Article Figures & Data
Figures
- Fig 1.
Left vertebral angiogram (early phase), showing abnormal vessels at the cervicomedullary junction. The feeding artery is the meningeal branch of the vertebral artery and ascending drainage route was recognized (arrowhead).
- Fig 2.
Left vertebral angiogram (late phase), showing shunt flow draining retrogradely into the left superior petrosal sinus (arrowhead).
- Fig 3.
Postoperative left vertebral angiogram, demonstrating complete disappearance of the abnormal vessels.
- Fig 4.
Left vertebral angiogram (early phase), showing abnormal vessels at the cervicomedullary junction. The feeder, the anterior spinal artery, feeds directly into the lateral medullary vein (arrow).
- Fig 5.
Left vertebral angiogram (late phase), showing shunt flow draining retrogradely into the bilateral inferior petrosal vein (arrowhead).
- Fig 6.
Postoperative left vertebral angiogram, demonstrating complete disappearance of the abnormal vessels.
Tables
- TABLE 1:
Summary of the six cases with arteriovenous fistulas at the cervicomedullary junction
Patient No./Age (y)/Sex Symptom Feeder SDAVF/SPAVF Fistula Point Drainer Related Sinus Treatment Outcome 1/61/M SAH Meningeal artery SDAVF Jugular foramen Anteromedial medullary vein Superior petrosal sinus–cavernous sinus Drainer occlusion GR 2/56/M SAH Meningeal artery SDAVF Jugular foramen Anterior spinal vein Cavernous sinus Drainer occlusion GR Petrosal vein 3/75/M SAH Ascending pharyngeal artery SDAVF Jugular foramen Pontomedullary vein Inferior petrosal sinus Drainer occlusion MD Inferior petrosal vein 4/68/M SAH Meningeal artery SDAVF Jugular foramen Anterior hemispheric vein Inferior petrosal sinus Drainer occlusion GR Lateral medullary vein 5/54/M SAH Anterior spinal artery SPAVF Jugular foramen–C1 Lateral medullary vein Inferior petrosal sinus Feeder occlusion GR 6/56/F SAH Anterior spinal artery SPAVF Jugular foramen–C1 Lateral hemispheric vein Inferior petrosal sinus Feeder occlusion GR Inferior vermian vein SAH indicates subarachnoid hemorrhage; GR, good recovery; MD, moderately disabled; C, cervical; SDAVF, spinal dural arteriovenous fistula; SPAVF, spinal perimedullary arteriovenous fistula.
- TABLE 2:
Summary of reported patients with arteriovenous fistula of cervicomedullary junction
Study Age (y)/Sex Symptom SDAVF/SPAVF Ascending/Descending Drainer Asakawa et al, 2002 (5) 64/M Myelopathy SDAVF Descending Spinal medullary veins Do et al, 1999 (6) 50/M SAH SDAVF Ascending Anterior medullary vein Ernst et al, 1997 (7) 71/M Myelopathy SDAVF Descending Spinal medullary veins 47/M Myelopathy SDAVF Descending UD 58/F Myelopathy SDAVF Descending Spinal medullary veins, superior petrosal sinus Fox and Allcock, 1978 (8) 54/M Tinnitus SDAVF Descending Jugular vein, varix (+) Gaensler et al, 1990 (9) 50/M Myelopathy SDAVF Descending Medullary vein 69/F Myelopathy SDAVF Descending Medullary vein Guglielmi et al, 1988 (10) 62/F Tinnitus SDAVF Descending Jugular vein Hahnel et al, 1998 (11) 67/M Myelopathy SDAVF Ascending Anterior pontomesencephalic vein, superior petrous sinus Hashimoto et al, 2000 (12) 66/F SAH SDAVF Ascending Perimedullary vein inferior petrosal sinus Inci et al, 2002 (13) 22/M Myelopathy SDAVF Descending Epidural vein Kinouchi et al, 1998 (14) 10 cases SAH 7 cases SDAVF Ascending: 6 Vatix: 4 cases Ascending and descending: 3 Descending: 1 Mascalchi et al, 1996 (16) 69/M Myelopathy SDAVF Descending Retromedullary vein, inferior petrosal sinus 53/M Myelopathy SDAVF Descending Anteromedullary veins, retromedullary veins Miyoshi et al, 1999 (17) 70/F Myelopathy SDAVF Descending Anterior and posterior spinal veins Niwa et al, 1997 (18) 61/F Asymptomatic SDAVF Descending Medullary vein 61/M Cerebellar ataxia SDAVF Descending Medullary vein Oda et al, 1989 (19) 58/M Myelopathy SDAVF Descending Medullary vein Oishi et al, 1999 (20) 62/F Myelopathy SDAVF Descending Medullary vein Partington et al, 1992 (21) 63/M Myelopathy SDAVF Descending Medullary vein Pulido et al, 2004 (22) 62/M Myelopathy SDAVF Descending Medullary vein Rodesch and Lasjaunias, 2003 (23) 36/M Myelopathy SDAVF Descending Medullary vein Slaba et al, 2000 (24) 36/M Myelopathy SDAVF UD Perimedullary veins Symon et al, 1984 (25) 60/M Myelopathy SDAVF Descending Perimedullary veins Trop et al, 1998 (26) 74/M Myelopathy SDAVF Descending Anterior medullary vein Vinuela et al, 1986 (27) 30/F Cerebellar dysfunction SDAVF UD UD Willinsky et al, 1990 (28) 36/F Myelopathy SDAVF Descending Anterior medullary vein Bayrakci et al, 1999 (30) 4 mo/M Torticolis SPAVF Descending Anterior spinal vein Heros et al, 1986 (31) 31/M Myelopathy SPAVF Ascending Anterior spinal vein Hida et al, 2002 (32) 58/M SAH SPAVF Ascending UD Nagashima et al, 1996 (33) 16/F Myelopathy SPAVF Descending Anterior spinal vein SAH indicates subarachnoid hemorrhage: SDAVF, spinal dural arteriovenous fistula; SPAVF, spinal perimedullary arteriovenous fistula; UD, unspecfied data.
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