Endovascular Therapy of Radicular Arteriovenous Fistula at the Craniocervical Junction Fed by the Posterior Inferior Cerebellar Artery

Objective: Arteriovenous fistula (AVF) at the craniocervical junction (CCJ) is a rare intracranial vascular disorder that is one cause of subarachnoid hemorrhage (SAH). We report on a rare case of AVF at the CCJ, which was mainly supplied by a branch of the posterior inferior cerebellar artery (PICA).Case Presentations: A man in his seventies presented with severe SAH. Angiography revealed that the shunt point was placed in the vicinity of the intradural radicular vein of the right C1 nerve root, and that the C1 radicular artery (C1 RA) was also feeding the AVF. An aneurysm on the PICA branch feeding the shunt was considered a bleeding point. Taking the radiological findings into account, we made the diagnosis of radicular AVF at the CCJ. Transarterial glue embolization obliterated the aneurysm. Brain magnetic resonance (MR) imaging, however, demonstrated infarcts localized in the posterior part of the upper cervical cord and the cerebellum.Conclusion: Arterial anastomotic channels around the CCJ can be the source of ischemic events after glue embolization.