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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:1949-1954, September 2005
© 2005 American Society of Neuroradiology

INTERVENTIONAL

Arteriovenous Fistulas at the Cervicomedullary Junction Presenting with Subarachnoid Hemorrhage: Six Case Reports with Special Reference to the Angiographic Pattern of Venous Drainage

Yutaka Kai^a, Jun-ichiro Hamada^a, Motohiro Morioka^a, Shigetoshi Yano^a, Takamasa Mizuno^a and Jun-ichi Kuratsu^a

^a From the Department of Neurosurgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan

Address correspondence to Yutaka Kai, MD, Department of Neurosurgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan

BACKGROUND AND PURPOSE: Cases with spinal perimedullary arteriovenous fistulas (SPAVFs) or spinal dural arteriovenous fistulas (SDAVFs) at the cervicomedullary junction are rare. We performed a retrospective, angiographic study of 6 such patients to assess whether available angiographic data were predictive of the risk for hemorrhage.

METHODS: We report 6 patients with arteriovenous fistulas at the cervicomedullary junction. All presented with subarachnoid hemorrhage (SAH). Angiography demonstrated that 4 of the 6 fistulas were SDAVFs fed by the meningeal branch of the vertebral artery; the other 2 were SPAVFs fed by the anterior spinal artery. Drainage was via the perimedullary vein of the cervicomedullary junction.

RESULTS: An ascending venous route into the intracranial sinus was recognized in all 6 cases; in 3 the draining system contained varices. In 2 cases, the venous route was on the ventral side of the brain stem with drainage into the cavernous sinus. In 4 cases, the venous route was lateral at the brain stem with drainage into the inferior petrosal sinus.

CONCLUSION: SPAVFs and SDAVFs at the cervicomedullary junction that manifest an ascending venous route into the intracranial sinus present an increased risk for SAH.