Dong Hyun Yoo1, Young Dae Cho1, Tiplada Boonchai2, Kang Min Kim3, Jeong Eun Kim3, Won-Sang Cho3, Sung Ho Lee3, Chun Kee Chung3, Hyun-Seung Kang4. 1. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. 2. Division of Neurology, Trang Hospital, Ministry of Public Health, Trang, Thailand. 3. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-Gu Seoul, Korea. 4. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-Gu Seoul, Korea. kanghs@snuh.org.
Abstract
PURPOSE: Dural arteriovenous fistulas (AVFs) draining to medullary bridging vein (MBV) are located at foramen magnum (FM) and craniocervical junction (CCJ). Such fistulas are rare but pose a challenge to endovascular management. This study was undertaken to assess clinical manifestations, angiographic features, and outcomes of endovascular treatment in patients with MBV dural AVFs. METHODS: A number of our patients (N = 22) were diagnosed with MBV dural AVF and treated by endovascular means. There were 9 FM lesions and 13 CCJ lesions. We reviewed clinical records and imaging studies to define clinical characteristics, vascular anatomic details, and treatment outcomes, comparing FM- and CCJ-level subsets. RESULTS: Subjects ranged from 37 to 74 years of age (mean, 57.7 years) with male predominance (2.7:1). They presented with intracranial hemorrhage (11/22, 50%), myelopathy (8/22, 36%), or nonspecific symptoms (3/22, 14%). In 17 patients (77.3%), the shunts showed complete or near-complete occlusion following endovascular treatment (FM, 100%; CCJ, 61.5%). However, seven patients experienced ischemic events (FM, 11.1%; CCJ, 46.2%) and one patient sustained a hemorrhagic complication. No hemorrhages recurred during follow-up monitoring, and myelopathic symptoms abated. CONCLUSION: MBV dural AVFs are highly aggressive lesions for which proper diagnosis and treatment are of utmost importance. Although transarterial embolization proved highly successful in FM lesions, shunt occlusion was less frequent in the CCJ subset, with greater risk of ischemic complications.
PURPOSE: Dural arteriovenous fistulas (AVFs) draining to medullary bridging vein (MBV) are located at foramen magnum (FM) and craniocervical junction (CCJ). Such fistulas are rare but pose a challenge to endovascular management. This study was undertaken to assess clinical manifestations, angiographic features, and outcomes of endovascular treatment in patients with MBV dural AVFs. METHODS: A number of our patients (N = 22) were diagnosed with MBV dural AVF and treated by endovascular means. There were 9 FM lesions and 13 CCJ lesions. We reviewed clinical records and imaging studies to define clinical characteristics, vascular anatomic details, and treatment outcomes, comparing FM- and CCJ-level subsets. RESULTS: Subjects ranged from 37 to 74 years of age (mean, 57.7 years) with male predominance (2.7:1). They presented with intracranial hemorrhage (11/22, 50%), myelopathy (8/22, 36%), or nonspecific symptoms (3/22, 14%). In 17 patients (77.3%), the shunts showed complete or near-complete occlusion following endovascular treatment (FM, 100%; CCJ, 61.5%). However, seven patients experienced ischemic events (FM, 11.1%; CCJ, 46.2%) and one patient sustained a hemorrhagic complication. No hemorrhages recurred during follow-up monitoring, and myelopathic symptoms abated. CONCLUSION: MBV dural AVFs are highly aggressive lesions for which proper diagnosis and treatment are of utmost importance. Although transarterial embolization proved highly successful in FM lesions, shunt occlusion was less frequent in the CCJ subset, with greater risk of ischemic complications.
Authors: C Cognard; Y P Gobin; L Pierot; A L Bailly; E Houdart; A Casasco; J Chiras; J J Merland Journal: Radiology Date: 1995-03 Impact factor: 11.105
Authors: M T Caton; K H Narsinh; A Baker; C F Dowd; R T Higashida; D L Cooke; S W Hetts; V V Halbach; M R Amans Journal: AJNR Am J Neuroradiol Date: 2021-05-06 Impact factor: 4.966