Dural arteriovenous fistulas at the craniocervical junction fed by multiple arteries: a case report

Abstract

Objectives: We report a case of dural arteriovenous fistula at the craniocervical junction fed by multiple arteries manifesting as subarachnoid hemorrhage at onset.
Case presentation: A 45-year-old male suffered subarachnoid hemorrhage. Investigation of the bleeding source found a dural arteriovenous fistula at the left craniocervical junction fed by the meningeal branch of the left vertebral artery, left ascending pharyngeal artery, occipital artery, and deep cervical artery. Transection of the emissary veins via craniotomy following two intravascular embolization procedures resulted in disappearance of the shunt.
Conclusions: Multiplanar reconstruction images of the three-dimensional digital subtraction angiography were useful to identify the dural arteriovenous fistula at the craniocervical junction fed by multiple arteries. Palliative embolization and open surgery were effective combination therapy for this case.