{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:00:22Z","timestamp":1781190022216,"version":"3.54.1"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The authors report on a broad range of microsurgical procedures in which the suboccipital median technique was used to treat craniocervical junction arteriovenous fistulas. Their aim was to evaluate the efficacy of the suboccipital posteromedian approach and to assess the associated clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors extracted information on the fistula site, clinical manifestation, and structural characteristics of arterial and venous vessels by retrospectively evaluating cases from a neurointerventional database spanning 10 years.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n In this study, 52 patients (median age 62 years; 23.1% female) were examined, with subarachnoid hemorrhage (SAH)\/intracranial hemorrhage (61.6%) and myelopathy (34.6%) as prevalent presentations. Forty craniotomies (76.9%) were performed using the suboccipital median approach. Six craniotomies (11.5%) were performed using the far-lateral approach. Five patients (9.6%) underwent embolization, resulting in a residual lesion in 1. The C1 radicular artery served as the main feeding artery (78.9%). During the operation, the fistulas were mainly located near the C1 dural nerve root sleeve (ventrolateral and dorsolateral to the spinal cord). After the lesion was located, the dentate ligament was severed. Patients with SAH demonstrated a more favorable prognosis (modified Rankin Scale score 0\u20132, 93.8%) compared to those without SAH (modified Rankin Scale score 0\u20132, 70%), with a statistically significant difference (p = 0.02).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The suboccipital posteromedian approach is suitable for resections of nearly all craniocervical junction dural arteriovenous fistulas. The prognosis of the patients with SAH was better than that of the patients without it.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.7.jns2497","type":"journal-article","created":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T20:41:40Z","timestamp":1734122500000},"page":"1449-1456","source":"Crossref","is-referenced-by-count":1,"title":["Microsurgical obliteration of craniocervical junction dural arteriovenous fistulas via a suboccipital median approach: a retrospective study"],"prefix":"10.3171","volume":"142","author":[{"given":"Yuanyuan","family":"Hu","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Huashan Hospital Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongliang","family":"Qian","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Huashan Hospital Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Leng","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Huashan Hospital Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Clin Neurol Neurosurg","first-page":"107548","article-title":"Dural arteriovenous fistula of the craniocervical junction along the first cervical nerve: a single-center experience and review of the literature","volume":"224","author":"Iampreechakul P","year":"2023","unstructured":"Iampreechakul P, Wangtanaphat K, Wattanasen Y, Hangsapruek S, Lertbutsayanukul P, Siriwimonmas S. Dural arteriovenous fistula of the craniocervical junction along the first cervical nerve: a single-center experience and review of the literature. Clin Neurol Neurosurg. 2023;224:107548."},{"key":"b2","series-title":"World Neurosurg","first-page":"e685","article-title":"Surgical management for craniocervical junction arteriovenous fistula targeting the intradural feeder","volume":"144","author":"Goto Y","year":"2020","unstructured":"Goto Y, Hino A, Shigeomi Y, Oka H. Surgical management for craniocervical junction arteriovenous fistula targeting the intradural feeder. World Neurosurg. 2020;144:e685\u2013e692."},{"issue":"6","key":"b3","series-title":"J Neurosurg","first-page":"1636","article-title":"Results of transvenous embolization of intracranial dural arteriovenous fistula: a consecutive series of 136 patients with 142 fistulas","volume":"135","author":"Gu\u00e9don A","year":"2021","unstructured":"Gu\u00e9don A, Saint-Maurice JP, Th\u00e9penier C, Results of transvenous embolization of intracranial dural arteriovenous fistula: a consecutive series of 136 patients with 142 fistulas. J Neurosurg. 