 ◽

Vol 18 (5) ◽

pp. E162-E163 ◽

Cited By ~ 1

Author(s):

Krunal Patel ◽

Leonardo Desessards Olijnyk ◽

Anderson Chun On Tsang ◽

Vitor Mendes Pereira ◽

Ivan Radovanovic

Keyword(s):

Vertebral Artery ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Craniocervical Junction ◽

Lateral Approach ◽

Venous Reflux ◽

Suboccipital Craniotomy ◽

Far Lateral Approach ◽

Key Steps ◽

Midline Approach

Abstract Dural arteriovenous fistulae at the craniocervical junction are rare. When present together with spinal and cranial venous reflux they can have an aggressive natural history with hemorrhage or progressive myelopathy from venous congestion. In this operative video we demonstrate key steps in the surgical ligation of a dural arteriovenous fistula supplied by meningeal branches of the V4 segment of the vertebral artery. Informed consent was obtained. The patient was positioned prone with chin tucked. Utilizing a midline suboccipital craniotomy and removal of the arch of C1, the vertebral artery was identified at its V4 segment at it transitions from extra to intradural. The video illustrates how a midline approach can be used to access this lesion and a far lateral approach is not required to access the vertebral artery and its dural branches at the craniocervical junction. Division of the denticulate ligaments and mobilization of the spinal accessory nerve allows visualization of the proximal portion of the draining vein. Important anatomy in this region is demonstrated. The critical use of indocyanine green (ICG) dye is demonstrated as the first 2 clip applications were not proximal enough to obliterate the proximal draining vein and persistent early venous reflux was still seen on ICG. The importance of access to and obliteration of the proximal draining vein is shown. An intraoperative ICG and postoperative angiogram demonstrates complete occlusion of the dural arteriovenous fistula. In this case the patient had minor sensory deficits postoperatively which were resolved by 6 wk postoperatively.

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