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

Murase, Sho; Fukumura, Masao; Kuroda, Yuzo; Gon, Yasufumi; Nakazawa, Keiji

doi:10.1016/j.inat.2021.101399

Cited by 1 publication

(6 citation statements)

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“…The drainage pattern of CCJ AVFs determines their clinical manifestation. CCJ AVFs with downward drainage mainly result in congestive myelopathy ( Figure 8 ), whereas those with upward drainage usually result in hemorrhage due to draining vein rupture ( Figures 9 , 10 ) ( 4 , 65 , 66 ). In addition, increased hemodynamic stress may lead to varices of the draining veins in nearly 80% of high cervical CCJ AVFs ( 36 , 53 , 55 ).…”

Section: Angioarchitecture Of High Cervical Ccj Avfsmentioning

confidence: 99%

“…High cervical CCJ AVFs can often present as acute hemorrhage, myelopathy, brainstem dysfunction, radiculopathy, etc. ( 2 , 4 , 36 , 44 , 53 , 61 , 66 , 78–81 ). For symptomatic or ruptured high cervical CCJ AVFs, treatment should be prompt, including open surgery, EVT or both ( 53 ).…”

Section: Treatment Options For High Cervical Ccj Avfsmentioning

confidence: 99%

“…Although EVT reportedly has the benefit of being a minimally invasive procedure, it is not the best choice for high cervical CCJ AVFs ( 44 , 80 , 82 ). In EVT, the feeding arteries are usually very thin and tortuous and arise from the VA at a straight angle, which makes transarterial catheterization difficult for the fistula ( 66 ). Due to substantial feeder vessel tortuosity and diminutive caliber, transarterial EVT may harbor a risk of vessel perforation during microcatheterization.…”

Section: Treatment Options For High Cervical Ccj Avfsmentioning

confidence: 99%

“…For type 1 CCJ DAVFs, EVT may be considered ( 54 ). For instance, in the report by Murase et al, a CCJ DAVF with a single feeding artery was successfully embolized by glue under the balloon-assisted technique ( 66 ).…”

Section: Treatment Options For High Cervical Ccj Avfsmentioning

confidence: 99%

“…Compared to EVT, open surgery has a higher rate of obliteration and is still considered first-line management for high cervical CCJ AVFs ( Figures 8 , 13 ) ( 4 , 5 , 35 , 56 , 62 , 66 , 85 , 86 ). For CCJ DAVFs and RAVFs with an intradural feeder, the surgical goal is to interrupt the intradural feeder and the draining vein by suboccipital craniotomy and C1 laminectomy.…”

Section: Treatment Options For High Cervical Ccj Avfsmentioning

confidence: 99%

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Treatment of high cervical arteriovenous fistulas in the craniocervical junction region

2023

Front. Neurol.

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The craniocervical junction (CCJ) is a complex region. Rarely, arteriovenous fistulas (AVFs) can occur in the CCJ region. Currently, it is accepted that CCJ AVFs should only refer to AVFs at the C1-C2 levels. It is reasonable to assume that high cervical CCJ AVFs are being referred to when discussing CCJ AVFs. High cervical CCJ AVFs can be divided into the following four types: dural AVF, radicular AVF, epidural AVF and perimedullary AVF. Until now, it was difficult to understand high cervical CCJ AVFs and provide a proper treatment for them. Therefore, an updated review of high cervical CCJ AVFs is necessary. In this review, the following issues are discussed: the definition of high cervical CCJ AVFs, vessel anatomy of the CCJ region, angioarchitecture of high cervical CCJ AVFs, treatment options, prognoses and complications. Based on the review and our experience, we found that the four types of high cervical CCJ AVFs share similar clinical and imaging characteristics. Patients may present with intracranial hemorrhage or congestive myelopathy. Treatment, including open surgery and endovascular treatment (EVT), can be used for symptomatic AVFs. Most high cervical CCJ AVFs can be effectively treated with open surgery. EVT remains challenging due to a high rate of incomplete obliteration and complications, and it can only be performed in superselective AVFs with simple angioarchitecture. Appropriate treatment can lead to a good prognosis.

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