TY - JOUR
T1 - Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm
AU - Yoshida, Keisuke
AU - Sato, Shinsuke
AU - Inoue, Tatsuya
AU - Ryu, Bikei
AU - Shima, Shogo
AU - Mochizuki, Tatsuki
AU - Kuwamoto, Kentaro
AU - Okada, Yoshikazu
AU - Niimi, Yasunari
N1 - Funding Information:
We appreciate Dr. Samuel Wang for his assistance with English language editing.
Publisher Copyright:
© The Author(s) 2019.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Arteriovenous fistulas at the craniocervical junction are rare vascular malformations with frequent hemorrhagic presentations, which may have a concurrent pial feeder aneurysm. A 65-year-old man presented with subarachnoid hemorrhage and angiography showed an epidural arteriovenous fistula at the C-2 level with an anterior spinal feeder aneurysm without perimedullary venous drainage. Transarterial coil embolization of the ruptured aneurysm and partial Onyx embolization of the shunt led to thrombosis of the aneurysm. However, three years later angiography showed an increased shunt flow and recurrence of the aneurysm. Transvenous embolization of the shunt using coils and Onyx yielded complete obliteration of the shunt, thus leading to occlusion of the aneurysm. This case demonstrates that partial transarterial embolization of arteriovenous fistula leaves a risk of rebleeding, whereas complete obliteration of the shunt with a transvenous approach can lead to disappearance of the flow-related aneurysm without embolization of the aneurysm itself.
AB - Arteriovenous fistulas at the craniocervical junction are rare vascular malformations with frequent hemorrhagic presentations, which may have a concurrent pial feeder aneurysm. A 65-year-old man presented with subarachnoid hemorrhage and angiography showed an epidural arteriovenous fistula at the C-2 level with an anterior spinal feeder aneurysm without perimedullary venous drainage. Transarterial coil embolization of the ruptured aneurysm and partial Onyx embolization of the shunt led to thrombosis of the aneurysm. However, three years later angiography showed an increased shunt flow and recurrence of the aneurysm. Transvenous embolization of the shunt using coils and Onyx yielded complete obliteration of the shunt, thus leading to occlusion of the aneurysm. This case demonstrates that partial transarterial embolization of arteriovenous fistula leaves a risk of rebleeding, whereas complete obliteration of the shunt with a transvenous approach can lead to disappearance of the flow-related aneurysm without embolization of the aneurysm itself.
KW - Craniocervical junction
KW - anterior spinal artery
KW - epidural arteriovenous fistula
KW - pial feeder aneurysm
KW - transvenous embolization
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U2 - 10.1177/1591019919874571
DO - 10.1177/1591019919874571
M3 - Article
C2 - 31488023
AN - SCOPUS:85073799070
SN - 1591-0199
VL - 26
SP - 170
EP - 177
JO - Interventional Neuroradiology
JF - Interventional Neuroradiology
IS - 2
ER -