RT Journal Article
SR Electronic
T1 Pre-operative embolization followed by clipping of Cognard type V dural arteriovenous fistula
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP neurintsurg-2020-017201
DO 10.1136/neurintsurg-2020-017201
A1 Krishna C Joshi
A1 André Beer-Furlan
A1 R Webster Crowley
A1 Stephan A Munich
YR 2021
UL http://jnis.bmj.com/content/early/2021/03/24/neurintsurg-2020-017201.abstract
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