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

• Published in: Neuroradiology 2022-02, Vol.64 (2), p.333-342
• Main Authors: Yoo, Dong Hyun, Cho, Young Dae, Boonchai, Tiplada, Kim, Kang Min, Kim, Jeong Eun, Cho, Won-Sang, Lee, Sung Ho, Chung, Chun Kee, Kang, Hyun-Seung
• Format: Article
• Language: English
• Subjects: Angiography; Cardiovascular system; Central nervous system diseases; Central Nervous System Vascular Malformations - diagnostic imaging; Central Nervous System Vascular Malformations - therapy; Complications; Embolization; Embolization, Therapeutic; Female; Fistula; Foramen Magnum - diagnostic imaging; Foramen Magnum - surgery; Hemorrhage; Humans; Imaging; Interventional Neuroradiology; Ischemia; Lesions; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Occlusion; Patients; Radiology; Shunts; Spinal cord; Treatment Outcome
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-021-02790-z

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.