Diagnostic and therapeutic analysis of dural arteriovenous fistula at the craniocervical junction

Objective To investigate the clinical features, diagnosis and treatment methods of dural arteriovenous fistula at the craniocervical junction. Methods The clinical data from 13 patients with dural arteriovenous fistula at the craniocervical junction admitted to the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2009 to January 2015 were analyzed retrospectively. All patients were diagnosed after performing encephalon angiography. Ten patients were treated with microsurgery of electric coagulation cutting off fistula via the posterior median suboccipital approach. Three patients were observed and followed up. The follow-up time ranged from 2 months to 5 years. Results In the 10 patients treated with surgery, postoperative cerebral angiography showed that the original fistulas, draining veins and aneurysmal changes disappeared in 9 cases, in one case there was partial residue of the fistula, which was completely removed after the secondary microsurgery.9 cases with the onset of subarachnoid hemorrhage had no significant postoperative neurological deficit.The pain in the patient who had trigeminal neuralgia relieved obviously after surgical procedure. During the follow-up period, no recurrence was found in the postoperative patients. Among the 3 patients under observation, one case who was completely paralyzed died of related complications, the remaining 2 cases were lost. Conclusions The clinical manifestation of dural arteriovenous fistula in the craniocervical junction do not have specificity, it can be diagnosed by performing encephalon angiography. Currently, microsurgery can generally find fistula and block it, and the efficacy is exact. Key words: Craniocervical junction; Dura mater; Arteriovenous fistula; Microsurgery