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Peeters JB, Bojanowski MW. Surgical treatment of marginal sinus dural arteriovenous fistula: a narrative review. Neurochirurgie 2024; 70:101534. [PMID: 38301429 DOI: 10.1016/j.neuchi.2024.101534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Dural arteriovenous fistulas of the marginal sinus (DAVFms) are uncommon and complex, with varied symptoms. Their complexity is heightened by the region's dense anastomotic network, posing risks for endovascular treatment. Surgical intervention can be effective, but this depends on thorough pre-operative understanding and optimal intra-operative visualization of the fistula. OBJECTIVE To review the relevant anatomy, presentation patterns of DAVFms, and provide insights for surgical treatment. METHODS Recent literature on DAVFms was reviewed, and three surgical cases are discussed to highlight treatment principles. RESULTS The symptoms of a DAVFms vary depending on its venous drainage pattern. Drainage may be either ascending towards the cranial compartment or descending towards the spinal canal. Patients suffering from DAVFms may experience hemorrhage, particularly when venous drainage is directed upwards. Congestive symptoms of the spinal cord or brainstem can occur in cases of downward venous drainage. Compared to the endovascular approach, open surgery has a higher success rate in obliterating the fistula and yields better outcomes in cases of perimedullary venous drainage. Achieving surgical success necessitates thorough preoperative evaluation and adequate surgical exposure. Brainstem hyperintensity observed on T2-weighted MRI scans is linked to a poorer prognosis for recovery. CONCLUSION Treating complex DAVFms often requires surgery, as endovascular methods may not be feasible. Successful surgery hinges on a precise understanding of the fistula's venous architecture and its spatial relationships, assessed using digital substraction angiography (DSA), angio-MRI, and angio-CT. Optimal intraoperative exposure is crucial for effective surgery.
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Affiliation(s)
- Jean-Baptiste Peeters
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center, 1000, Rue St-Denis Montréal, QC H2X 0C, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center, 1000, Rue St-Denis Montréal, QC H2X 0C, Canada.
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Ma Y, Song Z, Wang Y, Wang J, He C, Li G, Zhang P, Hong T, Sun L, Hu P, Ye M, Zhang H. Clinical features, treatment strategies and outcomes of craniocervical junction arteriovenous fistulas: a cohort study of 193 patients. Stroke Vasc Neurol 2024; 9:18-29. [PMID: 37236656 PMCID: PMC10956106 DOI: 10.1136/svn-2023-002436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Craniocervical junction (CCJ) arteriovenous fistulas (AVFs) are rare. The current treatment strategies for AVFs with different angioarchitecture need to be clarified. The present study aimed to analyse the correlation between angioarchitecture and clinical characteristics, share our experience in treating this disease and identify risk factors associated with subarachnoid haemorrhage (SAH) and poor outcomes. METHODS A total of 198 consecutive patients with CCJ AVFs from our neurosurgical centre were retrospectively reviewed. The patients were grouped according to their clinical manifestations, and their baseline clinical characteristics, angioarchitecture, treatment strategies and outcomes were summarised. RESULTS The patients' median age was 56 years (IQR 47-62 years). The majority of patients were men with 166 (83.8%) patients. The most common clinical manifestation was SAH (52.0%), followed by venous hypertensive myelopathy (VHM) (45.5%). The most common CCJ AVFs type was dural AVF, with 132 (63.5%) fistulas. The most frequent fistula location was C-1 (68.7%) and dural branch of vertebral artery (70.2%) was the most involved arterial feeders for fistulas. The most common direction of venous drainage was descending intradural drainage (40.9%), followed by ascending intradural drainage (36.5%). Microsurgery was the most common treatment strategy applied for 151 (76.3%) patients, 15 (7.6%) patients were treated with interventional embolisation only, and 27 (13.6%) received both interventional embolisation and microsurgical treatment. The learning curve for microsurgery only was analysed by cumulative summation method, and the turning point was the 70th case, and blood loss in post-group was lower than that in pre-group (p=0.034). At the last follow-up, there were 155 (78.3%) patients with favourable outcomes (modified Rankin Scale(mRS)<3). Age≥56 (OR 2.038, 95% CI 1.039 to 3.998, p=0.038), VHM as the clinical manifestation (OR 4.102, 95% CI 2.108 to 7.982, p<0.001) and pretreatment mRS≥3 (OR 3.127, 95% CI 1.617 to 6.047, p<0.001) were significantly associated with poor outcomes. CONCLUSION The arterial feeders and direction of the venous drainage were important factors in the clinical presentations. The location of fistula and drainage vein was essential for choosing different treatment strategies. Older age, VHM onset and poor pretreatment functional status predicted poor outcomes.
