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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.
AuthorsYuichiro Kikkawa, Akira Nakamizo, Koji Yamashita, Toshiyuki Amano, Ai Kurogi, Tomio Sasaki
JournalFukuoka igaku zasshi = Hukuoka acta medica (Fukuoka Igaku Zasshi) Vol. 104 Issue 9 Pg. 299-308 (Sep 2013) ISSN: 0016-254X [Print] Japan
PMID24364265 (Publication Type: Case Reports, Journal Article, Review)
Chemical References
  • Indocyanine Green
Topics
  • Angiography (methods)
  • Central Nervous System Vascular Malformations (complications, surgery)
  • Cervical Vertebrae (blood supply)
  • Disease Progression
  • Humans
  • Indocyanine Green
  • Male
  • Middle Aged
  • Neurosurgical Procedures (methods)
  • Pharynx (blood supply)
  • Spinal Cord (blood supply)
  • Spinal Cord Diseases (etiology)
  • Treatment Outcome
  • Vascular Surgical Procedures (methods)
  • Vertebral Artery (abnormalities)
  • Video-Assisted Surgery (methods)

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