Oper Neurosurg (Hagerstown). 2021 Jun 15;21(1):E55-E59. doi: 10.1093/ons/opab077.
Dural arteriovenous fistulas (dAVFs) are vascular abnormalities of the central nervous system that can cause a wide array of neurological dysfunction depending on their location, flow, and propensity to rupture. Symptomatic dAVFs at the cranio-cervical junction usually result in hemorrhage or cervical myelopathy. Distantly located dAVFs of the foramen magnum are a rare cause of thoracic intrinsic myelopathy.
An 83-yr-old man presented with progressive lower extremity weakness, numbness, and difficulty walking along with episodes of bowel incontinence. Magnetic resonance imaging of the cervical spine demonstrated multilevel cervical disc disease with stenosis and longitudinal cervical cord signal change extending into the upper thoracic spinal cord. Cerebral and spinal angiography revealed a dAVF in the lateral foramen magnum region. Given the location, feeding vasculature, and morphology of the fistula, endovascular embolization was not attempted. Microsurgical resection with confirmative indocyanine green fluorescent imaging was performed with adequate obliteration of the fistula. The patient's neurological baseline was preserved postoperatively with improvement of lower extremity numbness.
We present a brief overview of this neuropathologic entity and demonstrate microsurgical resection of a foramen magnum dAVF through operative video. Craniocervical dAVFs should remain on the differential diagnosis of patients presenting with progressive thoracolumbar myelopathy.
硬脑膜动静脉瘘（dAVF）是中枢神经系统的血管异常，根据其位置、血流和破裂倾向，可引起广泛的神经功能障碍。颅颈交界处有症状的 dAVF 通常导致出血或颈髓病。远隔部位的枕骨大孔 dAVF 是胸髓内在性脊髓病的罕见原因。
一名 83 岁男性出现进行性下肢无力、麻木和行走困难，并伴有大便失禁发作。颈椎磁共振成像显示多节颈椎间盘疾病伴狭窄和纵向颈椎脊髓信号改变延伸至胸髓上段。脑和脊髓血管造影显示侧枕骨大孔区存在 dAVF。鉴于瘘的位置、供血血管和形态，未尝试血管内栓塞。通过手术视频，我们采用显微外科切除术并结合吲哚菁绿荧光成像来确认，充分闭塞瘘。术后患者的神经基线保持不变，下肢麻木症状改善。
我们简要概述了这种神经病理学实体，并通过手术视频展示了枕骨大孔 dAVF 的显微外科切除术。颅颈交界处 dAVF 应作为进行性胸腰椎脊髓病患者的鉴别诊断之一。