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Affiliation(s)
- Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yinqing Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jiachen Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Guilin Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Liyong Sun
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
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Khan UA, Koumellis P, Almahfoudh R, Foroughi M. Bilateral mirror image lumbar spinal dural arterial venous fistula: a rare case and systematic review of the literature. Br J Neurosurg 2023; 37:982-985. [PMID: 33904360 DOI: 10.1080/02688697.2021.1914822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Spinal dural arteriovenous fistulas (SDAVF) are rare with an incidence of 5-10/million annually. They can be difficult to diagnose causing a delay in treatment with significant morbidity. We describe the first case in the literature of a symptomatic mirror lumbar SDAVF which may go unnoticed due to its unique vascular anatomy. CASE DESCRIPTION A 78-year-old gentleman presented with a progressive deterioration in his walking distance and urinary retention. An initial MRI scan of the whole spine did not show features suggestive of an underlying vascular malformation. During further investigations of neurological causes, the patient continued to have progressive symptoms over a 10-month period resulting in a repeat MRI scan. This showed a new finding of cord oedema without abnormal flow voids. He went on to have vascular imaging which demonstrated a mirror L3 SDAVF and underwent subsequent surgical management. At follow up there was a significant improvement in symptoms. CONCLUSIONS Completing a systematic review of the literature we find that the mirror lumbar SDAVF in our patient presented in a more aggressive manner with symptoms progressing faster than in single or multi-level SDAVF. Our case demonstrates how this unique vascular anatomy may result in a diagnostic challenge, behaving in an occult way where typical findings are not seen on initial MRI scanning. We provide an argument for early vascular imaging which can result in the treatment of these lesions in a timely manner.
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Affiliation(s)
| | | | - Rafid Almahfoudh
- Department of Neurosurgery, Royal Sussex County Hospital, Brighton, UK
| | - Mansoor Foroughi
- Department of Neurosurgery, Royal Sussex County Hospital, Brighton, UK
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Wang Y, Ma Y, Song Z, Yang C, Tu T, Yang K, He C, Li G, Hu P, Sun L, Ye M, Zhang H. Clinical and prognostic features of venous hypertensive myelopathy from craniocervical arteriovenous fistulas: a retrospective cohort study. J Neurosurg 2023; 139:687-697. [PMID: 36640099 DOI: 10.3171/2022.11.jns221958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Current knowledge about venous hypertensive myelopathy (VHM) is incomplete. This study was performed with the aim of clarifying the clinical features and outcomes of craniocervical VHM. METHODS This retrospective, single-center cohort study included 65 patients with craniocervical junction arteriovenous fistulas resulting in VHM treated in Xuanwu Hospital from January 1, 2002, to December 30, 2020. All patients underwent microsurgery or endovascular treatment. The primary outcome was neurological function assessment using the Japanese Orthopaedic Association (JOA) scale, modified Aminoff-Logue Scale (mALS), and Venous Hypertensive Myelopathy Scale (VHMS). The secondary outcomes were recurrences and postoperative adverse events. Pearson linear regression and receiver operating characteristic curves were used to evaluate the relationships among the three scales. Kaplan-Meier and multivariate logistic regression analyses were performed to predict outcomes. RESULTS The mean patient age was 57.4 ± 11.4 years, and 88% of patients were male. The 1-year follow-up rate was 83.1%, and the 5-year follow-up rate was 50.8%. The VHMS was correlated with the JOA (R2 = 0.6722) and mALS (R2 = 0.7399) and increased the assessment accuracy by approximately 20% when compared with the other two scales. Overall, 25.9% of patients experienced delayed neurological decline beyond the 1-year follow-up. Further logistic regression suggested that age > 65 years was an independent predictor (OR 7.831, 95% CI 1.090-56.266; p = 0.041). Embolic recanalization and new bilateral symmetry feeders were the major reasons for recurrence. Recurrence increased the risk of adverse events after the second surgery (OR 20.455, 95% CI 1.170-357.320; p = 0.039). CONCLUSIONS CCJ AVFs resulting in VHM are a rare but deadly complication, and providers should be cautious of age-related delayed neurological decline and strive for a one-time anatomical cure.
