Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm

Keisuke Yoshida, Shinsuke Sato, Tatsuya Inoue, Bikei Ryu, Shogo Shima, Tatsuki Mochizuki, Kentaro Kuwamoto, Yoshikazu Okada, Yasunari Niimi

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)170-177
Number of pages8
JournalInterventional Neuroradiology
Issue number2
Publication statusPublished - 2020 Apr 1
Externally publishedYes


  • Craniocervical junction
  • anterior spinal artery
  • epidural arteriovenous fistula
  • pial feeder aneurysm
  • transvenous embolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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