A Case of Dural Arteriovenous Fistulas at the Craniocervical Junction Presenting with Occipital/Neck Pain Associated with Sleep

Suda, Satoshi; Katsura, Ken‐ichiro; Okubo, Seiji; Abe, Arata; Kanamaru, Takuya; Ueda, Masayuki; Mishina, Masayoshi; Yamazaki, Mineo; Katayama, Yasuo

doi:10.2169/internalmedicine.51.6607

Cited by 9 publications

(4 citation statements)

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“…Myelopathy also remains the main presenting symptom. Atypical presentations included brainstem/cerebellar dysfunction,12 22 24–26 29 radiculopathy,5 cranial nerve palsy,23 and occipital neuralgia 30 31. Brainstem dysfunction as the initial symptom has often been reported in intracranial DAVFs, but is rarely documented in craniocervical DAVFs.…”

Section: Discussionmentioning

confidence: 99%

Dural arteriovenous fistulas at the craniocervical junction: a systematic review

Zhao

Ren

et al. 2015

J NeuroIntervent Surg

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DAVFs at the craniocervical junction are rare lesions, which often present with hemorrhage. Intracranial venous drainage and a venous varix are associated with increased risk of SAH. Surgical interruption of the feeding arteries or draining veins is an effective and reliable method for treating DAVFs at the craniocervical junction. Embolization is a feasible alternative to surgery in the treatment of selective DAVFs.

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Section: Discussionmentioning

confidence: 99%

Dural arteriovenous fistulas at the craniocervical junction: a systematic review

Zhao

Ren

et al. 2015

J NeuroIntervent Surg

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“…The main result of the present analysis on dural AVFs at the craniocervical junction was the high frequency of venous congestion of the brainstem (Fig. 2): 12 out of 56 lesions (21%) had venous congestion in the medulla (n = 12) 3,8,13,16,18,21,25) and/or pons (n = 2). 8,20) Venous congestion of the brainstem was associated with brainstem dysfunctions, including respiratory disturbances as well as disability of the four extremities.…”

Section: Dural Avfmentioning

confidence: 70%

Update on the Diagnosis and Treatment of Arteriovenous Fistulas at the Craniocervical Junction: A Systematic Review of 92 Cases

Takai

2019

JNET

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The purpose of this study was to provide an update on recent developments in the diagnosis and treatment of arteriovenous fistulas at the craniocervical junction (CCJ AVFs).Methods: Associated literature published between 2009 and 2018 on the PubMed database was reviewed. Results:The systematic review identified 97 lesions in 92 cases of CCJ AVFs. These lesions were divided into three groups according to their angioarchitecture: 56 lesions of dural AVFs, 34 of intradural AVFs, and 7 of extradural AVFs.Clinical features, neuroimaging findings, treatments, and outcomes were compared among the three groups. Cases of dural AVFs were commonly associated with myelopathy and/or brainstem dysfunction due to venous congestion in the spinal cord (38%) and/or brainstem (21%). Cases of intradural AVFs had a more complex angioarchitecture than those of dural AVFs and were associated with a hemorrhagic presentation (83%). Of the 34 intradural AVFs, 25 lesions (74%) had a feeder aneurysm (n = 20) or varix (n = 5). The development of the aneurysm/varix may be attributed to hemodynamic and flow-related phenomena. The surgical obliteration of the intradural drainer and/or feeder was effective in most cases of dural and intradural AVFs. Endovascular embolization may be more effective in cases of extradural AVFs than in those of dural or intradural AVFs. No permanent neurologic complications occurred in 80 cases treated by surgery; however, brain infarction occurred in 2 (9%) of 22 cases treated by endovascular embolization. Good recovery was more frequently achieved in cases of intradural (79%) and extradural AVFs (100%) than in those of dural AVFs (61%) because cases with hemorrhagic presentation had fewer permanent neurologic deficits than those with venous congestion. Conclusion:A differential diagnosis among dural, intradural, and extradural AVFs is important because clinical features, neuroimaging findings, and treatment outcomes markedly differ among the three groups.Keywords▶ arteriovenous shunt, arteriovenous fistula, angioarchitecture, pathophysiology, treatment MethodsTo investigate the clinical and neuroimaging findings of patients with CCJ AVFs, the associated literature was systematically reviewed. The PubMed database was searched

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“…A craniocervical junction arteriovenous fistula (CCJAVF) is a rare and peculiar disorder causing subarachnoid hemorrhage (SAH), myelopathy, brain stem dysfunction, occipital neuralgia, or neck pain, although thoracolumbar spinal arteriovenous fistulas (AVFs) mainly affect men and usually cause slowly progressive myelopathy due to venous congestion. [ 11 , 33 , 34 , 41 , 45 ] A Japanese nationwide surveillance study documented that CCJAVFs accounted for 2.4% of all dural AVF (DAVF) patients. [ 12 ] Recent developments in neuroradiological modalities have provided high-quality, three-dimensional angioarchitecture images to accurately clarify the location of the shunt point.…”

Section: Introductionmentioning

confidence: 99%

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

Matsubara

Toi

Takai

et al. 2021

Surgical Neurology International

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Background: Craniocervical junction arteriovenous fistulas (CCJAVFs) are known to be rare, but variations and clinical behaviors remain controversial. Methods: A total of 11 CCJAVF patients (M: F=9:2, age 54–77 years) were investigated. Based on the radiological and intraoperative findings, they were categorized into three types: dural AVF (DAVF), radicular AVF (RAVF), and epidural AVF (EDAVF). Results: There were four symptomatic patients (subarachnoid hemorrhage in two, myelopathy in one, and tinnitus in one) and seven asymptomatic patients in whom coincidental CCJAVFs were discovered on imaging studies for other vascular diseases (arteriovenous malformation in one, intracranial DAVF in two, ruptured cerebral aneurysm in two, and carotid artery stenosis in two). Of these 11 patients, 2 (18.2%) had multiple CCJAVFs. Of 14 lesions, the diagnoses were DAVF in 5, RAVF in 3, and EDAVF in 6 (C1–C2 level ratio =5:0, 2:1, 3:3). Patients with DAVF/RAVF in four lesions with intradural venous reflux underwent surgery, although an RAVF remained in one lesion after embolization/radiation. Since all six EDAVFs, two DAVFs, and one RAVF had neither feeder aneurysms nor significant symptoms, no treatment was provided; of these nine lesions, one DAVF and one RAVF remained unchanged, whereas six EDAVFs showed spontaneous obliteration within a year. Unfortunately, however, one DAVF bled before elective surgery. Conclusion: CCJAVFs have many variations of shunting site, angioarchitecture, and multiplicity, and they were frequently associated with coincidental vascular lesions. For symptomatic DAVF/RAVF lesions with intradural drainage, surgery is preferred, whereas asymptomatic EDAVFs without dangerous drainage may obliterate during their natural course.

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A Case of Dural Arteriovenous Fistulas at the Craniocervical Junction Presenting with Occipital/Neck Pain Associated with Sleep

Cited by 9 publications

References 10 publications

Dural arteriovenous fistulas at the craniocervical junction: a systematic review

Dural arteriovenous fistulas at the craniocervical junction: a systematic review

Update on the Diagnosis and Treatment of Arteriovenous Fistulas at the Craniocervical Junction: A Systematic Review of 92 Cases

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

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