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Affiliation(s)
- Yinqing Wang
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
- 2China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing; and
| | - Yongjie Ma
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
- 2China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing; and
| | - Zihao Song
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Chengbin Yang
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Tianqi Tu
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Kun Yang
- 3Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuan He
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Guilin Li
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Peng Hu
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Liyong Sun
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Ming Ye
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Hongqi Zhang
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing
- 2China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing; and
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Su H, Yu J. Treatment of high cervical arteriovenous fistulas in the craniocervical junction region. Front Neurol 2023; 14:1164548. [PMID: 37441609 PMCID: PMC10335834 DOI: 10.3389/fneur.2023.1164548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
The craniocervical junction (CCJ) is a complex region. Rarely, arteriovenous fistulas (AVFs) can occur in the CCJ region. Currently, it is accepted that CCJ AVFs should only refer to AVFs at the C1-C2 levels. It is reasonable to assume that high cervical CCJ AVFs are being referred to when discussing CCJ AVFs. High cervical CCJ AVFs can be divided into the following four types: dural AVF, radicular AVF, epidural AVF and perimedullary AVF. Until now, it was difficult to understand high cervical CCJ AVFs and provide a proper treatment for them. Therefore, an updated review of high cervical CCJ AVFs is necessary. In this review, the following issues are discussed: the definition of high cervical CCJ AVFs, vessel anatomy of the CCJ region, angioarchitecture of high cervical CCJ AVFs, treatment options, prognoses and complications. Based on the review and our experience, we found that the four types of high cervical CCJ AVFs share similar clinical and imaging characteristics. Patients may present with intracranial hemorrhage or congestive myelopathy. Treatment, including open surgery and endovascular treatment (EVT), can be used for symptomatic AVFs. Most high cervical CCJ AVFs can be effectively treated with open surgery. EVT remains challenging due to a high rate of incomplete obliteration and complications, and it can only be performed in superselective AVFs with simple angioarchitecture. Appropriate treatment can lead to a good prognosis.
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Song Z, Ma Y, Hong T, Zhang H. Arteriovenous Fistulas Fed by Spinal Arterial Feeders at the Craniocervical Junction Region. Oper Neurosurg (Hagerstown) 2022; 23:472-481. [DOI: 10.1227/ons.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/14/2022] [Indexed: 11/06/2022] Open
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Matsubara S, Toi H, Takai H, Miyazaki Y, Kinoshita K, Sunada Y, Yamada S, Tao Y, Enomoto N, Minami YO, Hirai S, Yagi K, Nakashima H, Uno M. Variations and management for patients with craniocervical junction arteriovenous fistulas: Comparison of dural, radicular, and epidural arteriovenous fistulas. Surg Neurol Int 2021; 12:411. [PMID: 34513175 PMCID: PMC8422467 DOI: 10.25259/sni_557_2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/15/2021] [Indexed: 12/31/2022] Open
Abstract
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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Affiliation(s)
- Shunji Matsubara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroyuki Toi
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroki Takai
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Yuko Miyazaki
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Keita Kinoshita
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshihiro Sunada
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Shodai Yamada
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshifumi Tao
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Noriya Enomoto
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | | | - Satoshi Hirai
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | | | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
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Khaing ZZ, Cates LN, Hyde J, DeWees DM, Hammond R, Bruce M, Hofstetter CP. Contrast-Enhanced Ultrasound for Assessment of Local Hemodynamic Changes Following a Rodent Contusion Spinal Cord Injury. Mil Med 2020; 185:470-475. [DOI: 10.1093/milmed/usz296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
ABSTRACT
Introduction
Severe trauma to the spinal cord leads to a near complete loss of blood flow at the injury site along with significant hypoperfusion of adjacent tissues. Characterization and monitoring of local tissue hypoperfusion is currently not possible in clinical practice because available imaging techniques do not allow for assessment of blood flow with sufficient spatial and temporal resolutions. The objective of the current study was to determine whether ultrafast contrast-enhanced ultrasound (CEUS) imaging could be used to visualize and quantify acute hemodynamic changes in a rat traumatic spinal cord injury (SCI) model.
