No shinkei geka. Neurological surgery
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Dural and perimedullary arteriovenous fistula (AVF) at the craniocervical junction tend to cause subarachnoid hemorrhage (SAH). However, their natural history and clinical manifestations still remain to be elucidated. From 2003 to 2009, we encountered 5 cases of dural and perimedullary AVF presented with SAH. ⋯ Following this treatment we performed coil embolization and repeated open surgery with the aid of intraoperative DSA, respectively. In 1 patient out of the remaining 2 patients, we utilized intraoperative DSA to confirm complete disappearance of AVF composed of multiple feeders. These observations show that SAH caused by dural and perimedullary AVF at the craniocervical junction should be mainly treated by open surgery with the aid of intraoperative DSA in order to accomplish obliteration of the feeders because, otherwise, we might fail to confirm complete disappearance of AVF.