Surgical and Endovascular Treatments for Asymptomatic Arteriovenous Fistulas at the Craniocervical Junction: A Multicenter Study

Tomoo Inoue; Toshiki Endo; Keisuke Takai; Toshitaka Seki; Neurospinal Society of Japan CCJ AVF study investigators

doi:10.1016/j.wneu.2023.04.068

Surgical and Endovascular Treatments for Asymptomatic Arteriovenous Fistulas at the Craniocervical Junction: A Multicenter Study

World Neurosurg. 2023 Jul:175:e1049-e1058. doi: 10.1016/j.wneu.2023.04.068. Epub 2023 Apr 21.

Authors

Tomoo Inoue¹, Toshiki Endo², Keisuke Takai³, Toshitaka Seki⁴; Neurospinal Society of Japan CCJ AVF study investigators

Collaborators

Neurospinal Society of Japan CCJ AVF study investigators:
Keisuke Ito⁵, Motoyuki Iwasaki⁶, Hisaaki Uchikado⁷, Daisuke Umebayashi⁸, Munehiro Otsuka⁹, Tatsuya Ohtonari¹⁰, Junpei Oda¹¹, Hiroto Kageyama¹², Ryu Kurokawa¹³, Izumi Koyanagi¹⁴, Satoshi Koizumi¹⁵, Taku Sugawara¹⁶, Yasuhiro Takeshima¹⁷, Yoshitaka Nagashima¹⁸, Misao Nishikawa¹⁹, Masashi Fujimoto²⁰, Fumiaki Honda²¹, Seishi Matsui²², Yoshihisa Matsumoto²³, Takafumi Mitsuhara²⁴, Yasuyuki Miyoshi²⁵, Hidetoshi Murata²⁶, Takao Yasuhara²⁷, Hitoshi Yamahata²⁸, Shinji Yamamoto²⁹

Affiliations

¹ Department of Neurosurgery, Saitama Red Cross Hospital, Saitama, Japan.
² Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan. Electronic address: endo@nsg.med.tohoku.ac.jp.
³ Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
⁴ Department of Neurosurgery, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
⁵ Department of Neurosurgery, Toho University Ohashi Hospital, Tokyo, Japan.
⁶ Department of Neurosurgery, Otaru General Hospital, Hokkaido, Japan.
⁷ Department of Neurosurgery, Kurume University Hospital, Fukuoka, Japan.
⁸ Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁹ Department of Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan.
¹⁰ Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Hiroshima, Japan.
¹¹ Department of Comprehensive Strokotology, Fujita Health University School of Medicine, Aichi, Japan.
¹² Department of Neurosurgery, Hyogo College of Medicine, Hyogo, Japan.
¹³ Department of Neurosurgery, Dokkyo Medical University Hospital, Tochigi, Japan.
¹⁴ Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.
¹⁵ Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
¹⁶ Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan.
¹⁷ Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan.
¹⁸ Department of Neurosurgery, Nagoya University Hospital, Nagoya, Japan.
¹⁹ Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, Osaka, Japan.
²⁰ Department of Neurosurgery, Mie University Graduate School of Medicine, Mie, Japan.
²¹ Department of Neurosurgery, Gunma University Hospital, Gunma, Japan.
²² Department of Neurosurgery, Ehime University Graduate School of Medicine.
²³ Department of Neurosurgery, St. Mary's Hospital, Fukuoka, Japan.
²⁴ Hiroshima University Hospital, Hiroshima, Japan.
²⁵ Department of Neurosurgery, Kawasaki medical school general medical center, Okayama, Japan.
²⁶ Department of Neurosurgery, Yokohama City University Graduate School of Medical Sciences and School of Medicine, Kanagawa, Japan.
²⁷ Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
²⁸ Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
²⁹ Department of Neurosurgery, Spine Center, Ohnishi Neurological Center, Hyogo, Japan, Yu Yamamoto; Spine and Peripheral Nerve Center, Department of Neurosurgery Inazawa MunicipaI Hospital, Aichi, Japan.

PMID: 37087032
DOI: 10.1016/j.wneu.2023.04.068

Abstract

Objective: Asymptomatic craniocervical junction arteriovenous fistulas (CCJ AVFs) are rare and, thus, a consensus has not yet been reached regarding the indication of surgical interventions. This retrospective multicenter cohort study investigated the risks associated with surgery for asymptomatic CCJ AVFs and discussed the indication of surgical interventions.

Methods: Using data from 111 consecutive patients with CCJ AVFs registered with the Neurospinal Society of Japan between 2009 and 2019, we analyzed the treatment, complications, and outcomes of 18 patients with asymptomatic CCJ AVF.

Results: The median age of the patient cohort was 68 years (37-80 years), and there were 11 males and 7 females. Diagnoses were 14 patients with dural AVF, one perimedullary AVF, one radicular AVF, one epidural AVF, and one bilateral dural and epidural AVF. Initial treatment included direct surgery in 12 patients, endovascular treatment in four, and conservative treatment in two. Among 16 patients, three complications (18.7%) occurred: spinal cord infarction associated with the surgical procedure, cerebral infarction associated with intraoperative angiography, and mortal medullary hemorrhage after endovascular treatment followed by open surgery. Complete occlusion was achieved in all 12 patients in the direct surgery group and in one out of four in the endovascular treatment group.

Conclusions: Given the risk of serious complications associated with asymptomatic CCJ AVF and the fact that no case of asymptomatic CCJ AVF became symptomatic in this study, prophylactic surgery for asymptomatic CCJ AVF should be carefully considered.

Keywords: Arteriovenous fistula; Asymptomatic; Craniocervical junction; Endovascular embolization; Surgery.

Publication types

Multicenter Study

MeSH terms

Aged
Angiography / methods
Arteriovenous Fistula* / diagnostic imaging
Arteriovenous Fistula* / surgery
Cohort Studies
Embolization, Therapeutic*
Female
Humans
Male
Spinal Cord Injuries*
Subarachnoid Hemorrhage* / surgery