Materials and Methods
We used novel ultrasound acquisition and processing methods that allowed for measurements of local tissue perfusion as well as for assessment of structural and functional integrity of spinal vasculature.
Results
CEUS imaging showed that traumatic SCI results in (1) an area with significant loss of perfusion, which increased during the first hour after injury, (2) structural alterations of the spinal cord vasculature, and (3) significant slowing of arterial blood flow velocities around the injury epicenter.
Conclusion
We conclude that CEUS has the spatial and temporal sensitivity and resolution to visualize local tissue perfusion and vessel architecture, which maybe useful clinically to determine injury extent and severity in patients with SCI.
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Affiliation(s)
- Zin Z Khaing
- Department of Neurological Surgery, The University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Lindsay N Cates
- Department of Neurological Surgery, The University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Jeffrey Hyde
- Department of Neurological Surgery, The University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Dane M DeWees
- Department of Neurological Surgery, The University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Ryan Hammond
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, The University of Washington, 1013 NE 40th Street, Seattle, WA 98105, USA
| | - Matthew Bruce
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, The University of Washington, 1013 NE 40th Street, Seattle, WA 98105, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, The University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
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Zhong W, Zhang J, Shen J, Su W, Wang D, Zhang P, Wang Y. Dural Arteriovenous Fistulas at the Craniocervical Junction: A Series Case Report. World Neurosurg 2018; 122:e700-e712. [PMID: 30385361 DOI: 10.1016/j.wneu.2018.10.124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Craniocervical junction dural arteriovenous fistulas (CJDAVFs) are rare vascular malformations with unclear clinical characteristics. This study investigated the clinical characteristics and outcomes of patients with CJDAVFs. METHODS Thirty-eight patients with CJDAVFs who had undergone either conservative or surgical treatment were retrospectively analyzed. RESULTS Eleven (28.9%) patients were women and 27 (71.1%) were men (median age, 52.5 years). Two (5.3%) had myelopathy, and 36 (94.7%) had subarachnoid hemorrhage (SAH). Three patients had SAH recurrence before treatment. Five patients (13.9%) with SAH initially had negative results on angiography, which may have been due to a low-flow fistula without varicose veins (P = 0.034) and acute hydrocephalus (P = 0.084). Coincidental vascular lesions were noted in 5 patients (13.2%). Caudal drainage was mainly found in patients with myelopathy, whereas superolateral drainage was frequently observed in patients with SAH (P = 0.021). Thirty-six (94.7%) patients underwent microsurgery; of these, 33 (91.7%) had favorable outcomes and 3 (8.3%) had unfavorable outcomes. The main neurosurgical complications included acute hydrocephalus in 4 (10.5%) and new-onset mild persistent myelopathy in 6 (15.7%). According to the univariate analysis, the presence of myelopathy predicted poor outcomes, whereas SAH predicted favorable outcomes (P = 0.004). However, the multivariate analysis did not show statistical significance. CONCLUSIONS SAH is a common presenting sign of CJDAVF that may be overlooked on initial cerebral angiography, especially in patients with acute hydrocephalus and a low-flow fistula without varicose veins. Microsurgery involving disconnecting the draining vein is effective and beneficial. Further studies should be performed to investigate predictive factors influencing the prognosis.
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Affiliation(s)
- Weiying Zhong
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, P. R. China
| | - Ji Zhang
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Jie Shen
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, P. R. China
| | - Wandong Su
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, P. R. China
| | - Donghai Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, P. R. China
| | - Ping Zhang
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, P. R. China
| | - Yunyan Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, P. R. China.
