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 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.

scholarly journals Foramen Magnum Meningioma: Far Lateral Approach

2019 ◽  
Vol 80 (S 04) ◽  
pp. S363-S364
Author(s):  
Ciro Vasquez ◽  
Alexander Yang ◽  
A. Samy Youssef
Keyword(s):  
Vertebral Artery ◽  
Cranial Nerves ◽  
Mass Effect ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Occipital Condyle ◽  
Far Lateral Approach ◽  
Far Lateral

We present a case of a foramen magnum meningioma in a 42-year-old female who presented with headaches for 2 years, associated with decreased sensation and overall feeling of “heaviness” of the right arm. The tumor posed significant mass effect on the brainstem, and given the location of the tumor in the anterolateral region of the foramen magnum, a right far lateral approach was chosen. The approach incorporates the interfascial dissection technique to safely expose and preserve the vertebral artery in the suboccipital triangle. After drilling the posteromedial portion of the occipital condyle and opening the dura, the tumor can be entirely exposed with minimal retraction on the cerebellum. The working space offered by the far lateral approach allows careful dissection at the lateral craniocervical junction, and preservation of the V4 segment of the vertebral artery and the lower cranial nerves. Simpson's grade-2 resection was achieved with coagulation of the dural base around the vertebral artery. The postoperative course was unremarkable for any neurological deficits. At the 2-year follow-up, imaging identified no recurrence of tumor and the patient remains asymptomatic.The link to the video can be found at: https://youtu.be/IMN1O7vO5B0.

scholarly journals Far lateral approach for microsurgical ligation of C1 dural arteriovenous fistula: surgical anatomy and technical nuances

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V6
Author(s):  
Varun R. Kshettry ◽  
Nina Z. Moore ◽  
Mark Bain
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Lateral Approach ◽  
Surgical Anatomy ◽  
Drainage Pattern ◽  
Mr Image ◽  
Far Lateral Approach ◽  
Far Lateral

This video demonstrates the diagnosis and surgical ligation of a C1 dural arteriovenous fistula via a far lateral, transcondylar approach. The patient’s dural arteriovenous fistula was identified by MRI signal changes in the spinal cord and a cerebrospinal angiogram demonstrating an abnormal hypertrophied early venous drainage pattern suggestive of a C1 vessel origin. Indocyanine green was used to verify surgical treatment of the fistula intraoperatively. A postoperative angiogram and MR image demonstrate fistula occlusion and resolution of the spinal cord edema. Anatomic details and technical nuances of the approach are demonstrated.The video can be found here: https://youtu.be/zSd0vuov8xk.

scholarly journals Resection of a Meningioma at Craniocervical Junction through Far Lateral Approach: Two-Dimensional Operative Video

2019 ◽  
Vol 80 (S 04) ◽  
pp. S358-S359
Author(s):  
Yong Yan ◽  
Hongxiang Wang ◽  
Tao Xu ◽  
Zhenyu Gong ◽  
Fan Hong ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Medulla Oblongata ◽  
Posterior Inferior Cerebellar Artery ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
World Health ◽  
Neurological Deficits ◽  
Who Grade ◽  
Far Lateral Approach ◽  
Far Lateral

Tumors located in the craniocervical junction region are significantly challenging for surgical resection. We shared our experience of a meningioma at craniocervical junction resected through far lateral approach in a 68-year-old female. The patient presented with intermittent headache with discomfort in the neck and shoulders for 3 years without any positive signs. Magnetic resonance imaging (MRI) revealed a tumor of 3.6 cm × 3.0 cm × 2.5 cm lying at the ventral side of medulla oblongata, with T1 hypointensity, T2 hyperintensity, and a significant enhancement on T1-contrast image. The far lateral approach on the right side was planned to resect the tumor with a park-bench position. The patient underwent a standard craniotomy using a lazy S-shaped incision. The transposition of vertebral artery was performed carefully therein, followed by removal of part of the arches of atlas and axis. After exposure of the tumor, vertebral artery (VA) and posterior inferior cerebellar artery (PICA) adhesive to the lesion could be seen operatively. Truncating the supplying blood vessels of the tumor was taken as the first step, followed by resecting the tumor mass in a piecemeal manner. While preserving VA, PICA, posterior nerves, medulla oblongata, and cervical cord, gross-total resection was achieved under the careful operation. The patient tolerated the procedure well without any neurological deficits. Histological examination confirmed the tumor as a meningioma (World Health Organization [WHO] grade I). Postoperative MRI scan depicted complete resection of the tumor. The patient remained symptom free without any evidence of recurrence during the follow-up period of 1 year. Informed consent was obtained from the patient.The link to the video can be found at: https://youtu.be/i9H-wS4fF10.

scholarly journals Trapping and V3-radial artery graft-V4 bypass for ruptured dissecting aneurysm of the vertebral artery

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video1 ◽  
Author(s):  
Tomohiro Inoue ◽  
Akira Tamura ◽  
Isamu Saito
Keyword(s):  
Vertebral Artery ◽  
Radial Artery ◽  
Cranial Nerves ◽  
Artery Aneurysm ◽  
Lateral Approach ◽  
Dissecting Aneurysm ◽  
Occipital Artery ◽  
Spinal Root ◽  
Suboccipital Craniotomy ◽  
Far Lateral Approach

The authors show a surgical technique of trapping/resection of ruptured dominant vertebral artery aneurysm in conjunction with reconstruction of vertebral artery by V3–radial artery (RA) graft–V4 bypass through suboccipital craniotomy and far lateral approach. Step by step muscle dissection in posterior fossa enable fine exposure of occipital artery for possible OA-PICA bypass and V3 portion of vertebral artery. Extradural drilling of posterior one-third condyle and condylar fossa facilitate exposure of triangular surgical corridor made by medulla, spinal root of 11th nerve and lower cranial nerves, and thus enabling aneurismal resection and RA–V4 anastomosis.The video can be found here: http://youtu.be/LxsARGdHSVw.

scholarly journals Application of the selective indocyanine green videoangiography in microsurgical treatment of a craniocervical junction dural arteriovenous fistula

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V5 ◽  
Author(s):  
Liyong Sun ◽  
Jian Ren ◽  
Hongqi Zhang
Keyword(s):  
Indocyanine Green ◽  
Arteriovenous Fistula ◽  
Operative Technique ◽  
Dural Arteriovenous Fistula ◽  
Craniocervical Junction ◽  
Indocyanine Green Videoangiography ◽  
Unique Type ◽  
Midline Approach ◽  
Neurovascular Anatomy ◽  
Fistula Site

Craniocervical junction dural arteriovenous fistula (CCJDAVF) is a rare and unique type of intracranial DAVF with complex neurovascular anatomy, making it difficult to identify the arterialized vein during operation. The authors report the case of a 50-year-old male who presented with symptoms of venous hypertensive myelopathy. Angiography demonstrated a left CCJDAVF. The fistula was successfully disconnected via a suboccipital midline approach. The selective indocyanine green videoangiography (SICG-VA) technique was applied to distinguish the fistula site and arterialized vein from adjacent normal vessels. Favorable clinical and angiographic outcomes were attained. The detailed operative technique, surgical nuances, and utility of SICG-VA are illustrated in this video atlas.The video can be found here: https://youtu.be/GJYl_jOJQqU.

Sign in / Sign up

Export Citation Format

Share Document