頭蓋頚椎移行部動静脈ろうの検討

Abstract

We report 6 patients with rare arteriovenous fistulas of the craniocervical junction: 5 men and 1 woman ranging in age from 54 to 75 years. All manifested associated subarachnoid hemorrhage. Angiography demonstrated that 4 of the 6 fistulas were spinal dural arteriovenous fistulas (SDAVF) fed by the meningeal branch of the vertebral artery, the other 2 were spinal perimedullary arteriovenous fistulas (SPAVF) fed by the anterior spinal artery. Drainage was via the perimedullary vein of the craniocervical junction. Retrograde leptomeningeal venous drainage (RLVD) into the intracranial venous system was recognized in 5 cases; in 3 the draining system contained varices. All 6 patients underwent direct surgery using the transcondylar fossa approach. Before proceeding to surgical coagulation, intraoperative angiography proved useful for the temporary clipping to the feeding artery in our SPAVF cases or the drainer in the SDAVF cases. The postoperative course of 5 patients was good; the other patient remained moderately disabled due to initial damage of the medulla oblongata. SPAVF and SDAVF in the craniocervical junction led to subarachnoid hemorrhage and the presence of RLVD into the intracranial venous system was related to the hemorrhagic symptoms. By direct surgery a good prognosis can be achieved in patients with arteriovenous fistulas of the craniocervical junction.