Background:
Craniocervical junction dural A-V fistula is a rare disease, mainly presented by subarachnoid haemorrhage, myelopathy and venous hypertension. The aetiology of dural A-V fistula is still not fully understood but it is now generally accepted that these fistulae are acquired lesions and the Primary pathognomonic factor is the venous hypertension which may be related to either thrombotic or non-thrombotic reduction of venous outflow.
Material &methods:
In this article, we present four patients with dural arteriovenous fistulae at craniocervical junction who were managed in various modalities, with radiological and clinically follow up for one year.
Results:
All patients were males with mean age of 53 years. Two patients presented with cervical myelopathy in form of progressive quadriparesis and other two patients presented with subarachnoid haemorrhage. In one case, surgical extirpation of varix was done while in remaining three cases, endovascular embolization was done. All patients showed remarkable improvement at one year follow up. Follow up angiography showed complete occlusion of fistulae in all cases.
Conclusion:
Craniocervical junction dural A-V fistula is a rare disease but should be considered in differential diagnosis of subarachnoid haemorrhage. Endovascular embolization is main line of management but in the presence of venous varix causing myelopathy; surgical disconnection of the fistula and cord decompression should be the treatment of choice.