Dural arteriovenous fistulae at the craniocervical junction: the relation between clinical symptom and pattern of venous drainage.
BACKGROUND
dural arteriovenous fistula (DAVF) at the craniocervical junction is an unusual condition with alternative presentations and is a rare cause of intracranial subarachnoid hemorrhage (SAH). We performed a retrospective, angiographic study of six consecutive patients to assess the relation between symptom and venous drainage and to predict the risk for SAH.


METHODS
there were three females and three males; ages ranged between 37 and 64 with a mean of 52.5. Among them, four had SAH and two had pain. Diagnosis of DVAF was based on CTA, MRA and angiograph.


RESULTS
three patients (50%, 3/6), with single or main ascending venous route into the intracranial vein, all had intracranial SAH. Among these three patients, varix or pouches was identified in two cases (66.7%, 2/3). Three cases were treated by surgical interventions, while two subjects were endovascular techniques. The overall clinical outcomes were good during an average follow-up period of 13 months. In particular, follow-up angiographs performed 6 months later revealed the complete disappearance of DAVF in three patients.


CONCLUSIONS
there was an increased risk of SAH if DAVF at the craniocervical junction manifested an ascending venous route into the intracranial vein and/or presented with varix or pouches.
Department of Neurosurgery, Huashan Hospital, Neurosurgical Department, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
Gong
G
Chen
Qihong
Q
Wang
Yanlong
Y
Tian
Yuxinag
Y
Gu
Bin
B
Xu
Bing
B
Leng
Donglei
D
Song
D000328:Adult; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000209:etiology*; D004388:Dura Mater / Q000098:blood supply*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D015898:Tomography Scanners, X-Ray Computed