2021;135(6):1636\u20131644."},{"issue":"6","key":"b4","series-title":"J Neurosurg","first-page":"1884","article-title":"Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas","volume":"126","author":"Gross BA","year":"2017","unstructured":"Gross BA, Albuquerque FC, Moon K, McDougall CG. Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas. J Neurosurg. 2017;126(6):1884\u20131893."},{"issue":"11","key":"b5","series-title":"J Clin Neurosci","first-page":"1701","article-title":"Natural history and treatment of craniocervical junction dural arteriovenous fistulas","volume":"22","author":"Wang JY","year":"2015","unstructured":"Wang JY, Molenda J, Bydon A, Natural history and treatment of craniocervical junction dural arteriovenous fistulas. J Clin Neurosci. 2015;22(11):1701\u20131707."},{"issue":"1","key":"b6","series-title":"Neurosurgery","first-page":"205","article-title":"Microsurgical obliteration of craniocervical junction dural arteriovenous fistulas: multicenter experience","volume":"92","author":"Salem MM","year":"2023","unstructured":"Salem MM, Srinivasan VM, Tonetti DA, Microsurgical obliteration of craniocervical junction dural arteriovenous fistulas: multicenter experience. Neurosurgery. 2023;92(1):205\u2013212."},{"issue":"S4","key":"b7","series-title":"Acta Biomed","first-page":"e2021352","article-title":"Far lateral approach","volume":"92","author":"Luzzi S","year":"2022","unstructured":"Luzzi S, Giotta Lucifero A, Bruno N, Baldoncini M, Campero A, Galzio R. Far lateral approach. Acta Biomed. 2022;92(S4):e2021352."},{"issue":"6","key":"b8","series-title":"J Neurointerv Surg","first-page":"648","article-title":"Dural arteriovenous fistulas at the craniocervical junction: a systematic review","volume":"8","author":"Zhao J","year":"2016","unstructured":"Zhao J, Xu F, Ren J, Manjila S, Bambakidis NC. Dural arteriovenous fistulas at the craniocervical junction: a systematic review. J Neurointerv Surg. 2016;8(6):648\u2013653."},{"issue":"Suppl 2","key":"b9","series-title":"Neurosurg Focus","first-page":"V2","article-title":"Surgical treatment of previously embolized craniocervical junction dural arteriovenous fistula","volume":"46","author":"Sorenson TJ","year":"2019","unstructured":"Sorenson TJ, De Maria L, Rangel-Castilla L, Lanzino G. Surgical treatment of previously embolized craniocervical junction dural arteriovenous fistula. Neurosurg Focus. 2019;46(Suppl 2):V2."},{"issue":"8","key":"b10","series-title":"AJNR Am J Neuroradiol","first-page":"1486","article-title":"Dural arteriovenous fistulas of the foramen magnum region: clinical features and angioarchitectural phenotypes","volume":"42","author":"Caton MT","year":"2021","unstructured":"Caton MT, Narsinh KH, Baker A, Dural arteriovenous fistulas of the foramen magnum region: clinical features and angioarchitectural phenotypes. AJNR Am J Neuroradiol. 2021;42(8):1486\u20131491."},{"key":"b11","series-title":"Front Neurol","first-page":"1164548","article-title":"Treatment of high cervical arteriovenous fistulas in the craniocervical junction region","volume":"14","author":"Su H","year":"2023","unstructured":"Su H, Yu J. Treatment of high cervical arteriovenous fistulas in the craniocervical junction region. 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J Neurosurg Case Lessons. 2022;3(23):CASE22100."},{"issue":"6","key":"b14","series-title":"Neurol India","first-page":"1554","article-title":"Far lateral craniotomy for obliteration of high-risk craniocervical junction arteriovenous fistula","volume":"69","author":"Agnoletto GJ","year":"2021","unstructured":"Agnoletto GJ, Fredrickson VL, Hollon TC, Couldwell WT. Far lateral craniotomy for obliteration of high-risk craniocervical junction arteriovenous fistula. Neurol India. 2021;69(6):1554\u20131556."},{"issue":"8","key":"b15","series-title":"Acta Neurochir (Wien)","first-page":"1489","article-title":"How I do it: surgical ligation of craniocervical junction dural AV fistulas","volume":"159","author":"Sorenson TJ","year":"2017","unstructured":"Sorenson TJ, La Pira B, Hughes J, Lanzino G. How I do it: surgical ligation of craniocervical junction dural AV fistulas. Acta Neurochir (Wien). 2017;159(8):1489\u20131492."},{"issue":"6","key":"b16","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Foramen magnum meningiomas: concepts, classifications, and nuances","volume":"14","author":"Boulton MR","year":"2003","unstructured":"Boulton MR, Cusimano MD. Foramen magnum meningiomas: concepts, classifications, and nuances. Neurosurg Focus. 