Article
Cranial Dural Arteriovenous Fistula Type Cognard V: A Rare Cause of Cervical Myelopathy
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Authors
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Josef Michael Lang
- Department of Neurosurgery, Hannover, Deutschland
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Apedjinou Anani
- Department of Neurosurgery, Hannover Medical School, Hannover, Deutschland
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Friedrich Götz
- Institut für Diagnostische und Interventionelle Neuroradiologie, Neuroradiologie, Hannover, Deutschland
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Joachim K. Krauss
- Medizinische Hochschule Hannover, Neurochirurgische Klinik, Klinik für Neurochirurgie, Hannover, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Cranial dural arteriovenous fistulas (DAVFs) are rare disorders. They share only 10-15% of cerebral arteriovenous malformations (AVMs). One of the entities rarely diagnosed is cranial DAVF type V according to the Cognard classification. We report on two cases of cranial DAVF Cognard type V presenting with spinal cord disorders due to cervical myelopathy.
Methods: Reviewing the medical charts and imaging studies of two patients with cranial DAVF Cognard type V.
Results: The first patient, a 44 years old woman presented acutely with subarachnoid haemorrhage Hunt and Hess IV, Fisher group III. Before that she complained gait disturbances and prickling at the lower extremities since several weeks. Magnet resonance imaging (T2-weighted) showed an edema of the cervical cord and enlarged perimedullary vessels. Cranial angiography revealed a DAVF, Cognard type V, of the posterior fossa feeding from left occipital artery with drainage to the transverse sinus and perimedullary spinal veins. The fistula was successfully embolized. However, the patient developed subsequently cerebral vasospasms and died 16 days later from consecutive multiple cerebral infarctions.
The second patient, a 50 years old woman presented with incontinence and progressive tetraparesis. Magnet resonance imaging (T2-weighted) showed a cervical myelopathy and enlarged perimedullary vessels. Angiography revealed a cranial DAVF (Cognard type V) from left occipital artery and drainage to the superior petrosal and to enlarged anterior and posterior perimedullary veins. She was treated first with embolization and subsequently underwent surgical revision after angiographic evidence of recurrence via multiple small dural arteries. 7 months later the fistula recanalised again und was successfully reembolized. The neurological symptoms improved partially. Postprocedural magnet resonance imaging (T2-weighted) showed a regredient edema of the cervical spinal cord.
Conclusion: Cranial DAVF Cognard type V may present with cervical myelopathy and consecutive spinal cord symptoms in variable clinical pictures. Outcome depends on the extent of primary and secondary damage caused by bleeding or venous congestion and the timing of treatment.
