Surgical treatment assisted by three-dimensional image reconstruction based on 3D Slicer software for dural arteriovenous fistula in the foramen magnum:a case report and literature review

CUI Hao; WANG Kui-zhong; WANG Xiao-gang; XU Guang-zhen; WANG Bo-dong; ZHU Wei-jie

doi:10.13798/j.issn.1009-153X.2024.02.005

Abstract：Objective To investigate the imaging features of patients with dural arteriovenous fistula(DAVF)in the foramen magnum region and the efficacy of surgical treatment assisted by three-dimensional image reconstruction based on 3D Slicer software for such patients.Methods The clinical data of a patient with DAVF in the foramen magnum region admitted in June 2021 were retrospectively analyzed,and the relevant literatures were reviewed.Results A 50-year-old man was admitted to hospital due to numbness and pain in the lower limbs for 1 month.Spinal MRI showed abnormal signals of cervical spinal cord from medulla oblongata to the C5 spinal cord.Angiographies via bilateral internal carotid arteries,bilateral external carotid arteries,and the right vertebral artery showed no abnormalities,while angiography via the left vertebral artery showed DAVF in the foramen magnum region,which was supplied by multiple branches of the posterior meningeal artery,and drained into the left transverse sinus,suprapetrosal sinus,and basilar sinus through the severely tortuous dilated cortical veins of the dura mater.The tortuous anterior and posterior dural veins were involved in the blood drainage of the fistula.The left posterior inferior cerebellar artery(PICA)was running and tortuously near to the fistula.The three-dimensional reconstructed images using 3D Slicer software clearly showed the location of DAVF,the feeding arteries and draining veins,and multimodal reconstructed images showed that the fistula was located in the posterior median region of the occipital foramen magnum and close to the dura mater.The patient underwent microsurgery through posterior median approach,and intraoperative indocyanine green fluorescence angiography showed the disappearance of DAVF.Three months after operation,the numbness and pain in the lower limbs were relieved;reexamination of MRI showed that the edema of brainstem and spinal cord disappeared,and DSA showed complete occlusion of DAVF.Conclusions Surgical treatment of DAVF in the foramen magnum can significantly improve the prognosis of patients.The application of 3D Slicer three-dimensional reconstruction technology to accurately locate DAVF can greatly reduce the operation time and improve the quality of operation.