scholarly journals Letter: Craniocervical Junction Vertebral Artery Dural Arteriovenous Fistula With Cranial and Spinal Venous Reflux: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Chih-Hsiang Liao ◽  
Chung-Hsin Lee ◽  
Yuang-Seng Tsuei
Keyword(s):  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Craniocervical Junction ◽  
Venous Reflux

Craniocervical Junction Vertebral Artery Dural Arteriovenous Fistula With Cranial and Spinal Venous Reflux: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (5) ◽  
pp. E162-E163 ◽  
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.

scholarly journals Progressive Myelopathy From a Craniocervical Junction Dural Arteriovenous Fistula

Stroke ◽  
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

Dural Arteriovenous Fistula With Sinus Thrombosis and Venous Reflux Presenting as Parkinsonism

2019 ◽  
Vol 24 (4) ◽  
pp. 132-135
Author(s):  
Chia-Wei Chang ◽  
Hung-Chang Hung ◽  
Jiao-I Tsai ◽  
Po-Chang Lee ◽  
Shih-Chang Hung
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Sinus Thrombosis ◽  
Venous Reflux

“Loop-like formation” in the cortical venous reflux of dural arteriovenous fistula with intracranial hemorrhage

2014 ◽  
Vol 41 (5) ◽  
pp. 316-321 ◽  
Author(s):  
Masaomi Koyanagi ◽  
Nobuyuki Sakai ◽  
Hidemitsu Adachi ◽  
Yasushi Ueno ◽  
Takeharu Kunieda ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Intracranial Hemorrhage ◽  
Dural Arteriovenous Fistula ◽  
Venous Reflux ◽  
Cortical Venous Reflux

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

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.

Abstract T P368: Subcortical Calcification on CT as Diagnostic Sign of Transverse-Sigmoid Dural Arteriovenous Fistula With Cortical Venous Reflux

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shunji Mugikura ◽  
Takahiro Metoki ◽  
Takaki Murata ◽  
Noriko Kurihara ◽  
Yasushi Matsumoto ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Clinical Symptoms ◽  
Posterior Part ◽  
Ct Scans ◽  
Venous Reflux ◽  
Specific Symptom ◽  
Diagnostic Sign ◽  
Cortical Venous Reflux ◽  
Diagnostic Symptoms

Background: and purpose The annual mortality rate of the patients who had dural arteriovenous fistula (dAVF) with cortical venous reflux (CVR) is high without treatment and early diagnosis is considered desirable. However, diagnostic symptoms of dAVF with CVR are varied and sometimes non specific or chronic one such as tinnitus, headache, dizziness, dementia and so on, which causes of delay in diagnosis. We sought to determine the subcortical calcifications on computed tomography (CT) scans as the diagnostic sign of dAVF with CVR. Material and methods: In 119 consecutive patients diagnosed with dAVF by the cerebral angiographic findings, we reviewed for the prevalence of subcortical calcifications on CT, shunting sites and side of shunting and the presence of cortical venous reflux (CVR) on angiograms and clinical symptoms leading to the diagnosis (diagnostic symptoms). Results: Subcortical calcifications on CT scans were seen in 10 patients (8.4% of 119 patients with dAVF). All of them had dAVF of transverse-sigmoid sinus (TS-dAVF) with CVR. Prevalence of subcortical calcifications was significantly higher in patients with TS-dAVF (P<0.001) (21%, 10 of 48 patients) than in patients with other than TS-dAVF (0 of 71 patients), and significantly higher in patients with CVR (P<0.001) (19 %, 10 of 52 patients) than in patients without CVR (0%, 0 of 67 patients). Subcortical calcifications tended to limited in the posterior part of the same hemisphere as hemisphere with shunting and appeared to be curvilinear ones predominantly involving the cortico-medullary junction at the bottom of cerebral gyri. Prevalence of subcortical calcifications was significantly higher in patients with chronic or non specific symptom (P<0.001, 26 %, 8 of 31 patients) than those with acute or ophthalmic symptom (2%, 2 of 88 patients). Conclusion: Subcortical calcification on CT is a sign of TS-dAVF with CVR, specifically in patients who present chronic or non specific symptoms. Subcortical calcifications found in TS-dAVF could be caused by venous congestion due to long-lasting CVR without being noticed or diagnosed.

scholarly journals Foramen magnum dural arteriovenous fistula presenting with epilepsy

2015 ◽  
Vol 21 (6) ◽  
pp. 724-727 ◽  
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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