Endovascular Therapy of Radicular Arteriovenous Fistula at the Craniocervical Junction Fed by the Posterior Inferior Cerebellar Artery

Abstract

Objective: Arteriovenous fistula (AVF) at the craniocervical junction (CCJ) is a rare intracranial vascular disorder that is one cause of subarachnoid hemorrhage (SAH). We report on a rare case of AVF at the CCJ, which was mainly supplied by a branch of the posterior inferior cerebellar artery (PICA).Case Presentations: A man in his seventies presented with severe SAH. Angiography revealed that the shunt point was placed in the vicinity of the intradural radicular vein of the right C1 nerve root, and that the C1 radicular artery (C1 RA) was also feeding the AVF. An aneurysm on the PICA branch feeding the shunt was considered a bleeding point. Taking the radiological findings into account, we made the diagnosis of radicular AVF at the CCJ. Transarterial glue embolization obliterated the aneurysm. Brain magnetic resonance (MR) imaging, however, demonstrated infarcts localized in the posterior part of the upper cervical cord and the cerebellum. Conclusion:Arterial anastomotic channels around the CCJ can be the source of ischemic events after glue embolization.

Variations and management for patients with craniocervical junction arteriovenous fistulas: Comparison of dural, radicular, and epidural arteriovenous fistulas

“…However, recent developments in various neuroradiological modalities and accumulation of surgical experience have led to identification of a variation of AVF that includes the combination type of perimedullary and DAVF,[ 28 , 29 ] or RAVF on the spinal nerves located between the spinal cord and dura. [ 18 , 35 ] In the present study, the AVFs were categorized into five subgroups according to the classification proposed by a Japanese study group. [ 4 ] They were, however, exclusively designated as Type 1 (DAVF), Type 2 (RAVF), or Type 4 (EDAVF), because neither Type 3 patients nor Type 5 patients were seen in the current study.…”

“…However, several reports regarding radicular AVFs (RAVFs), which are present between the spinal cord and the dura mater, have recently been published. [ 4 , 18 , 21 , 35 ] Since RAVFs in the craniocervical junction, in particular, may have distinct characteristics, differential diagnosis is of great importance. To clarify their true nature, various radiological examinations and the medical charts of these complicated CCJAVFs were retrospectively analyzed, focusing on the shunting site, angiographical features, comorbidities, treatments, and outcomes.…”