Right jugular foramen dural arteriovenous fistula Cognard IV.

08:00 EDT 1st April 2019 | BioPortfolio

Summary of "Right jugular foramen dural arteriovenous fistula Cognard IV."

Posterior fossa dural arteriovenous fistulas (dAVFs) are rare vascular malformations. They carry a significant risk of hemorrhage if associated with cortical venous reflux. A 70-year-old man presented with right-sided medullary hemorrhage with pronounced Wallenberg syndrome. Angiography demonstrated right jugular foramen dAVF with direct brainstem venous reflux (Cognard IV). It was fed from multiple branches of the external carotid artery and the vertebral artery, and draining into the ascending pontomesencephalic vein. Primary two-stage transarterial embolization was performed with near-total occlusion of the fistula to prevent it from rebleeding in the acute phase. Because of the patient's significant neurological deficit, the surgery was deferred to later and if the DAVF showed further progression. Follow-up angiography 8 months later demonstrated obvious recurrence and progression of the fistula from adjacent feeders. In the meantime, the patient had a remarkable recovery from the Wallenberg symptoms. To achieve complete occlusion of the fistula, a right far lateral approach was chosen with complete disconnection of the fistula. Postoperative angiography confirmed complete occlusion of the fistula, and the patient remained intact from the procedure.The video can be found here:


Journal Details

This article was published in the following journal.

Name: Neurosurgical focus
ISSN: 1092-0684
Pages: V7


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An abnormal direct communication between an artery and a vein without passing through the CAPILLARIES. An A-V fistula usually leads to the formation of a dilated sac-like connection, arteriovenous aneurysm. The locations and size of the shunts determine the degree of effects on the cardiovascular functions such as BLOOD PRESSURE and HEART RATE.

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Abnormal formation of blood vessels that shunt arterial blood directly into veins without passing through the CAPILLARIES. They usually are crooked, dilated, and with thick vessel walls. A common type is the congenital arteriovenous fistula. The lack of blood flow and oxygen in the capillaries can lead to tissue damage in the affected areas.

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