[Dural fistula in the craniocervical junction. A case report and review of the literature].
BACKGROUND
Spinal dural fistulas consist in an artery that penetrates into the dura mater and drains into a perispinal vein. They are most commonly located in the dorsal or lumbar region; a craniocervical position is infrequent. The clinical features presented by these patients involve an progressive ascending myelopathy caused by severe venous hypertension, although they can also start with symptoms of a subarachnoid haemorrhage.


METHODS
A 62 year old male with symptoms of progressive myelopathy due to a dural fistula dependent on meningeal branches of the right PICA, which was treated surgically by fistula clipping performed using an extreme lateral suboccipital approach. In the literature that was reviewed there were 35 cases of dural fistulas located at the craniocervical junction.


CONCLUSIONS
The existence of clinical features compatible with cervical myelopathy and an anodyne cervical resonance justify the need to perform medullar arteriography owing to a suspected vascular malformation. An early diagnosis of a dural fistula and its proper treatment lead to a diminished morbidity and mortality rate in these patients.
Pulido Rivas
P
P
Hospital Universitario Niño Jesus, Madrid, España. ppulido@neurorgs.com
Villoria Medina
F
F
Fortea Gil
F
F
Sola
R G
RG
D001269:Atlanto-Occipital Joint; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D004388:Dura Mater / Q000000981:diagnostic imaging; D004417:Dyspnea / Q000209:etiology; D006801:Humans; D008026:Ligation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology; D010292:Paresthesia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D016055:Urinary Retention / Q000209:etiology; D014711:Vertebral Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging