Consideration of the Mechanism for Anterior Condylar Confluent Dural AVF Diagnosed with Neck Pain

Objective: Anterior condylar confluent dural arteriovenous fistula(ACC-dAVF)constitutes 3.7% of the total dAVF cases reported and has been regarded as a rare disease in the past. However, encounters with this disease are increasing due to MRI and awareness of this condition. The symptoms of this disease have been reported as tinnitus(75%), ocular symptoms(31%), sublingual nerve palsy(12%), spinal cord symptoms(11%), and intracranial bleeding(5%). Here, we report our identification of a case of ACC-dAVF, which is different from conventional reports, and the associated findings.

Methods: We experienced a series of 3 cases of ACC-dAVF with the chief complaint of neck pain. The symptoms in all three patients disappeared after transvenous embolization. Based on the pathophysiology of cervical pain, we presumed that the blood flow dynamics of the odontoid arcade was involved. As expected, after the blood flow near the transverse ligament of the atlas was normalized the symptoms disappeared.

Conclusions: We could not find previous reports of ACC-dAVF where the main symptom was cervical pain. We report the possibility of a mechanism of dAVF different from those reported previously.