頭蓋頸椎移行部dural AV fistulaの外科治療  [in Japanese] Surgical Management for Craniocervical Junction Dural AV Fistula  [in Japanese]

Spinal dural arteriovenous fistula (AVF) is the most common type of spinal vascular malformations. We experienced 3 surgically treated cases of craniocervical junction dural AVF. Case 1 was a 69-year-old man who suffered from headache and had no neurological deficet. Case 2 was a 65-year-old man who presented subarachnoid hemorrhage. His conciousness was confused but he had no motor weakness. Case 3 was a 38-year-old woman who suffered from headache and had no neurological deficet. MRI, DSA, and 3D-CTA studies were performed for all cases. The lesions were diagnosed as craniocervical junction dural AVFs with intradural varix and drainage in Case 1 and Case 3, and a C2 level dural AVF with intradural varix and drainage and with an expansive epidural drainage. All cases were successfully treated with surgical drainer clipping. Pre-operative 3D-CTA study, intra-operative DSA, directional color-flow doppler and the surgical technique of dentate ligament cutting were useful to treat these lesions.