title: [Dural arteriovenous fistulas at the craniocervical junction fed by bilateral vertebral arteries with intracranial drainage: a case report].
abstract: We report a case of dural arteriovenous fistulas (DAVFs) at the craniocervical junction, which are supplied by the radicular arteries from bilateral vertebral arteries separately, and drainaged into intracranial sinuses. A 58-year-old man with intermittent neck pain visited our hospital. T2-weighted magnetic resonance (MR) imaging showed flow voids on the dorsal surface of the medulla and upper cervical cord without any signal changes suggesting ischemia. Postcontrast MR digital subtraction angiography (MRDSA) showed early venous filling at the craniocervical junction. Angiography demonstrated bilateral fistulas near each vertebral artery penetration point of the dura matter, which were drainaged into the superior and inferior petrosal sinuses. The patient underwent suboccipital craniotomy and laminectomy of the C1, then disruption of the bilateral fistulas was performed by using micro Doppler sonography after intradural exposure of the shunt points. His symptom subsided post operatively, and MRDSA showed no abnormal vessels. Angiography performed 1 week after surgery confirmed complete obliteration of the fistulas. DAVFs at the craniocervical junction fed by bilateral vertebral arteries is extremely rare. Even in such a case, direct interruption of the fistulas using micro Doppler sonography is the most effective treatment. In addition. MRDSA could be useful for screening and perioperative studies.
authors.affiliation: Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Takeshita
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Kitagawa
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Suyama
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
mesh_terms: D020785:Central Nervous System Vascular Malformations / Q000473:pathology* / Q000601:surgery; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D014711:Vertebral Artery / Q000473:pathology*