Arteriovenous fistula at the craniocervical junction found after cervical laminoplasty for ossification of the posterior longitudinal ligament

Susumu Sasada, Masafumi Hiramatsu, Akira Kusumegi, Haruto Fujimura, Shogo Oshikata, Yuichi Takahashi, Kenki Nishida, Takao Yasuhara, Isao Date

Research output: Contribution to journalArticlepeer-review

Abstract

Ossification of the posterior longitudinal ligament (OPLL) is common in East Asia. Arteriovenous fistula at the craniocervical junction (CCJ-AVF), in contrast, is rare. As OPLL occurs most often in the cervical region, these 2 conditions can coexist in the cervical spinal canal of a single patient. We report a case of CCJ-AVF found after cervical laminoplasty (CLP) for OPLL. A 68-year-old man experienced progressive myelopathy due to cervical OPLL. Magnetic resonance imaging (MRI) revealed a high-intensity area inside the spinal cord. CLP was performed and his symptoms immediately improved. Three months after CLP, however, myelopathy recurred. MRI revealed an exacerbated and enlarged high-intensity area inside the cord from the medulla oblongata to the C4/5 level with a flow void around the cord. Left vertebral artery angiography revealed CCJ-AVF with ascending and descending draining veins. Direct surgery was performed to interrupt shunt flow into the draining veins. The patient’s symptoms improved to a limited degree. In this case, increased pressure inside the spinal canal due to OPLL might have decreased the shunt flow of the CCJ-AVF. Thus, the venous congestion induced by CCJ-AVF might have been exacerbated after the pressure was removed by CLP. Magnetic resonance angiography screening could help detect concurrent CCJ-AVF and OPLL.

Original languageEnglish
Pages (from-to)947-953
Number of pages7
JournalNeurospine
Volume17
Issue number4
DOIs
Publication statusPublished - Dec 2020

Keywords

  • Arteriovenous fistula at the craniocervical junction
  • Cervical laminoplasty
  • Myelopathy
  • Ossification of the posterior longitudinal ligament

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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