Mirror-image spinal dural arteriovenous fistulas at the craniocervical junction: case report and review of the literature

Jumpei Oshita; Satoshi Yamaguchi; Shinji Ohba; Kaoru Kurisu

doi:10.1227/NEU.0b013e318223bab5

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Mirror-image spinal dural arteriovenous fistulas at the craniocervical junction: case report and review of the literature

Journal article

Peer reviewed

Mirror-image spinal dural arteriovenous fistulas at the craniocervical junction: case report and review of the literature

Jumpei Oshita, Satoshi Yamaguchi, Shinji Ohba and Kaoru Kurisu

Neurosurgery, Vol.69(5), pp.E1166-E1171

11/2011

DOI: 10.1227/NEU.0b013e318223bab5

PMID: 21577170

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Abstract

We report an extremely rare case with mirror-site spinal dural arteriovenous fistulas (DAVFs) at the craniocervical junction. Although multiple spinal DAVFs have been reported in the literature, complete mirror-site lesions with fistulas and feeding arteries in the symmetric position have not been previously described. A 74-year-old man presented with walking disturbance, urinary incontinence, and constipation progressing over a 14-month period. T2-weighted magnetic resonance imaging showed a high-intensity area in the spinal cord at the level from C4 to C6 and multiple flow voids at the surface of the spinal cord. Three-dimensional computed tomographic angiography revealed bilateral DAVFs located in the mirror site of the craniocervical junction. Direct surgery with suboccipital craniectomy and C1 laminectomy revealed dilated tortuous red veins on the dorsal surface of the spinal cord. We found bilateral symmetric red veins around the dural penetration of the vertebral artery. Both red veins were successfully interrupted with the aneurysmal clips. Postoperative 3-dimensional computed tomographic angiography revealed a disappearance of the bilateral fistulas. Magnetic resonance images obtained 6 months after the surgery confirmed the disappearance of the intramedullary high-intensity area and flow voids. The symptoms before the operation improved after surgery, especially urinary incontinence and constipation, with slight walking disturbance. Because fistulas in the present case existed at the same spinal level, we found multiple fistulas on the first examination. This early notification resulted in a good outcome from the first operation. If patients with spinal DAVFs have rapidly progressing symptoms, one should suspect multiple fistulas.

Humans

Vascular Surgical Procedures - instrumentation

Central Nervous System Vascular Malformations - diagnostic imaging

Foramen Magnum - surgery

Male

Spinal Cord - blood supply

Veins - surgery

Radiography

Spinal Cord Ischemia - etiology

Vascular Surgical Procedures - methods

Occipital Bone - surgery

Spinal Cord - pathology

Veins - physiopathology

Spinal Cord Ischemia - pathology

Spinal Cord Ischemia - physiopathology

Central Nervous System Vascular Malformations - pathology

Laminectomy - instrumentation

Aged

Laminectomy - methods

Spinal Cord - physiopathology

Central Nervous System Vascular Malformations - surgery

Veins - pathology

Cervical Atlas - surgery

Details

Title: Subtitle: Mirror-image spinal dural arteriovenous fistulas at the craniocervical junction: case report and review of the literature
Creators: Jumpei Oshita - Department of Neurosurgery, National Hospital Organization Kure Medical Center, Kure, Japan. oshitaj@kure-nh.go.jp
Satoshi Yamaguchi
Shinji Ohba
Kaoru Kurisu
Resource Type: Journal article
Publication Details: Neurosurgery, Vol.69(5), pp.E1166-E1171
Publisher: United States
DOI: 10.1227/NEU.0b013e318223bab5
PMID: 21577170
ISSN: 0148-396X
eISSN: 1524-4040
Language: English
Date published: 11/2011
Academic Unit: Neurosurgery
Record Identifier: 9984040399402771

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