[Pontine Hemorrhage Suspected due to Dural Arteriovenous Fistula at the Craniocervical Junction:A Case Report].

ABSTRACT

Dural arteriovenous fistulas occurring at the craniocervical junction(CCJd-AVF)are uncommon; however, they demonstrate a wide range of clinical presentations. We describe the case of a patient with pontine hemorrhage suspected due to CCJd-AVF. A 68-year-old man presented to our hospital with a sudden onset of left hemiparesis. Cranial computed tomography(CT)revealed pontine and subarachnoid hemorrhage. Magnetic resonance imaging, as well as MR, CT, and left vertebral angiograms were performed and showed a CCJd-AVF in addition to a varix coincident with the hematoma cavities. The patient was successfully treated using surgical drainer clipping. A CCJd-AVF presenting concomitantly with a pontine hemorrhage is extremely rare. Careful assessment of the anatomical relationship between the skull base and the surrounding vascular structures is important to plan neurosurgical procedures for direct interruption of the draining vein. Three-dimensional CT angiography is a useful modality that facilitates visualization of complex and anomalous anatomical structures.