Letter to the editor.

摘要

I have some questions concerning the article "Perimedullary Arteriovenous Fistula at the Craniocervical Junction-Case Report" published in Neurol Med Chir (Tokyo) 51: 299-301, 2011. On a personal basis, this case seems to represent dural arteriovenous fistula (AVF) at the craniocervical junction for the following reasons. The author did not point out the exact fistulous point and feeding arteries on either the digital subtraction angiography or the intraoperative image. In cases of perimedullary AVF, the fistulous point is usually diagnosed as the portion where the caliber of the vessels changes abruptly. In this case, I think that the abnormal vessels connecting to the vertebral artery (VA) have the same caliber and are draining veins. I experienced a case in which the draining veins seemed to connect to the VA, but the vessels just coursed along the VA and connected to the dura around VA.