Skip to main content

Advertisement

SpringerLink
Log in

Endovascular treatment of medullary bridging vein-draining dural arteriovenous fistulas: foramen magnum vs. craniocervical junction lesions

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

Dural arteriovenous fistulas (AVFs) draining to medullary bridging vein (MBV) are located at foramen magnum (FM) and craniocervical junction (CCJ). Such fistulas are rare but pose a challenge to endovascular management. This study was undertaken to assess clinical manifestations, angiographic features, and outcomes of endovascular treatment in patients with MBV dural AVFs.

Methods

A number of our patients (N = 22) were diagnosed with MBV dural AVF and treated by endovascular means. There were 9 FM lesions and 13 CCJ lesions. We reviewed clinical records and imaging studies to define clinical characteristics, vascular anatomic details, and treatment outcomes, comparing FM- and CCJ-level subsets.

Results

Subjects ranged from 37 to 74 years of age (mean, 57.7 years) with male predominance (2.7:1). They presented with intracranial hemorrhage (11/22, 50%), myelopathy (8/22, 36%), or nonspecific symptoms (3/22, 14%). In 17 patients (77.3%), the shunts showed complete or near-complete occlusion following endovascular treatment (FM, 100%; CCJ, 61.5%). However, seven patients experienced ischemic events (FM, 11.1%; CCJ, 46.2%) and one patient sustained a hemorrhagic complication. No hemorrhages recurred during follow-up monitoring, and myelopathic symptoms abated.

Conclusion

MBV dural AVFs are highly aggressive lesions for which proper diagnosis and treatment are of utmost importance. Although transarterial embolization proved highly successful in FM lesions, shunt occlusion was less frequent in the CCJ subset, with greater risk of ischemic complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Not available (personal medical records).

Code availability

Not applicable.

References

  1. Cognard C, Gobin YP, Pierot L et al (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194:671–680. https://doi.org/10.1148/radiology.194.3.7862961

    Article  CAS  PubMed  Google Scholar 

  2. Borden JA, Wu JK, Shucart WA (1995) A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82:166–179. https://doi.org/10.3171/jns.1995.82.2.0166

    Article  CAS  PubMed  Google Scholar 

  3. Geibprasert S, Pereira V, Krings T et al (2008) Dural arteriovenous shunts: a new classification of craniospinal epidural venous anatomical bases and clinical correlations. Stroke 39:2783–2794. https://doi.org/10.1161/STROKEAHA.108.516757

    Article  PubMed  Google Scholar 

  4. Li C, Yu J, Li K et al (2018) Dural arteriovenous fistula of the lateral foramen magnum region: A review. Interv Neuroradiol 24:425–434. https://doi.org/10.1177/1591019918770768

    Article  PubMed  PubMed Central  Google Scholar 

  5. Caton MT, Narsinh KH, Baker A et al (2021) Dural arteriovenous fistulas of the foramen magnum region: clinical features and angioarchitectural phenotypes. AJNR Am J Neuroradiol. https://doi.org/10.3174/ajnr.A7152

    Article  PubMed  Google Scholar 

  6. Mitsuhashi Y, Aurboonyawat T, Pereira VM et al (2009) Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas. Clinical article J Neurosurg 111:889–899. https://doi.org/10.3171/2009.1.JNS08840

    Article  PubMed  Google Scholar 

  7. Hiramatsu M, Sugiu K, Ishiguro T et al (2018) Angioarchitecture of arteriovenous fistulas at the craniocervical junction: a multicenter cohort study of 54 patients. J Neurosurg 128:1839–1849. https://doi.org/10.3171/2017.3.JNS163048

    Article  PubMed  Google Scholar 

  8. Motebejane MS, Choi IS (2018) Foramen magnum dural arteriovenous fistulas: clinical presentations and treatment outcomes, a case-series of 12 patients. Oper Neurosurg 15:262–269. https://doi.org/10.1093/ons/opx229

    Article  Google Scholar 

  9. Reinges MH, Thron A, Mull M et al (2001) Dural arteriovenous fistulae at the foramen magnum. J Neurol 248:197–203. https://doi.org/10.1007/s004150170226

