Kontrastverstärkte Cone-Beam-CT: Ein unterschätztes Werkzeug in der Diagnostik und Therapie von kraniozervikalen duralen arteriovenösen Fisteln – Erkenntnisse aus einer Fallserie und einem systematischen Review

Dural arteriovenous fistulas at the craniocervical junction (CCJ DAVF) pose diagnostic challenges due to their rarity and complex angioarchitecture. This study presents a case series of CCJ DAVFs, focusing on our treatment algorithm and experiences with contrast-enhanced cone-beam CT (CE-CBCT). A systematic review was conducted to emphasize neurological symptoms, diagnostic imaging techniques, obliteration rates, and neurological outcomes.

A retrospective case series included consecutive patients treated at our hospital from January 2010 to December 2023. Clinical and imaging data, including CE-CBCT, were collected. A systematic review following PRISMA Guidelines included original studies with ≥5 cases and detailed clinical information from January 2020 to December 2023.

The systematic review included 14 studies with 705 cases, predominantly male (79%). Mean age was 60,20 ± 5,89 years. Progressive myelopathy (39%) and subarachnoid hemorrhage (40%) were common presenting symptoms. Diagnostic workup involved digital subtraction angiography in all cases, computed tomography angiography and magnetic resonance angiography in 34%. No study utilized CE-CBCT preoperatively. Most patients underwent microsurgery or a combined approach. Our series included seven consecutive patients; CE-CBCT was performed in all cases. Imaging and treatment strategies as well as clinical features are presented.

CCJ DAVFs present ongoing challenges. CE-CBCT enhances preoperative diagnostic workup and patient safety by improving anatomical orientation, as observed in our series. Despite its potential, the systematic review suggests limited widespread use of CE-CBCT in CCJ DAVF cases.