Foramen magnum dural arteriovenous fistula presenting with epilepsy

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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Bilateral Cervical Spinal Dural Arteriovenous Fistulas with Intracranial Venous Drainage Mimicking a Foramen Magnum Dural Arteriovenous Fistula

Interventional Neuroradiology ◽

10.1177/159101991301900413 ◽

2013 ◽

Vol 19 (4) ◽

pp. 483-488 ◽

Cited By ~ 6

Author(s):

Steven W. Hetts ◽

Joey D. English ◽

Shirley I. Stiver ◽

Vineeta Singh ◽

Erin J. Yee ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Foramen Magnum ◽

Venous Hypertension ◽

Complex Case ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Diagnostic Angiography ◽

Spinal Dural Arteriovenous Fistulas

We describe a unique case of bilateral cervical spinal dural arteriovenous fistulas mimicking an intracranial dural arteriovenous fistula near the foramen magnum. We review its detection via MRI and digital subtraction angiography and subsequent management through surgical intervention. Pitfalls in diagnostic angiography are discussed with reference to accurate location of the fistula site. The venous anastomotic connections of the posterior midline spinal vein to the medial posterior medullary vein, posterior fossa bridging veins, and dural venous sinuses of the skull base are discussed with reference to problem-solving in this complex case. The mechanism of myelopathy through venous hypertension produced by spinal dural fistulas is also emphasized.

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Intracranial Dural Arteriovenous Fistula Presenting with Tetraparesis Due to Cervicomedullary Junction Compression

Interventional Neuroradiology ◽

10.1177/159101990401000410 ◽

2004 ◽

Vol 10 (4) ◽

pp. 347-351 ◽

Cited By ~ 4

Author(s):

S.M. Chng ◽

Y.Y. Sitoh ◽

F. Hui

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Foramen Magnum ◽

Venous Hypertension ◽

Good Reduction ◽

Arteriovenous Fistulas ◽

Cervicomedullary Junction ◽

Dural Arteriovenous Fistulas ◽

Glue Embolization

Cranial dural arteriovenous fistulas (DAVFs) may give rise to myelopathy due to spinal perimedullary venous drainage causing intramedullary venous hypertension. Such cases are uncommon but not rare, with several cases reported in the literature. We report a case of foramen magnum DAVF presenting with symptoms of tetraparesis. The unusual feature was that in this case it was due to compression of the cervicomedullary junction by a large venous pouch rather than the result of spinal perimedullary venous hypertension. Transarterial glue embolization achieved good reduction of flow in the fistula with shrinkage of the venous pouch and corresponding clinical improvement.

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Dural arteriovenous fistulas presenting with brainstem dysfunction: diagnosis and surgical treatment

Neurosurgical FOCUS ◽

10.3171/2012.2.focus1217 ◽

2012 ◽

Vol 32 (5) ◽

pp. E10 ◽

Cited By ~ 14

Author(s):

Charles Kulwin ◽

Bradley N. Bohnstedt ◽

John A. Scott ◽

Aaron Cohen-Gadol

Keyword(s):

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Craniocervical Junction ◽

Rare Entity ◽

Arteriovenous Fistulas ◽

Drainage Patterns ◽

Clinical Presentations ◽

Wide Range ◽

Brainstem Dysfunction ◽

Dural Arteriovenous Fistulas

A cerebral dural arteriovenous fistula (DAVF) is an acquired abnormal arterial-to-venous connection within the leaves of the intracranial dura with a wide range of clinical presentations and natural history. The Cognard classification correlates venous drainage patterns with neurological course, identifying 5 DAVF types with increasing rates of symptomatic presentation. A spinal DAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dural leaflets of the nerve root sleeve. A cervical DAVF is a rare entity, as most spinal DAVFs present as thoracolumbar lesions with myelopathy. In this paper the authors present 2 patients presenting initially with brainstem dysfunction rather than myelopathy secondary to craniocervical DAVF. The literature is then reviewed for similar rare aggressive DAVFs at the craniocervical junction presenting with brainstem symptomatology.

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Spinal dural arteriovenous fistula associated with a spinal perimedullary fistula

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.3.241 ◽

2006 ◽

Vol 4 (3) ◽

pp. 241-245 ◽

Cited By ~ 20

Author(s):

Timo Krings ◽

Volker A. Coenen ◽

Martin Weinzierl ◽

Marcus H. T. Reinges ◽

Michael Mull ◽

...

