Abstract TP583: Consideration on Surgical Treatment of Arteriovenous Fistula at the Craniocervical Junction
| Autor: | Jun Tanabe, Kenichiro Suyama, Ichiro Nakahara, Tatsuo Omi, Shoji Matsumoto, Jumpei Oda, Sadayoshi Watanabe, Shigeta Moriya, Tsukasa Ganaha, Akiko Hasebe, Takeya Suzuki |
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| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Stroke. 50 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/str.50.suppl_1.tp583 |
| Popis: | Objective: Management of arteriovenous fistula at the craniocervical junction (CCJ-AVF) is challenging, because CCJ-AVF is quite rare, most cases are difficult to treat by the endovascular treatment only, and difficult to understand its complicated anatomy preoperatively. The aim of this presentation is to propose several tips and pitfalls regarding the surgical strategy for CCJ-AVF, particularly focused on anatomical relationships with shunting point and key structures. Methods: We experienced 9 cases of CCJ-AVF during about 4 years since April 2015. These patients presented by as follows, 3 subarachnoid hemorrhage, 2 hematomyelia, 1 cerebellar hemorrhage, and 3 incindentally. We performed surgical ligation for 8 cases and endovascular treatment for 2 cases, including combined therapy for one case in each. Direct surgery was usually performed as follows: general anesthesia, park-bench position, transcondylar fossa approach and C1 laminectomy, cut the dentate ligament with MEP/SEP and NIM monitoring and ICG video angiography repeatedly. Results: Postoperative DSA showed a complete cure in every case. One case treated by surgical ligation had a transient neurological deficit, while another case treated by endovascular treatment showed deterioration of preoperative motor dysfunction. Conclusions: For CCJ-AVFs, we prefer direct surgical ligation, because this lesion has a dangerous anastomoses between radiculo-meningeal and pial supply which cannot be detect preoperatively. Our approach can provide a suitable operative field to ensure understanding of its complicated structure. In our series, the patients who underwent surgical ligation had a good result except one patient with transient neurological deficit caused by postoperative excessive venous thrombosis of the drainer which required temporary anticoagulation. |
| Databáze: | OpenAIRE |
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