2003;14(6):E10."},{"issue":"5","key":"b17","series-title":"Acta Neurochir (Wien)","first-page":"869","article-title":"The suboccipital midline approach to foramen magnum meningiomas","volume":"157","author":"Della Puppa A","year":"2015","unstructured":"Della Puppa A, Rustemi O, Scienza R. The suboccipital midline approach to foramen magnum meningiomas. Acta Neurochir (Wien). 2015;157(5):869\u2013873."},{"issue":"6","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"1557","article-title":"Intraoperative DSA-guided minimal approach for craniocervical junction DAVFs obliteration","volume":"165","author":"Li CR","year":"2023","unstructured":"Li CR, Shen CC, Tsuei YS, Chen WH, Lee CH. Intraoperative DSA-guided minimal approach for craniocervical junction DAVFs obliteration. Acta Neurochir (Wien). 2023;165(6):1557\u20131564."},{"key":"b19","article-title":"Surgical Neuroangiography","volume":"Vol 2","author":"Berenstein A","year":"2004","unstructured":"Berenstein A, Lasjaunias P, Ter Brugge KG. Surgical Neuroangiography. Vol 2. 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Clin Neurol Neurosurg. 2023;224:107548."},{"key":"b2","series-title":"World Neurosurg","first-page":"e685","article-title":"Surgical management for craniocervical junction arteriovenous fistula targeting the intradural feeder","volume":"144","author":"Goto Y","year":"2020","unstructured":"Goto Y, Hino A, Shigeomi Y, Oka H. Surgical management for craniocervical junction arteriovenous fistula targeting the intradural feeder. World Neurosurg. 2020;144:e685\u2013e692."},{"issue":"6","key":"b3","series-title":"J Neurosurg","first-page":"1636","article-title":"Results of transvenous embolization of intracranial dural arteriovenous fistula: a consecutive series of 136 patients with 142 fistulas","volume":"135","author":"Gu\u00e9don A","year":"2021","unstructured":"Gu\u00e9don A, Saint-Maurice JP, Th\u00e9penier C, Results of transvenous embolization of intracranial dural arteriovenous fistula: a consecutive series of 136 patients with 142 fistulas. J Neurosurg. 2021;135(6):1636\u20131644."},{"issue":"6","key":"b4","series-title":"J Neurosurg","first-page":"1884","article-title":"Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas","volume":"126","author":"Gross BA","year":"2017","unstructured":"Gross BA, Albuquerque FC, Moon K, McDougall CG. Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas. J Neurosurg. 2017;126(6):1884\u20131893."},{"issue":"11","key":"b5","series-title":"J Clin Neurosci","first-page":"1701","article-title":"Natural history and treatment of craniocervical junction dural arteriovenous fistulas","volume":"22","author":"Wang JY","year":"2015","unstructured":"Wang JY, Molenda J, Bydon A, Natural history and treatment of craniocervical junction dural arteriovenous fistulas. J Clin Neurosci. 2015;22(11):1701\u20131707."},{"issue":"1","key":"b6","series-title":"Neurosurgery","first-page":"205","article-title":"Microsurgical obliteration of craniocervical junction dural arteriovenous fistulas: multicenter experience","volume":"92","author":"Salem MM","year":"2023","unstructured":"Salem MM, Srinivasan VM, Tonetti DA, Microsurgical obliteration of craniocervical junction dural arteriovenous fistulas: multicenter experience. Neurosurgery. 2023;92(1):205\u2013212."},{"issue":"S4","key":"b7","series-title":"Acta Biomed","first-page":"e2021352","article-title":"Far lateral approach","volume":"92","author":"Luzzi S","year":"2022","unstructured":"Luzzi S, Giotta Lucifero A, Bruno N, Baldoncini M, Campero A, Galzio R. Far lateral approach. Acta Biomed. 2022;92(S4):e2021352."},{"issue":"6","key":"b8","series-title":"J Neurointerv Surg","first-page":"648","article-title":"Dural arteriovenous fistulas at the craniocervical junction: a systematic review","volume":"8","author":"Zhao J","year":"2016","unstructured":"Zhao J, Xu F, Ren J, Manjila S, Bambakidis NC. Dural arteriovenous fistulas at the craniocervical junction: a systematic review. J Neurointerv Surg. 2016;8(6):648\u2013653."