Complex spinal arteriovenous fistula of the craniocervical junction with pial and dural shunts combined with contralateral dural arteriovenous fistula

A high cervical dural arteriovenous fistula (dAVF) is relatively rare and tends to have different features, as compared with a thoracolumbar dAVF. Here, we report a case involving a complex AVF located at the craniocervical junction that was fed by the dural and pial arteries, combined with a contralateral dAVF.

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Progressive Myelopathy From a Craniocervical Junction Dural Arteriovenous Fistula

Stroke ◽

10.1161/strokeaha.120.032552 ◽

2021 ◽

Author(s):

Ryan M. Naylor ◽

Britney Topinka ◽

Lorenzo Rinaldo ◽

Jaclyn Jacobi ◽

Bryan Neth ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Craniocervical Junction ◽

Progressive Myelopathy

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Dural arteriovenous fistula of the craniocervical junction manifesting as cerebellar haemorrhage

The Neuroradiology Journal ◽

10.1177/1971400916665374 ◽

2016 ◽

Vol 29 (5) ◽

pp. 356-360 ◽

Cited By ~ 6

Author(s):

Joji Inamasu ◽

Riki Tanaka ◽

Ichiro Nakahara ◽

Yuichi Hirose

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Craniocervical Junction ◽

Cerebellar Haemorrhage

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Enhanced MR angiography for depiction of spinal dural arteriovenous fistula in the craniocervical junction

Journal of Neuroradiology ◽

10.1016/j.neurad.2010.08.003 ◽

2011 ◽

Vol 38 (3) ◽

pp. 196-198

Author(s):

T. Yamashita ◽

S. Takehara ◽

K. Miyazaki ◽

Y. Kitahama ◽

H. Namba

Keyword(s):

Arteriovenous Fistula ◽

Mr Angiography ◽

Dural Arteriovenous Fistula ◽

Craniocervical Junction ◽

Spinal Dural Arteriovenous Fistula

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Far Lateral Approach for Disconnection of Craniocervical Junction Dural Arteriovenous Fistula Presented with Myelopathy and Hydrocephalus

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1714402 ◽

2020 ◽

Author(s):

Siu Kei Samuel Lam ◽

Sai Lok Chu ◽

Shing Chau Yuen ◽

Kwong Yui Yam

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Hybrid Approach ◽

Normal Pressure ◽

Craniocervical Junction ◽

Lateral Approach ◽

External Carotid Artery ◽

External Carotid ◽

Far Lateral Approach ◽

Far Lateral

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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Foramen magnum dural arteriovenous fistula presenting with epilepsy

Interventional Neuroradiology ◽

10.1177/1591019915609783 ◽

2015 ◽

Vol 21 (6) ◽

pp. 724-727 ◽

Cited By ~ 8

Author(s):

Raoul Pop ◽

Monica Manisor ◽

Ziad Aloraini ◽

Salvatore Chibarro ◽

Francois Proust ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Clonic Seizure ◽

Craniocervical Junction ◽

Foramen Magnum ◽

Venous Congestion ◽

Arteriovenous Fistulas ◽

Complex Anatomy ◽

Significant Clinical Improvement

Intracranial dural arteriovenous fistulas (dAVFs) with perimedullary drainage represent a rare subtype of intracranial dAVF. Patients usually experience slowly progressive ascending myelopathy and/or lower brainstem signs. We present a case of foramen magnum dural arteriovenous fistula with an atypical clinical presentation. The patient initially presented with a generalised tonic-clonic seizure and no signs of myelopathy, followed one month later by rapidly progressive tetraplegia and respiratory insufficiency. The venous drainage of the fistula was directed both to the left temporal lobe and to the perimedullary veins (type III + V), causing venous congestion and oedema in these areas and explaining this unusual combination of symptoms. Rotational angiography and overlays with magnetic resonance imaging volumes were helpful in delineating the complex anatomy of the fistula. After endovascular embolisation, there was complete remission of venous congestion on imaging and significant clinical improvement. To our knowledge, this is the first report of a craniocervical junction fistula presenting with epilepsy.

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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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