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Vascular Malformations ◽

Venous Drainage ◽

Elevated Pressure ◽

Spinal Dural Arteriovenous Fistula ◽

Arteriovenous Fistulas ◽

Progressive Myelopathy ◽

Dural Arteriovenous Fistulas

✓ Among spinal cord vascular malformations, dural arteriovenous fistulas (DAVFs) must be distinguished from intradural malformations. The concurrence of both is extremely rare. The authors report the case of a 35-year-old man who suffered from progressive myelopathy and who harbored both a DAVF and an intradural perimedullary fistula. During surgery, both fistulas were identified, confirmed, and subsequently obliterated. The fistulas were located at two levels directly adjacent to each other. Although the incidence of concurrent spinal DAVFs is presumed to be approximately 2%, the combination of a dural and an intradural fistula is exceedingly rare; only two other cases have been reported in the literature. One can speculate whether the alteration in venous drainage caused by the (presumably congenital) perimedullary fistula could possibly promote the production of a second dural fistula due to elevated pressure with concomitant venous stagnation and subsequent thrombosis. The authors conclude that despite the rarity of dual pathological entities, the clinician should be aware of the possibility of the concurrence of more than one spinal fistula in the same patient.

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A case of dural arteriovenous fistula at the craniocervical junction with intramedullary hemorrhage in the medulla oblongata caused by venous congestion

Nosotchu ◽

10.3995/jstroke.10951 ◽

2021 ◽

Author(s):

Kazuki Sogawa ◽

Koichi Satoh ◽

Masaaki Korai ◽

Mami Hanaoka ◽

Tadashi Yamaguchi ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Medulla Oblongata ◽

Dural Arteriovenous Fistula ◽

Craniocervical Junction ◽

Venous Congestion

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Dural arteriovenous fistula in the sphenoid bone lesser wing region: Endovascular adjuvant techniques of treatment and literature review

Interventional Neuroradiology ◽

10.1177/1591019918777233 ◽

2018 ◽

Vol 24 (5) ◽

pp. 559-566 ◽

Cited By ~ 6

Author(s):

Dmitriy V Kandyba ◽

Konstantin N Babichev ◽

Artem V Stanishevskiy ◽

Arevik A Abramyan ◽

Dmytriy V Svistov

Keyword(s):

Literature Review ◽

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Sphenoid Bone ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

The Given ◽

Balloon Protection

This article describes the successful endovascular treatment of a dural arteriovenous fistula of a rare localization (the area of sphenoid bone lesser region). We examine one report of an unusually located dural arteriovenous fistula successfully treated with Onyx (ev3, Irvine, USA) using a combination of endovascular adjuvant techniques: pressure cooker and remodeling balloon protection of cerebral artery. The article includes previously published observations of such fistulas and discusses anatomic features and venous drainage of dural arteriovenous fistulas in the given location.

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Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm

Interventional Neuroradiology ◽

10.1177/1591019919874571 ◽

2019 ◽

Vol 26 (2) ◽

pp. 170-177

Author(s):

Keisuke Yoshida ◽

Shinsuke Sato ◽

Tatsuya Inoue ◽

Bikei Ryu ◽

Shogo Shima ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Arteriovenous Fistula ◽

Vascular Malformations ◽

Transarterial Embolization ◽

Venous Drainage ◽

Craniocervical Junction ◽

Transvenous Embolization ◽

Arteriovenous Fistulas ◽

Complete Obliteration ◽

Transvenous Approach

Arteriovenous fistulas at the craniocervical junction are rare vascular malformations with frequent hemorrhagic presentations, which may have a concurrent pial feeder aneurysm. A 65-year-old man presented with subarachnoid hemorrhage and angiography showed an epidural arteriovenous fistula at the C-2 level with an anterior spinal feeder aneurysm without perimedullary venous drainage. Transarterial coil embolization of the ruptured aneurysm and partial Onyx embolization of the shunt led to thrombosis of the aneurysm. However, three years later angiography showed an increased shunt flow and recurrence of the aneurysm. Transvenous embolization of the shunt using coils and Onyx yielded complete obliteration of the shunt, thus leading to occlusion of the aneurysm. This case demonstrates that partial transarterial embolization of arteriovenous fistula leaves a risk of rebleeding, whereas complete obliteration of the shunt with a transvenous approach can lead to disappearance of the flow-related aneurysm without embolization of the aneurysm itself.

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Balloon-backstop technique: Preserving physiologic venous drainage during transvenous coil embolization of sigmoid sinus dural arteriovenous fistulas

The Neuroradiology Journal ◽

10.1177/19714009211042898 ◽

2021 ◽

pp. 197140092110428

Author(s):

Madhavi Duvvuri ◽

Michael T Caton ◽

Kazim Narsinh ◽

Matthew R Amans

Keyword(s):

Arteriovenous Fistula ◽

Coil Embolization ◽

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Sigmoid Sinus ◽

Transvenous Embolization ◽

Venous Infarction ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Superior Petrosal Sinus

Dural arteriovenous fistulas can lead to catastrophic intracranial hemorrhage if left untreated. Transvenous embolization can cure arteriovenous fistulas, but preserving normal venous structures can be challenging. Inadvertent embolization of a functioning vein can result in catastrophic venous infarction or hemorrhage. Here, we report a case using balloon-assistance to facilitate preservation of the superior petrosal sinus during transvenous embolization of a sigmoid sinus dural arteriovenous fistula.

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