Kikkawa Yuichiro, Nakamizo Akira, Yamashita Koji, Amano Toshiyuki, Kurogi Ai, Sasaki Tomio
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Fukuoka Igaku Zasshi. 2013 Sep;104(9):299-308.
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.
由双侧椎动脉供血的颅颈交界区硬脑膜动静脉瘘（CCJDAVF）极为罕见。我们报告一例63岁男性患者，其因CCJDAVF导致进行性脊髓病，该瘘由双侧椎动脉、枕动脉和咽升动脉供血，有多个分流点，并引流至颅内静脉窦和脊髓静脉。采用逐步吲哚菁绿（ICG）血管造影术成功地对该硬脑膜动静脉瘘（DAVF）进行了手术治疗。术后，DAVF消失，脊髓病明显改善。我们展示了这个罕见DAVF的详细术前影像和术中发现，并强调选择性血管造影对术前评估供血动脉的重要性以及术中ICG血管造影术在识别瘘管及其闭塞确认方面的实用性。
