PT  - JOURNAL ARTICLE
AU  - Krishna C Joshi
AU  - André Beer-Furlan
AU  - R Webster Crowley
AU  - Stephan A Munich
TI  - Pre-operative embolization followed by clipping of Cognard type V dural arteriovenous fistula
AID  - 10.1136/neurintsurg-2020-017201
DP  - 2021 Mar 25
TA  - Journal of NeuroInterventional Surgery
PG  - neurintsurg-2020-017201
4099  - http://jnis.bmj.com/content/early/2021/03/24/neurintsurg-2020-017201.short
4100  - http://jnis.bmj.com/content/early/2021/03/24/neurintsurg-2020-017201.full
AB  - Cognard type V dural arteriovenous fistulas (DAVFs) are a rare type of cerebrovascular malformation characterized by congestion of the perimedullary venous system and often lead to devastating spinal cord pathology if left untreated. We present a unique case in which a middle-aged patient presented with history of gradually progressive weakness in both lower limbs for 6 months and sudden onset of weakness in both upper limbs and face over 3 days. Magnetic resonance imaging (MRI) showed edema in the cervicomedullary junction. Further investigation with conventional angiogram revealed a Cognard type V fistula in the right cerebellopontine angle with multiple feeders from both right external and internal carotid arteries, with drainage into the cerebellar cortical veins and spinal perimedullary veins. We first attempted embolization of the fistula with PHIL liquid embolic system (MicroVention, Tustin, CA, USA) followed by surgical ligation of the fistula. The patient made a remarkable recovery and was symptom-free at his 3-month follow-up. His follow-up MRI showed complete resolution of the edema in his cervicomedullary junction. This case highlights the fact that a combined approach may be often needed to treat these complex fistulas (video 1).Video 1