[Dural fistula in the craniocervical junction. A case report and review of the literature]. / Fistula dural en la union craneocervical. Presentacion de caso clinico y revision de la bibliografia.

INTRODUCTION: Spinal dural fistulas consist in an artery that penetrates into the dura mater and drains into a perispinal vein. They are most commonly located in the dorsal or lumbar region; a craniocervical position is infrequent. The clinical features presented by these patients involve an progressive ascending myelopathy caused by severe venous hypertension, although they can also start with symptoms of a subarachnoid haemorrhage. CASE REPORT: A 62 year old male with symptoms of progressive myelopathy due to a dural fistula dependent on meningeal branches of the right PICA, which was treated surgically by fistula clipping performed using an extreme lateral suboccipital approach. In the literature that was reviewed there were 35 cases of dural fistulas located at the craniocervical junction. CONCLUSIONS: The existence of clinical features compatible with cervical myelopathy and an anodyne cervical resonance justify the need to perform medullar arteriography owing to a suspected vascular malformation. An early diagnosis of a dural fistula and its proper treatment lead to a diminished morbidity and mortality rate in these patients.

Fístula dural en la unión craneocervical. Presentación de un caso clínico y revisión de la bibliografía / Dural fistula in the craniocervical junction. A case report and review of the literature

Introducción. Las fístulas durales medulares consisten en una arteria que penetra en la duramadre y drena en una vena perimedular. Las localizaciones más frecuentes son dorsal y lumbar; la craneocervical es infrecuente. La clínica que presentan estos pacientes es de mielopatía progresiva ascendente por hipertensión venosa grave, aunque también puede iniciarse con un cuadro de hemorragia subaracnoidea. Caso clínico. Varón de 62 años, con cuadro de mielopatía progresiva por fístula dural dependiente de las ramas meníngeas de la arteria cerebelosa posteroinferior derecha, que se trató quirúrgicamente con la realización de un pinzamiento de la fístula mediante abordaje extremolateral suboccipital. En la bibliografía revisada hay publicados 35 casos de fístulas durales localizadas en la unión craneocervical. Conclusiones. La existencia de una clínica compatible con mielopatía cervical y una resonancia cervical anodina justifica la realización de una arteriografía medular por sospecha de una malformación vascular. El diagnóstico precoz de una fístula dural y su correcto tratamiento supone una disminución de la morbimortalidad de estos pacientes (AU)

Introduction. Spinal dural fistulas consist in an artery that penetrates into the dura mater and drains into a perispinal vein. They are most commonly located in the dorsal or lumbar region; a craniocervical position is infrequent. The clinical features presented by these patients involve an progressive ascending myelopathy caused by severe venous hypertension, although they can also start with symptoms of a subarachnoid haemorrhage. Case report. A 62-year-old male with symptoms of progressive myelopathy due to a dural fistula dependent on meningeal branches of the right PICA, which was treated surgically by fistula clipping performed using an extreme lateral suboccipital approach. In the literature that was reviewed there were 35 cases of dural fistulas located at the craniocervical junction. Conclusions. The existence of clinical features compatible with cervical myelopathy and an anodyne cervical resonance justify the need to perform medullar arteriography owing to a suspected vascular malformation. An early diagnosis of a dural fistula and its proper treatment lead to a diminished morbidity and mortality rate in these patients (AU)