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10
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Jablawi F, Mull M. Double spinal dural arteriovenous fistulas. J Neuroradiol 2018; 46:168-172. [PMID: 30389511 DOI: 10.1016/j.neurad.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 07/04/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Spinal dural arteriovenous fistulas (SDAVF) are usually solitary lesions. Synchronous and/or metachronous double SDAVF have rarely been reported in the literature. We report on three patients with double SDAVF and present our single center experience in the diagnostic and treatment management in these patients. MATERIAL AND METHODS We retrospectively revised our medical database for all patients who were diagnosed and treated in our center due to a SDAVF between 1990 and 2017. All data including demographics, clinical presentations, as well as radiological data were re-evaluated for this study. RESULTS Three (1.4%) of 209 consecutive patients with SDAVF presented double SDAVF with different arterial feeders and venous drainage patterns. All three patients were men. The mean age at time of diagnosis was 67.9 ± 10 years (median; 68, range: 53-82). Myelopathic symptoms were reported in all three cases. All three fistulas were located in the thoracolumbar region between T7 and L2. MRI/CE-MRA showed medullar T2-hyperintensity, intramedullary contrast-enhancement and dilatation of perimedullary veins in various extensions. CONCLUSION Double SDAVF are extremely rare and were found in 1.4% of patients in our series. The vast majority of the reported double SDAVF in the literature has been detected synchronously within an area of equal or less than three vertebral levels. Thus, whenever the SDAVF is identified, further injections of the fistula-zone neighbored segmental arteries might be recommended. However, due to the extremely low incidence of double SDAVF a complete spinal DSA is not indicated.
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Affiliation(s)
- F Jablawi
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Pauwelsstrasse, 30, 52074 Aachen, Germany; Department of Neurosurgery, Justus-Liebig-University, Klinikstrasse, 33, 35392 Giessen, Germany
| | - M Mull
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Pauwelsstrasse, 30, 52074 Aachen, Germany.
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Fujimoto S, Takai K, Nakatomi H, Kin T, Saito N. Three-dimensional angioarchitecture and microsurgical treatment of arteriovenous fistulas at the craniocervical junction. J Clin Neurosci 2018; 53:140-146. [PMID: 29731281 DOI: 10.1016/j.jocn.2018.04.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
Digital subtraction angiography (DSA) is the gold standard for diagnosing vascular malformations; however, difficulties are associated with visualizing the angioarchitecture of arteriovenous fistulas at the craniocervical junction (CCJ AVFs) using DSA because of their complex regional neurovascular anatomy. The present study evaluated the application of 3-dimensional computer graphics (3D CG) to the surgical planning of CCJ AVFs. Six patients with CCJ AVFs who underwent microsurgery and/or endovascular treatment were included. The results of DSA and 3D CG were compared in the last 3 patients. The visibility of important anatomical structures were evaluated using visibility grading scores. Clinical outcomes were assessed based on the rate of occlusion of AVFs, surgical complications, neurological status, and recurrence in long-term follow-ups. The 3D CG images could combine arteries, veins, the spinal cord and dura mater in one single picture to evaluate the anatomy of CCJ AVFs. The image interpretation of vascular structures, particularly narrow arterial feeders, was significantly better using 3D CG than DSA (overall visibility scores, 97% vs 51%, p = 0.001). In all patients, the complete occlusion of AVFs was achieved by microsurgery except for 2 patients without surgical planning with 3D CG. Postoperatively, the neurological status of all patients improved or stabilized without the recurrence of AVFs (median, 5.4 years). 3D CG may help to improve the quality of the microsurgical procedures in complex AVFs. However, it should be used as a complementary diagnostic modality rather than the alternative of DSA because 3D CG has no hemodynamic information at this time.
