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Dural arteriovenous shunts at the craniocervical junction
H Kinouchi1, K Mizoi, A Takahashi
1Department of Neurosurgery, Akita University School of Medicine, Japan. kinouchi@nsg.med.akita-u.ac.jp
Journal of Neurosurgery
|November 17, 1998
Summary
Spinal dural arteriovenous shunts (AVSs) at the craniocervical junction are rare but treatable. Surgical interruption of the draining vein is effective, with satisfactory outcomes and no recurrence in follow-up studies.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Radiology
Background:
- Spinal dural arteriovenous shunts (AVSs) are typically found in the thoracic and lumbar spine.
- AVSs at the craniocervical junction are uncommon and present unique diagnostic and therapeutic challenges.
Observation:
- This study analyzed 10 patients with craniocervical junction AVSs.
- Presentations included subarachnoid hemorrhage (SAH), myelopathy, and incidental findings.
- Angiography revealed feeding arteries from vertebral artery branches and varied venous drainage patterns.
Findings:
- AVSs at C-1/C-2 levels were supplied by vertebral artery dural branches.
- Venous drainage was either caudal (myelopathy) or intracranial (SAH).
- Varices were present in 40% of patients; surgical vein interruption yielded excellent results.
Implications:
- Suggests proximal vertebral angiography for suspected posterior fossa SAH without intracranial findings.
- Surgical intervention for craniocervical AVSs demonstrates satisfactory outcomes.
- Highlights the importance of considering this rare AVS location in specific clinical scenarios.