Cervical dural arteriovenous fistula presenting with brainstem dysfunction: case report and review

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Cervical dural arteriovenous fistulas (C-DAVF) are rare vascular malformations.
• Treatment selection between endovascular surgery and direct surgical interruption remains controversial.
• C-DAVF can present with diverse and uncommon neurological symptoms, including brainstem dysfunction.

Observation:

• This study reviews 31 cases of C-DAVF, including a rare case presenting with brainstem dysfunction.
• Open surgical interruption of the draining vein was employed in 20 cases, endovascular surgery in 8, and a combined approach in 3.
• Patients undergoing surgical interruption showed no recurrence, while 3 patients (10%) who initially had endovascular surgery required revisions.

Findings:

• Surgical interruption of the draining vein demonstrated higher efficacy in achieving a complete cure for C-DAVF.
• Endovascular surgery was associated with a higher rate of recurrence or need for revision.
• Twenty-one patients experienced symptomatic improvement or stabilization post-treatment.

Implications:

• Direct surgical interruption of the draining vein is recommended as the primary treatment for C-DAVF for optimal cure rates.
• Endovascular surgery remains a viable option for elderly, medically compromised patients, or those with contraindications to general anesthesia.
• Understanding the hemodynamic alterations and anatomical features is crucial for managing C-DAVF and predicting treatment outcomes.