Cervical Radiculopathy Caused by Epidural Venous Varix Associated with a Dural Arteriovenous Fistula in the Anterior Condylar Confluence: A Case Report.

OBJECTIVE: While degenerative disorders are the typical cause of cervical radiculopathy, vascular etiologies are exceedingly rare. Dural arteriovenous fistulas (dAVFs) in the anterior condylar confluence (ACC) generally manifest with cranial neuropathies or pulsatile tinnitus. This report presents a unique case of ACC dAVF producing an epidural venous varix and cervical radiculopathy and describes the staged therapeutic strategy leading to complete recovery. CASE PRESENTATION: A man in his 70s presented with progressive right upper limb weakness. MRI detected an extradural mass compressing the C5 and C6 nerve roots, initially mimicking a tumor. DSA revealed an ACC dAVF with venous drainage into the cervical epidural venous plexus, forming a varix compressing the nerve roots. Through staged embolization (transarterial and transvenous), the fistula was successfully obliterated, resulting in partial neurological improvement. However, residual foraminal varices continued to cause motor weakness. After a short observation period, the patient underwent direct posterior foraminotomy with variceal coagulation. Postoperatively, motor strength steadily improved and eventually normalized, with sustained recovery during follow-up. CONCLUSION: This case highlights the rarity of cervical radiculopathy caused by an epidural venous varix secondary to ACC dAVF. Through endovascular embolization for shunt flow reduction, followed by surgical decompression, both the hemodynamic abnormality and mass effect were resolved.