1997 Volume 25 Issue 5 Pages 398-404
Spinal dural arteriovenous shunts (dAVS) is commonly located in the thoracic and lumbar regions. The symptoms of dAVS are usually gradual in onset and hemorrhage is less common. We experienced 6 unusual cases with dAVS in the cranio-cervical junction. There were 2 females and 4 males. Four patients presented with subarachnoid hemorrhage (SAH) and 1 patient showed slowly progressive tetraparesis due to myelopathy. The remaining 1 patient was diagnosed incidentally.
Angiograms revealed that all dAVSs were fed with the dural branches of C1 radicular artery from the vertebral artery and drained into the medullary veins. In the patient with myelopathy, venous drainage was in a caudal direction and further into the anterior spinal vein. In contrast, in the patients with SAH, shunting flow drained into the intracranial venous system, and there was an aneurysmal venous distension in the drainer. In all patients, the draining vein was interrupted surgically at the point where the drainer enters the subarachnoid space. The postoperative courses were uneventful in all patients. Symptoms of myelopathy in 1 patient had improved gradually. We discuss pathophysiology and surgical treatment of dAVS in the cranio-cervical junction.
