Arteriovenous Fistulas Fed by Spinal Arterial Feeders at the Craniocervical Junction Region

Abstract

BACKGROUND: Arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) region with spinal arterial feeders are rare. There are few reports on such diseases. This study retrospectively reviewed 20 consecutive cases with CCJ AVFs with spinal arterial feeders from our neurosurgical center, which can enrich the experience of diagnosis and treatment of such arteriovenous fistulas. OBJECTIVE: To further explain the clinical manifestations, angiographic characteristics, and treatment strategies of CCJ AVFs with spinal arterial feeders and share the treatment experience of our neurosurgical center. METHODS: A total of 113 patients with CCJ AVFs treated at our institution between January 2013 and December 2020 were enrolled. After analyzing their imaging data, 20 patients with CCJ AVFs with spinal arterial feeders were included. Clinical presentation, angiographic characteristics, intraoperative findings, and treatment outcomes were analyzed. RESULTS: The median age was 52 years (IQR 45-58 years). Twenty-four fistulas were included in this study and were classified based on angiographic characteristics: dural AVF (1 [4.2%] of 24), radicular AVF (15 [62.5%] of 24), epidural AVF (2 [8.3%] of 24), and perimedullary AVF (6 [25.0%] of 24). Subarachnoid hemorrhage occurred in 19 cases (95.0%) and was the main clinical manifestation. Thirteen patients (65.0%) were treated with microsurgery only, 6 (30.0%) with embolization and microsurgery, and 1 (5.0%) with interventional electrocoagulation. Nineteen patients (95.0%) had favorable outcomes. CONCLUSION: Subarachnoid hemorrhage was the most common presentation of CCJ AVFs with spinal arterial feeders. Different treatment strategies should be selected based on different angioarchitecture.

Clinical features, treatment strategies and outcomes of craniocervical junction arteriovenous fistulas: a cohort study of 193 patients

“…The proportion of males in patients with spinal arterial feeders was higher (p=0.002). 22 In this study, the proportion of men and women was about 5:1, which could be due to the high number of patients with spinal arterial feeders. Although CCJ AVF tended to occur in middle-aged people, patients with VHM were older (p<0.001), which could be due to the insidious onset and longer duration of the disease, resulting in misdiagnosis in many patients.…”

Transarterial embolization of radicular arteriovenous fistula at the craniocervical junction

“…On the other hand, in the acute phase of hemorrhage, due to brain swelling, it is considered difficult to ensure the operative field. In addition, Song et al [10] reported that, in most cases of AVFs at CCJ fed by ASA, the fistula was often situated on the ventral side of spinal cord, and it was almost impossible to expose and clip the aneurysm associated with the AVF during direct surgery, so endovascular embolization was a useful treatment.…”

Arteriovenous fistulas in the craniocervical junction region: With vs. without spinal arterial feeders

“…In the previous study, we carefully explored the classification and treatment strategies of CCJ AVFs with spinal arterial feeders using our single-center data (9). In the present study, we divided the CCJ AVFs into two groups according to whether they were with or without spinal arterial feeders to explore the differences between the two groups in clinical presentation and treatment strategies.…”