Microsurgical obliteration of craniocervical junction dural arteriovenous fistulas via a suboccipital median approach: a retrospective study.

Objective: The authors report on a broad range of microsurgical procedures in which the suboccipital median technique was used to treat craniocervical junction arteriovenous fistulas. Their aim was to evaluate the efficacy of the suboccipital posteromedian approach and to assess the associated clinical outcomes.

Methods: The authors extracted information on the fistula site, clinical manifestation, and structural characteristics of arterial and venous vessels by retrospectively evaluating cases from a neurointerventional database spanning 10 years.

Results: In this study, 52 patients (median age 62 years; 23.1% female) were examined, with subarachnoid hemorrhage (SAH)/intracranial hemorrhage (61.6%) and myelopathy (34.6%) as prevalent presentations. Forty craniotomies (76.9%) were performed using the suboccipital median approach. Six craniotomies (11.5%) were performed using the far-lateral approach. Five patients (9.6%) underwent embolization, resulting in a residual lesion in 1. The C1 radicular artery served as the main feeding artery (78.9%). During the operation, the fistulas were mainly located near the C1 dural nerve root sleeve (ventrolateral and dorsolateral to the spinal cord). After the lesion was located, the dentate ligament was severed. Patients with SAH demonstrated a more favorable prognosis (modified Rankin Scale score 0-2, 93.8%) compared to those without SAH (modified Rankin Scale score 0-2, 70%), with a statistically significant difference (p = 0.02).

Conclusions: The suboccipital posteromedian approach is suitable for resections of nearly all craniocervical junction dural arteriovenous fistulas. The prognosis of the patients with SAH was better than that of the patients without it.