Wada Kentaro, Tanei Takafumi, Hattori Kenichi, Hatano Hisashi, Fujitani Shigeru, Ito Risa, Kubo Hiroaki, Nishimura Yusuke, Maesawa Satoshi, Saito Ryuta
Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan.
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Surg Neurol Int. 2023 Mar 10;14:85. doi: 10.25259/SNI_122_2023. eCollection 2023.
An arteriovenous fistula (AVF) at the craniocervical junction (CCJ) is a rare vascular malformation. Definitive diagnosis and curative treatment of CCJ AVF are challenging.
A 77-year-old man presented with subarachnoid hemorrhage. Cerebral angiography showed an AVF at the CCJ, which drained into a radicular vein. The lesion was fed by a vertebral artery, anterior and lateral spinal arteries (LSAs), and the occipital artery (OA). There were two unique structures: the LSA originating from the posterior inferior cerebellar artery of the extracranial V3 segment and the OA feeding the shunt. Curative treatment involved two steps: endovascular embolization of feeders using Onyx and surgical shunt disconnection. Feeding arteries were blackened by Onyx, which helped identify the location of the shunt. The shunt was located behind the first cervical (C1) spinal nerve, and the draining vein was confirmed on the deep side of the nerve. A clip was applied to the draining vein distal to the shunt. Tiny vessels supplying the shunt were then coagulated referring to blackened arteries.
A radicular AVF at the CCJ along the C1 spinal nerve had unique vascular structures. Definitive diagnosis and curative treatment were achieved by combining endovascular embolization using Onyx and direct surgery.
颅颈交界区动静脉瘘（AVF）是一种罕见的血管畸形。颅颈交界区AVF的明确诊断和根治性治疗具有挑战性。
一名77岁男性出现蛛网膜下腔出血。脑血管造影显示颅颈交界区有一个AVF，引流至一根神经根静脉。该病变由椎动脉、脊髓前动脉和外侧脊髓动脉（LSA）以及枕动脉（OA）供血。有两个独特结构：LSA起源于颅外V3段的小脑后下动脉，以及OA为分流供血。根治性治疗包括两个步骤：使用Onyx对供血动脉进行血管内栓塞和手术切断分流。供血动脉被Onyx染黑，这有助于确定分流的位置。分流位于第一颈神经（C1）后方，引流静脉在神经深侧得到确认。在分流远端的引流静脉上夹闭夹子。然后参照染黑的动脉对供应分流的微小血管进行凝固。
沿C1脊神经的颅颈交界区神经根型AVF具有独特的血管结构。通过联合使用Onyx进行血管内栓塞和直接手术实现了明确诊断和根治性治疗。