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Affiliation(s)
- So Fujimoto
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo 183-8524, Japan.
| | - Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Taichi Kin
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Do ASM, Kapurch J, Kumar R, Port J, Miller JW, Van Gompel JJ. The Long and Winding Road: Thoracic Myelopathy Associated With Occipitocervical Dural Arteriovenous Fistula. World Neurosurg 2017; 108:998.e7-998.e16. [DOI: 10.1016/j.wneu.2017.09.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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13
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Jeon JP, Cho YD, Kim CH, Han MH. Complex spinal arteriovenous fistula of the craniocervical junction with pial and dural shunts combined with contralateral dural arteriovenous fistula. Interv Neuroradiol 2015; 21:733-7. [PMID: 26464289 DOI: 10.1177/1591019915609128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/28/2015] [Indexed: 11/16/2022] Open
Abstract
A high cervical dural arteriovenous fistula (dAVF) is relatively rare and tends to have different features, as compared with a thoracolumbar dAVF. Here, we report a case involving a complex AVF located at the craniocervical junction that was fed by the dural and pial arteries, combined with a contralateral dAVF.
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Affiliation(s)
- Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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14
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Wang JY, Molenda J, Bydon A, Colby GP, Coon AL, Tamargo RJ, Huang J. Natural history and treatment of craniocervical junction dural arteriovenous fistulas. J Clin Neurosci 2015. [PMID: 26195333 DOI: 10.1016/j.jocn.2015.05.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) located at the craniocervical junction are rare vascular malformations with distinctive features, and their natural history and the optimal treatment strategy remains unclear. We retrospectively reviewed eight patients with craniocervical junction DAVF who were evaluated at our institution between 2009 and 2012. We also conducted a MEDLINE search for all reports of craniocervical junction DAVF between 1970 and 2013, and reviewed 119 patients from 56 studies. From a total of 127 patients, 46 (37.1%) presented with myelopathy, 53 (43.1%) with subarachnoid hemorrhage (SAH), and four (3.3%) with brainstem dysfunction. SAH was typically mild, most often Hunt and Hess Grade I or II (83.3%), and associated with ascending venous drainage via the intracranial veins (p<0.001). Higher rates of obliteration were observed after microsurgery compared to embolization. Overall, younger age (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01-1.12; p=0.011), hemorrhagic presentation (OR 0.17; 95% CI 0.06-0.50; p=0.001), and microsurgery (OR 0.23; 95% CI 0.08-0.6; p=0.004) were independently predictive of good outcome at the last follow-up. Microsurgery was the only independent predictor of overall improvement at the last follow-up (OR 4.35; 95% CI 1.44-13.2; p=0.009). Prompt diagnosis and microsurgical management, offering a greater chance of immediate obliteration, may optimize the outcomes for patients with craniocervical junction DAVF. Endovascular treatment is often not feasible due to lesion angioarchitecture, and is associated with a higher risk of lesion recanalization or recurrence. However, long term studies with newer embolic agents such as Onyx (ev3 Endovascular, Plymouth, MN, USA) are yet to be performed.
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Affiliation(s)
- Joanna Y Wang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Joseph Molenda
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Alexander L Coon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA.
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15
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Hetts SW, English JD, Stiver SI, Singh V, Yee EJ, Cooke DL, Halbach VV. Bilateral cervical spinal dural arteriovenous fistulas with intracranial venous drainage mimicking a foramen magnum dural arteriovenous fistula. Interv Neuroradiol 2013; 19:483-8. [PMID: 24355154 DOI: 10.1177/159101991301900413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 07/24/2013] [Indexed: 12/15/2022] Open
Abstract
We describe a unique case of bilateral cervical spinal dural arteriovenous fistulas mimicking an intracranial dural arteriovenous fistula near the foramen magnum. We review its detection via MRI and digital subtraction angiography and subsequent management through surgical intervention. Pitfalls in diagnostic angiography are discussed with reference to accurate location of the fistula site. The venous anastomotic connections of the posterior midline spinal vein to the medial posterior medullary vein, posterior fossa bridging veins, and dural venous sinuses of the skull base are discussed with reference to problem-solving in this complex case. The mechanism of myelopathy through venous hypertension produced by spinal dural fistulas is also emphasized.
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Affiliation(s)
- Steven W Hetts
- Department of Radiology and Biomedical Imaging; University of California; San Francisco, CA, USA -
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