Cervical Extradural Arteriovenous Fistula without Intradural Drainage Successfully Treated with Endovascular Treatment Using Both Transvenous and Transarterial Approach: Case Report and Review of Literatures

Toshiyuki OKAZAKI; Yukoh OHARA; Hidenori MATSUOKA; Kazuaki SHIMOJI; Kazunari KOGURE; Nahoko KIKUCHI; Takaoki KIMURA; Shintaro NAKAJIMA; Satoshi TANI; Junichi MIZUNO; Hajime ARAI; Hidenori OISHI

doi:10.2176/nmccrj.cr.2020-0260

Case Reports

Cervical Extradural Arteriovenous Fistula without Intradural Drainage Successfully Treated with Endovascular Treatment Using Both Transvenous and Transarterial Approach: Case Report and Review of Literatures

Toshiyuki OKAZAKI, Yukoh OHARA, Hidenori MATSUOKA, Kazuaki SHIMOJI, Kazunari KOGURE, Nahoko KIKUCHI, Takaoki KIMURA, Shintaro NAKAJIMA, Satoshi TANI, Junichi MIZUNO, Hajime ARAI, Hidenori OISHI

Author information

Toshiyuki OKAZAKI
Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
Yukoh OHARA
Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Hidenori MATSUOKA
Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
Kazuaki SHIMOJI
Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Kazunari KOGURE
Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
Nahoko KIKUCHI
Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
Takaoki KIMURA
Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
Shintaro NAKAJIMA
Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Satoshi TANI
Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
Junichi MIZUNO
Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
Hajime ARAI
Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Hidenori OISHI
Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan

Keywords: extradural arteriovenous fistula, cervical spine, endovascular treatment, anterior condylar emissary vein

JOURNAL OPEN ACCESS FULL-TEXT HTML

2021 Volume 8 Issue 1 Pages 335-342

DOI https://doi.org/10.2176/nmccrj.cr.2020-0260

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Abstract

The classification of spinal extradural arteriovenous fistulas (AVFs) was reported based on a case series treated by microsurgery in 2009 and endovascular interventions in 2011. The present report describes a patient with extradural AVFs at the cervical spine manifesting gradual progressive radiculomyelopathy of bilateral upper extremities. Magnetic resonance imaging (MRI) revealed a mass sign from C1 to C4 at the right ventral side and the spinal cord was deviated to the left and indicated as a flow void sign. Diagnostic angiography revealed an extradural AVFs located at the C1–C4 level that was supplied by bilateral radicular artery from the vertebral artery (VA) and right ascending cervical artery (ACA). The shunting points were recognized multiply at C2/3 and C3/4 levels on the right. The transvenous embolization to the enlarged extradural venous plexus around the shunting points via right hypoglossal canal and the transarterial embolization against multi-feeders of the branch of left radicular artery, right ACA achieved complete occlusion of the lesions. His symptom was gradually recovered, and angiography performed 2 weeks after embolization showed no recurrence. When the arteriovenous shunts in the upper cervical spine were high flow shunts, transvenous approach via the hypoglossal canal might be one option for the treatment of spinal extradural AVFs.

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