Dural arteriovenous fistula of the craniocervical junction along the first cervical nerve: A single-center experience and review of the literature

Iampreechakul, Prasert; Wangtanaphat, Korrapakc; Wattanasen, Yodkhwan; Hangsapruek, Sunisa; Lertbutsayanukul, Punjama; Siriwimonmas, Somkiet

doi:10.1016/j.clineuro.2022.107548

Cited by 5 publications

(20 citation statements)

References 33 publications

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“…Despite advances in endovascular techniques, endovascular embolization alone of CCJ AVFs may not be feasible or safe. [ 3 , 13 , 16 ] In the present case, preoperative endovascular embolization was performed using Onyx to reduce shunt flows. CCJ AVFs supplied by not only dural but also pial arteries have many tiny feeders around the shunt and the draining vein.…”

Section: Discussionmentioning

confidence: 97%

“…[ 3 ] Radicular AVF at the CCJ along the C1 spinal nerve root may be overlooked on routine initial cerebral angiography if bilateral VA injection is not performed. [ 3 ] Contralateral VA angiography would be omitted when confirming retrograde filling of the distal contralateral VA to the level of the PICA on a selective ipsilateral VA injection. In the present case, the right VA angiography showed the lesion, although left VA angiography did not.…”

Section: Discussionmentioning

confidence: 99%

“…Arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) are rare vascular malformations, accounting for approximately 2% of spinal AVFs. [ 1 , 3 ] Typical manifestations of the lesions are subarachnoid hemorrhage or myelopathy induced by chronic venous congestion. [ 2 , 3 , 14 , 15 ] Preoperative diagnosis of CCJ AVFs is challenging because the anatomy of the neurovascular structures is complex.…”

Section: Introductionmentioning

confidence: 99%

“…[ 1 , 3 ] Typical manifestations of the lesions are subarachnoid hemorrhage or myelopathy induced by chronic venous congestion. [ 2 , 3 , 14 , 15 ] Preoperative diagnosis of CCJ AVFs is challenging because the anatomy of the neurovascular structures is complex. CCJ AVFs are diagnosed based on the location of the AV shunt (intradural, dural, and epidural), feeding arteries (spinal cord or dural artery), and draining veins.…”

Section: Introductionmentioning

confidence: 99%

“…In particular, radicular AVFs at the CCJ along the first cervical (C1) spinal nerve are a rare and unique subtype. [ 3 ] Definitive diagnosis is difficult by imaging findings alone and the treatment strategy remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Unique vascular structures of a radicular arteriovenous fistula at the craniocervical junction along the first cervical spinal nerve: A case report

Wada

Tanei

Hattori

et al. 2023

Surgical Neurology International

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Background: An arteriovenous fistula (AVF) at the craniocervical junction (CCJ) is a rare vascular malformation. Definitive diagnosis and curative treatment of CCJ AVF are challenging. Case Description: A 77-year-old man presented with subarachnoid hemorrhage. Cerebral angiography showed an AVF at the CCJ, which drained into a radicular vein. The lesion was fed by a vertebral artery, anterior and lateral spinal arteries (LSAs), and the occipital artery (OA). There were two unique structures: the LSA originating from the posterior inferior cerebellar artery of the extracranial V3 segment and the OA feeding the shunt. Curative treatment involved two steps: endovascular embolization of feeders using Onyx and surgical shunt disconnection. Feeding arteries were blackened by Onyx, which helped identify the location of the shunt. The shunt was located behind the first cervical (C1) spinal nerve, and the draining vein was confirmed on the deep side of the nerve. A clip was applied to the draining vein distal to the shunt. Tiny vessels supplying the shunt were then coagulated referring to blackened arteries. Conclusion: A radicular AVF at the CCJ along the C1 spinal nerve had unique vascular structures. Definitive diagnosis and curative treatment were achieved by combining endovascular embolization using Onyx and direct surgery.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Unique vascular structures of a radicular arteriovenous fistula at the craniocervical junction along the first cervical spinal nerve: A case report

Wada

Tanei

Hattori

et al. 2023

Surgical Neurology International

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Dural arteriovenous fistulas at the craniocervical junction: a systematic review and meta-analysis

Qedair,

Sankarappan,

Mirahmadi Eraghi

et al. 2024

Neurosurg Rev

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Holocord myelopathy misdiagnosed as neuromyelitis optica spectrum disorder (NMOSD): A unique case of dural arteriovenous fistula at the craniocervical junction along first spinal nerve

Iampreechakul,

Sopchokchai,

Wangtanaphat

et al. 2024

Surgical Neurology International

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Background: Dural arteriovenous fistulas (DAVFs) at the craniocervical junction (CCJ) involving the first spinal nerve represent a particularly rare and challenging subtype of DAVFs, with holocord myelopathy secondary to cerebrospinal DAVFs being an exceedingly rare presentation. Case Description: We report the case of a 70-year-old woman who presented with progressive paraparesis over 2 weeks. Initial magnetic resonance imaging (MRI) of the spine showed extensive holocord myelopathy, leading to a misdiagnosis of inflammatory myelopathy and subsequent inappropriate steroid treatment at a local hospital, which exacerbated her neurological symptoms. On transfer to our institution and further evaluation with MRI and magnetic resonance angiography, a lower thoracic DAVF was initially suspected. However, comprehensive spinal angiography failed to localize the fistula, prompting cranial angiography, which ultimately identified a DAVF at the CCJ along the C1 nerve root, supplied by a small radiculomeningeal branch of the left vertebral artery. Successful management involved coagulation of the proximal draining vein, with follow-up imaging confirming complete fistula obliteration and resolution of the holocord edema. Conclusion: This case highlights the diagnostic and therapeutic challenges associated with DAVFs at the CCJ, particularly when presenting with holocord myelopathy. It underscores the importance of a high index of suspicion and the need for timely, accurate diagnosis and intervention to prevent permanent spinal cord damage in such rare and complex cases.

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Dural arteriovenous fistula of the craniocervical junction along the first cervical nerve: A single-center experience and review of the literature

Cited by 5 publications

References 33 publications

Unique vascular structures of a radicular arteriovenous fistula at the craniocervical junction along the first cervical spinal nerve: A case report

Unique vascular structures of a radicular arteriovenous fistula at the craniocervical junction along the first cervical spinal nerve: A case report

Dural arteriovenous fistulas at the craniocervical junction: a systematic review and meta-analysis

Holocord myelopathy misdiagnosed as neuromyelitis optica spectrum disorder (NMOSD): A unique case of dural arteriovenous fistula at the craniocervical junction along first spinal nerve

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