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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Management of craniocervical dural arteriovenous malformations

Meeting Abstract

  • M. Westphal - Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • J. Regelsberger - Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • E. Neimaier-Probst - Abteilung für Neuroradiologie, Universitätsklinikum Mannheim
  • U. Grzyska - Abteilung für Neuroradiologie, Klinik und Poliklinik für Radiologie, Universitätsklinikum Hamburg-Eppendorf
  • H. Zeumer - Abteilung für Neuroradiologie, Klinik und Poliklinik für Radiologie, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.06-06

doi: 10.3205/09dgnc149, urn:nbn:de:0183-09dgnc1491

Published: May 20, 2009

© 2009 Westphal et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: To describe the specifics of the subgroup of cranial dural arteriovenous malformations which are located at the craniocervical junction and present with characteristic features due to venous congestion in the upper, pontine or pontomedullary brainstem compartment.

Methods: 11 patients with craniocervical dural arteriovenous malformations were identified. All patients underwent superselective angiography. Feeding vessels were typically the ascendant pharyngeal and the external occipital arteries. Collateral feeders may originate from tentorial branches or the middle menigeal artery.

Results: The symptoms are those of insidious onset of brainstem dysfunction but never acute. None of the lesions in our series of 11 cases had bled. The arteriovenous fistulous point, which is usually within a small nidus, is typically around the jugular foramen.

Therapy consisted in an attempt at embolization with diluted, very liquid acrylic material because the feeding vessels are thin and the distance to the nidus is long. Occlusion was achieved in more than 50% of the cases. If the embolization was incomplete or appeared to dangerous because of appearing collaterals to the spinal artery, surgical exposure was performed to obliterate the fistulous point either by coagulation, clipping or transection after coagulation. In one patient the symptoms resolved, in 8 patients the symptoms improved, one patient deteriorated and one patient died.

Conclusions: The prognosis of neurological deficits after obliteration of a csDAVF is unpredictable. Surgical therapy as well as complete embolization result in an immediate change of haemodynamics which angiographically then appear ”normal” but may be inappropriate in the sense of hyperperfusion or reperfusion injury. It is hypothesized that preembolization with timely surgical intervention thereafter allows for more gradual adaptation.