Purpose

Dural arteriovenous fistulas (AVFs) draining to medullary bridging vein (MBV) are located at foramen magnum (FM) and craniocervical junction (CCJ). Such fistulas are rare but pose a challenge to endovascular management. This study was undertaken to assess clinical manifestations, angiographic features, and outcomes of endovascular treatment in patients with MBV dural AVFs.

Methods

A number of our patients (N = 22) were diagnosed with MBV dural AVF and treated by endovascular means. There were 9 FM lesions and 13 CCJ lesions. We reviewed clinical records and imaging studies to define clinical characteristics, vascular anatomic details, and treatment outcomes, comparing FM- and CCJ-level subsets.

Results

Subjects ranged from 37 to 74 years of age (mean, 57.7 years) with male predominance (2.7:1). They presented with intracranial hemorrhage (11/22, 50%), myelopathy (8/22, 36%), or nonspecific symptoms (3/22, 14%). In 17 patients (77.3%), the shunts showed complete or near-complete occlusion following endovascular treatment (FM, 100%; CCJ, 61.5%). However, seven patients experienced ischemic events (FM, 11.1%; CCJ, 46.2%) and one patient sustained a hemorrhagic complication. No hemorrhages recurred during follow-up monitoring, and myelopathic symptoms abated.

Conclusion

MBV dural AVFs are highly aggressive lesions for which proper diagnosis and treatment are of utmost importance. Although transarterial embolization proved highly successful in FM lesions, shunt occlusion was less frequent in the CCJ subset, with greater risk of ischemic complications.

中文翻译：

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髓质桥静脉引流硬脑膜动静脉瘘的血管内治疗：枕骨大孔与颅颈交界处病变

目的

引流至髓桥静脉 (MBV) 的硬脑膜动静脉瘘 (AVF) 位于枕骨大孔 (FM) 和颅颈交界处 (CCJ)。这种瘘管很少见，但对血管内治疗提出了挑战。本研究旨在评估 MBV 硬脑膜 AVF 患者的临床表现、血管造影特征和血管内治疗结果。

方法

我们的一些患者 ( N  = 22) 被诊断为 MBV 硬脑膜 AVF 并通过血管内手段进行治疗。FM病灶9个，CCJ病灶13个。我们回顾了临床记录和影像学研究，以定义临床特征、血管解剖细节和治疗结果，比较 FM 和 CCJ 水平的子集。

结果

受试者的年龄范围为 37 至 74 岁（平均 57.7 岁），男性占优势（2.7:1）。他们出现颅内出血 (11/22, 50%)、脊髓病 (8/22, 36%) 或非特异性症状 (3/22, 14%)。在 17 名患者 (77.3%) 中，血管内治疗后分流管完全或接近完全闭塞 (FM, 100%; CCJ, 61.5%)。然而，7 名患者出现缺血事件（FM，11.1%；CCJ，46.2%），1 名患者出现出血并发症。随访监测期间无出血复发，脊髓病症状减轻。

结论

MBV 硬脑膜 AVF 是高度侵袭性病变，对其进行正确的诊断和治疗至关重要。尽管经动脉栓塞在 FM 病变中被证明非常成功，但在 CCJ 亚群中分流闭塞的频率较低，缺血性并发症的风险更大。