The role of venous anatomy in guiding treatment approach for dural arteriovenous fistulas of the craniocervical junction; case series & systematic review

Kainaat Javed, Sertac Kirnaz, Richard Zampolin, Deepak Khatri, Rose Fluss, Adisson Fortunel, Ryan Holland, Mousa K. Hamad, Julio Fidel Ko Inocencio, Ariel Stock, Aleka Scoco, Rafael De La Garza Ramos, Samuel Ahmad, Neil Haranhalli, David Altschul

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)27-38
Number of pages12
JournalJournal of Clinical Neuroscience
Volume110
DOIs
StatePublished - Apr 2023

Keywords

  • Craniocervical junction
  • Dural arteriovenous fistula
  • Embolization
  • Microsurgery

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Fingerprint

Dive into the research topics of 'The role of venous anatomy in guiding treatment approach for dural arteriovenous fistulas of the craniocervical junction; case series & systematic review'. Together they form a unique fingerprint.

Cite this