PT  - JOURNAL ARTICLE
AU  - Kai, Yutaka
AU  - Hamada, Jun-ichiro
AU  - Morioka, Motohiro
AU  - Yano, Shigetoshi
AU  - Mizuno, Takamasa
AU  - Kuratsu, Jun-ichi
TI  - Arteriovenous Fistulas at the Cervicomedullary Junction Presenting with Subarachnoid Hemorrhage: Six Case Reports with Special Reference to the Angiographic Pattern of Venous Drainage
DP  - 2005 Sep 01
TA  - American Journal of Neuroradiology
PG  - 1949--1954
VI  - 26
IP  - 8
4099  - http://www.ajnr.org/content/26/8/1949.short
4100  - http://www.ajnr.org/content/26/8/1949.full
SO  - Am. J. Neuroradiol.2005 Sep 01; 26
AB  - 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.