},{"issue":"Suppl 2","key":"b9","series-title":"Neurosurg Focus","first-page":"V2","article-title":"Surgical treatment of previously embolized craniocervical junction dural arteriovenous fistula","volume":"46","author":"Sorenson TJ","year":"2019","unstructured":"Sorenson TJ, De Maria L, Rangel-Castilla L, Lanzino G. Surgical treatment of previously embolized craniocervical junction dural arteriovenous fistula. Neurosurg Focus. 2019;46(Suppl 2):V2."},{"issue":"8","key":"b10","series-title":"AJNR Am J Neuroradiol","first-page":"1486","article-title":"Dural arteriovenous fistulas of the foramen magnum region: clinical features and angioarchitectural phenotypes","volume":"42","author":"Caton MT","year":"2021","unstructured":"Caton MT, Narsinh KH, Baker A, Dural arteriovenous fistulas of the foramen magnum region: clinical features and angioarchitectural phenotypes. AJNR Am J Neuroradiol. 2021;42(8):1486\u20131491."},{"key":"b11","series-title":"Front Neurol","first-page":"1164548","article-title":"Treatment of high cervical arteriovenous fistulas in the craniocervical junction region","volume":"14","author":"Su H","year":"2023","unstructured":"Su H, Yu J. Treatment of high cervical arteriovenous fistulas in the craniocervical junction region. Front Neurol. 2023;14:1164548."},{"key":"b12","series-title":"World Neurosurg","first-page":"e700","article-title":"Dural arteriovenous fistulas at the craniocervical junction: a series case report","volume":"122","author":"Zhong W","year":"2019","unstructured":"Zhong W, Zhang J, Shen J, Dural arteriovenous fistulas at the craniocervical junction: a series case report. World Neurosurg. 2019;122:e700\u2013e712."},{"issue":"23","key":"b13","series-title":"J Neurosurg Case Lessons","first-page":"CASE22100","article-title":"Efficacy of intraarterial indocyanine green videoangiography in surgery for arteriovenous fistula at the craniocervical junction in a hybrid operating room: illustrative cases","volume":"3","author":"Shimada K","year":"2022","unstructured":"Shimada K, Yamaguchi I, Miyamoto T, Efficacy of intraarterial indocyanine green videoangiography in surgery for arteriovenous fistula at the craniocervical junction in a hybrid operating room: illustrative cases. J Neurosurg Case Lessons. 2022;3(23):CASE22100."},{"issue":"6","key":"b14","series-title":"Neurol India","first-page":"1554","article-title":"Far lateral craniotomy for obliteration of high-risk craniocervical junction arteriovenous fistula","volume":"69","author":"Agnoletto GJ","year":"2021","unstructured":"Agnoletto GJ, Fredrickson VL, Hollon TC, Couldwell WT. Far lateral craniotomy for obliteration of high-risk craniocervical junction arteriovenous fistula. Neurol India. 2021;69(6):1554\u20131556."},{"issue":"8","key":"b15","series-title":"Acta Neurochir (Wien)","first-page":"1489","article-title":"How I do it: surgical ligation of craniocervical junction dural AV fistulas","volume":"159","author":"Sorenson TJ","year":"2017","unstructured":"Sorenson TJ, La Pira B, Hughes J, Lanzino G. How I do it: surgical ligation of craniocervical junction dural AV fistulas. Acta Neurochir (Wien). 2017;159(8):1489\u20131492."},{"issue":"6","key":"b16","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Foramen magnum meningiomas: concepts, classifications, and nuances","volume":"14","author":"Boulton MR","year":"2003","unstructured":"Boulton MR, Cusimano MD. Foramen magnum meningiomas: concepts, classifications, and nuances. Neurosurg Focus. 2003;14(6):E10."},{"issue":"5","key":"b17","series-title":"Acta Neurochir (Wien)","first-page":"869","article-title":"The suboccipital midline approach to foramen magnum meningiomas","volume":"157","author":"Della Puppa A","year":"2015","unstructured":"Della Puppa A, Rustemi O, Scienza R. The suboccipital midline approach to foramen magnum meningiomas. Acta Neurochir (Wien). 2015;157(5):869\u2013873."},{"issue":"6","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"1557","article-title":"Intraoperative DSA-guided minimal approach for craniocervical junction DAVFs obliteration","volume":"165","author":"Li CR","year":"2023","unstructured":"Li CR, Shen CC, Tsuei YS, Chen WH, Lee CH. Intraoperative DSA-guided minimal approach for craniocervical junction DAVFs obliteration. Acta Neurochir (Wien). 2023;165(6):1557\u20131564."},{"key":"b19","article-title":"Surgical Neuroangiography","volume":"Vol 2","author":"Berenstein A","year":"2004","unstructured":"Berenstein A, Lasjaunias P, Ter Brugge KG. Surgical Neuroangiography. Vol 2. 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