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CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2021; 82(S 01): S43-S44
DOI: 10.1055/s-0040-1705162
Skull Base: Operative Videos

Far-Lateral Transcondylar Approach to a Right Cervicomedullary Dural Arteriovenous Fistula of the Posterior Fossa

Roberto R. Rubio
1   Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, United States
2   Department of Neurological Surgery, University of California, San Francisco, California, United States
3   Department of Otolaryngology- Head and Neck Surgery, University of California, San Francisco, California, United States
,
Ricky Chae
1   Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, United States
2   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
Todd Dubnicoff
2   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
Ethan Winkler
2   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
Adib A. Abla
1   Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, United States
2   Department of Neurological Surgery, University of California, San Francisco, California, United States
› Author Affiliations Disclosure of Funding None.
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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.

Keywords

cervicomedullary - dural arteriovenous fistula - vertebral artery - far-lateral approach - transcondylar


Publication History

Received: 28 March 2019

Accepted: 04 January 2020

Article published online:
05 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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