    Article  CAS  PubMed  Google Scholar 

  10. Zhao J, Xu F, Ren J et al (2016) Dural arteriovenous fistulas at the craniocervical junction: a systematic review. J Neurointerv Surg 8:648–653. https://doi.org/10.1136/neurintsurg-2015-011775

    Article  PubMed  Google Scholar 

  11. Choi HS, Kim DI, Kim BM et al (2012) Endovascular treatment of dural arteriovenous fistula involving marginal sinus with emphasis on the routes of transvenous embolization. Neuroradiology 54:163–169. https://doi.org/10.1007/s00234-011-0852-4

    Article  PubMed  Google Scholar 

  12. Zhong W, Zhang J, Shen J et al (2019) Dural arteriovenous fistulas at the craniocervical junction: a series case report. World Neurosurg 122:e700-712. https://doi.org/10.1016/j.wneu.2018.10.124

    Article  PubMed  Google Scholar 

  13. Soderman M, Edner G, Ericson K et al (2006) Gamma knife surgery for dural arteriovenous shunts: 25 years of experience. J Neurosurg 104:867–875. https://doi.org/10.3171/jns.2006.104.6.867

    Article  PubMed  Google Scholar 

  14. Geibprasert S, Pongpech S, Armstrong D et al (2009) Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know. AJNR Am J Neuroradiol 30:1459–1468. https://doi.org/10.3174/ajnr.A1500

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Newton TH (1968) The anterior and posterior meningeal branches of the vertebral artery. Radiology 91:271–279

    Article  CAS  Google Scholar 

  16. Lasjaunias P, Vallee B, Person H et al (1985) The lateral spinal artery of the upper cervical spinal cord. Anatomy, normal variations, and angiographic aspects. J Neurosurg 63:235–241. https://doi.org/10.3171/jns.1985.63.2.0235

    Article  CAS  PubMed  Google Scholar 

  17. Siclari F, Burger IM, Fasel JH et al (2007) Developmental anatomy of the distal vertebral artery in relationship to variants of the posterior and lateral spinal arterial systems. AJNR Am J Neuroradiol 28:1185–1190. https://doi.org/10.3174/ajnr.A0498

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Vaidya S, Tozer KR, Chen J (2008) An overview of embolic agents. Semin Intervent Radiol 25:204–215. https://doi.org/10.1055/s-0028-1085930

    Article  PubMed  PubMed Central  Google Scholar 

  19. Miyamoto N, Naito I, Shimizu T et al (2015) Efficacy and limitations of transarterial acrylic glue embolization for intracranial dural arteriovenous fistulas. Neurol Med Chir (Tokyo) 55:163–172. https://doi.org/10.2176/nmc.oa.2014-0223

    Article  Google Scholar 

  20. Krings T, Geibprasert S (2009) Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 30:639–648. https://doi.org/10.3174/ajnr.A1485

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

    Dong Hyun Yoo & Young Dae Cho

  2. Division of Neurology, Trang Hospital, Ministry of Public Health, Trang, Thailand

    Tiplada Boonchai

  3. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-Gu Seoul, Korea

    Kang Min Kim, Jeong Eun Kim, Won-Sang Cho, Sung Ho Lee, Chun Kee Chung & Hyun-Seung Kang

Authors
  1. Dong Hyun Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Young Dae Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tiplada Boonchai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kang Min Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeong Eun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Won-Sang Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sung Ho Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chun Kee Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hyun-Seung Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hyun-Seung Kang.

Ethics declarations

Conflict of interest

The authors declare that we have no conflict of interest.

Ethical approval

This study was approved by Seoul National University Hospital Institutional Review Board.

Informed consent

Informed consent was waived (retrospective study).

Consent for publication

Consent for publication waived (retrospective study).

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 533 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoo, D.H., Cho, Y.D., Boonchai, T. et al. Endovascular treatment of medullary bridging vein-draining dural arteriovenous fistulas: foramen magnum vs. craniocervical junction lesions. Neuroradiology 64, 333–342 (2022). https://doi.org/10.1007/s00234-021-02790-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-021-02790-z

Keywords

Search

Navigation