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Arteriovenous Fistula at the Craniocervical Junction Found After Cervical Laminoplasty for Ossification of the Posterior Longitudinal Ligament

Neurospine 2020년 17권 4호 p.947 ~ 953
Sasada Susumu, Hiramatsu Masafumi, Kusumegi Akira, Fujimura Haruto, Oshikata Shogo, Takahashi Yuichi, Nishida Kenki, Yasuhara Takao, Date Isao,
소속 상세정보
 ( Sasada Susumu ) - Shinkomonji Hospital Department of Spinal Surgery
 ( Hiramatsu Masafumi ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Neurological Surgery
 ( Kusumegi Akira ) - Shinkomonji Hospital Department of Spinal Surgery
 ( Fujimura Haruto ) - Shinkomonji Hospital Department of Neurosurgery
 ( Oshikata Shogo ) - Shinkomonji Hospital Department of Neurosurgery
 ( Takahashi Yuichi ) - Shinkomonji Hospital Department of Spinal Surgery
 ( Nishida Kenki ) - Shintakeo Hospital Department of Spinal Surgery
 ( Yasuhara Takao ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Neurological Surgery
 ( Date Isao ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Neurological Surgery

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.

키워드

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

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