title: Preoperative evaluation and surgical strategies for craniocervical junction dural arteriovenous fistula with multiple feeders: case report and review of the literature.
abstract: Craniocervical junction dural arteriovenous fistula (CCJDAVF) fed by bilateral vertebral arteries (VAs) is extremely rare. We report a case of a 63-year-old man presenting with progressive myelopathy caused by a CCJDAVF, which was fed by bilateral VAs and occipital and ascending pharyngeal arteries with multiple shunting points and that drained into intracranial sinus and spinal veins. The dural arteriovenous fistula (DAVF) was successfully treated surgically using stepwise indocyanine green (ICG) videoangiography. After surgery, the DAVF disappeared and myelopathy was markedly improved. We show detailed preoperative images and intraoperative findings of this rare DAVF and emphasize the importance of selective angiography for preoperative evaluation of feeding arteries and the usefulness of intraoperative ICG videoangiography for both identification of the fistula and confirmation of its obliteration.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. ykikkawa@ns.med.kyushu-u.ac.jp
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kikkawa
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Nakamizo
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Amano
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Kurogi
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tomio
authors.initials: T
authors.lastname: Sasaki
mesh_terms: D000792:Angiography / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000601:surgery*; D002574:Cervical Vertebrae / Q000098:blood supply*; D018450:Disease Progression; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010614:Pharynx / Q000098:blood supply; D013116:Spinal Cord / Q000098:blood supply*; D013118:Spinal Cord Diseases / Q000209:etiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014711:Vertebral Artery / Q000002:abnormalities*; D020535:Video-Assisted Surgery / Q000379:methods*
chemical_list: D007208:Indocyanine Green