Highlights
- •DAVF of the craniocervical junction can have different venous drainage patterns.
- •The venous drainage can be inferior, superior or both.
- •The anatomy of the DAVF predicts the clinical presentation of the patient. Patients with superior drainage are more likely to present with a hemorrhage whereas patients with inferior drainage tend to present with myelopathy.
- •In our paper, we propose a novel classification system in which DAVF of the craniocervical junction can be grouped into three types and for each type, we present a treatment paradigm.
- •Microsurgery remains an effective treatment option. There is an emerging role of transvenous embolization particularly for superior draining DAVF.
Abstract
Background
Dural arteriovenous fistulas (DAVF) of the craniocervical junction (CCF) are an uncommon
entity with the following venous drainage pattern: inferior, superior and mixed. Patients
may present with subarachnoid hemorrhage, myelopathy or brainstem dysfunction. CCJ
DAVF can be treated with microsurgery or with transarterial and transvenous embolization,
depending on the venous drainage pattern. We present our institutional experience
of treating CCJ DAVFs along with a systematic review of the literature.
Methods
Six patients with CCJ DAVF were treated at our institution over five years. Data was
collected using electronic medical record review. Systematic review was performed
on CCJ DAVF using the PubMed database from 1990 to 2021. We characterized venous drainage
patterns, treatment choices, and outcomes to create a classification system.
Results
50 case reports, consisting of 115 patients, were included in our review. 61 (53.0 %)
patients had inferior drainage while 32 (27.8 %) patients had superior drainage and
22 (19.2 %) patients had mixed venous drainage. Patients with inferior drainage had
the fistulous connection at the foramen magnum while patients with superior drainage
had a fistulous connection at C1-C2 (p value = 0.026). Patients with inferior drainage
were more likely to present with myelopathy while patients with superior drainage
presented with hemorrhage (p value = 0.000).
Conclusions
Classifying the venous drainage pattern is essential in making treatment decision.
Transvenous embolization works best with large superior venous drainage. If endovascular
treatment is not an option, then surgical clipping can achieve successful cure. Transarterial
embolization is a reasonable option in cases with a large arterial feeder.
Keywords
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Article info
Publication history
Accepted:
February 7,
2023
Received:
December 28,
2022
Identification
Copyright
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