Document Detail

Dural arteriovenous fistula at the foramen magnum presenting with subarachnoid hemorrhage: case reports and literature review.
MedLine Citation:
PMID:  20050886     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Spinal dural arteriovenous fistulas (DAVFs) may arise at any level from the foramen magnum to the sacrum. Only a few case series of DAVFs at the foramen magnum have been reported, especially with patients presenting with subarachnoid hemorrhage (SAH). We performed a retrospective study of four such cases and summarize experiences in the diagnosis and surgical treatment of a DAVF at the foramen magnum.
METHODS: Four male patients, aged from 35 to 51 years, were admitted with severe headache. The cranial computerized tomography scans of all four patients showed SAH, with hemorrhage in the fourth ventricle with or without hemorrhage in the occipital horns of the lateral ventricles. Pre-operative digital subtraction cerebral angiography showed a DAVF at the foramen magnum draining to medullary veins and/or the straight sinus and the confluence of sinuses. Two DAVFs were fed by the vertebral artery, whilst the others were fed by dural branches of the occipital artery and/or the ascending pharyngeal artery.
RESULTS: Three patients underwent direct microsurgical electrocoagulation and disconnection of the arteriovenous shunt via an enlargement of the foramen magnum and a hemilaminectomy at C1 by the far lateral suboccipital approach. Post-operative angiography confirmed complete obliteration of the fistula.
CONCLUSIONS: Cerebral digital subtraction angiography is an effective and accurate method for examination of a DAVF at the foramen magnum. It can be treated effectively and with minimal surgical trauma by microsurgical electrocoagulation and disconnection of the shunt.
L-M Guo; H-Y Zhou; J-W Xu; G-S Wang; X Tian; Y Wang; Y-M Qiu; J-Y Jiang
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2009-12-29
Journal Detail:
Title:  European journal of neurology : the official journal of the European Federation of Neurological Societies     Volume:  17     ISSN:  1468-1331     ISO Abbreviation:  Eur. J. Neurol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-06-04     Completed Date:  2011-01-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9506311     Medline TA:  Eur J Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  684-91     Citation Subset:  IM    
Department of Neurosurgery, Renji Hospital, Medical College, Shanghai Jiaotong University, Shanghai, China.
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MeSH Terms
Central Nervous System Vascular Malformations / complications,  diagnosis,  pathology*
Diagnosis, Differential
Foramen Magnum / pathology*,  radiography
Middle Aged
Neurosurgical Procedures / methods
Subarachnoid Hemorrhage / diagnosis,  etiology,  pathology*
Tomography, X-Ray Computed
Treatment Outcome

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