Back to Search
Start Over
Far-Lateral Transcondylar Approach to a Right Cervicomedullary Dural Arteriovenous Fistula of the Posterior Fossa
- Source :
- Journal of Neurological Surgery. Part B, Skull Base
- Publication Year :
- 2020
- Publisher :
- Georg Thieme Verlag KG, 2020.
-
Abstract
- Objectives Dural arteriovenous fistulas (DAVFs) at the cervicomedullary junction are uncommon and often accompanied by subarachnoid hemorrhage (SAH). We aim to illustrate in detail the microsurgical procedure for treating a DAVF located at the cervicomedullary junction. Design We present a two-dimensional operative video that includes clinical history, preoperative imaging, surgical strategy, still images with labels, clinical course, and postoperative imaging. Setting The microsurgery was performed at an academic medical center. Participant The patient is a 55-year-old female who presented with SAH, acute onset headache, nausea, and vomiting. Angiography demonstrated right vertebral artery vasospasm and a persistent arteriovenous shunt at the cervicomedullary junction supplied by small perforating arteries of the right vertebrobasilar junction (Fig. 1). Main Outcome Measures The patient was placed in the park-bench position with the head turned to the contralateral side. A hockey stick incision was made, followed by a right-side far-lateral transcondylar approach. Indocynanine green videoangiography was performed to help identify the areas of arteriovenous shunting. Multiple clips were placed to interrupt vessels that corresponded to arterial feeders at the level of the C1 and C2 nerve root sleeves (Fig. 2). The dura was closed in a water tight fashion and the posterior fossa was reconstructed with a titanium mesh. Results Postoperative imaging showed no evidence of continued arteriovenous shunting. The patient was discharged in good clinical condition with an uneventful postoperative course. Conclusion A deep understanding of the microsurgical vascular anatomy is necessary for successful occlusion of a cervicomedullary DAVF.The link to the video can be found at: https://youtu.be/-LfOcNB05BY.
- Subjects :
- transcondylar
medicine.medical_specialty
Subarachnoid hemorrhage
medicine.diagnostic_test
business.industry
Vertebral artery
medicine.medical_treatment
Arteriovenous fistula
cervicomedullary
Microsurgery
medicine.disease
Cervicomedullary Junction
Surgery
Skull Base: Operative Videos
Perforating arteries
Hockey stick
medicine.artery
Angiography
vertebral artery
medicine
far-lateral approach
Neurology (clinical)
business
dural arteriovenous fistula
Subjects
Details
- ISSN :
- 2193634X and 21936331
- Volume :
- 82
- Database :
- OpenAIRE
- Journal :
- Journal of Neurological Surgery Part B: Skull Base
- Accession number :
- edsair.doi.dedup.....bd3b4ec5a21dd3760e82b9da0fd85a1a