Vertebral Arteriovenous Fistula: An Unwelcome Thrill

Neurofibromatosis type 1, severe cervical spinal kyphotic deformity, and vertebral arteriovenous fistula presenting with tetraplegia: case report and literature review

INTRODUCTION

Neurofibromatosis type 1 (NF-1) is an autosomal-dominant disorder affecting 1 in 3000 individuals worldwide. NF-1 is characterized by café-au-lait macules and peripheral nerve sheath tumors. Patients with NF-1 frequently exhibit bony dysplasia, including spinal deformities such as scoliosis or kyphosis, pseudarthrosis of the tibia, and soft tissue tumors. Some patients with NF-1 exhibit spinal changes, including acutely angled cervical kyphosis. Prior studies have also described arteriovenous (AV) fistulas in individuals with NF-1, as well as a predisposition to cervical fistulas which display symptoms secondary to mass effect, rather than hemorrhage. Sometimes, fistulas are incidentally detected during evaluations for cervical kyphotic deformities.

CASE PRESENTATION

The case herein describes a patient with NF-1 who exhibited a severe cervical spinal kyphotic deformity and a vertebral AV fistula. The patient initially presented with neck pain that radiated to all four limbs and resulted in limb weakness.

DISCUSSION

Spinal kyphosis is common in patients with NF-1, and if dystrophic changes are noted on plain radiographs, MRI should be considered for the further survey of potential spinal vascular lesions.

Endovascular and surgical approaches of iatrogenic vertebrovertebral arteriovenous fistula

Vertebrovertebral arteriovenous fistula is an uncommon vascular disease with no clear management guidelines. It is most commonly caused by iatrogenic injury. We have presented the details of two iatrogenic cases and a review to discuss strategies for endovascular and surgical approaches. From the digital subtraction angiography findings, the vertebrovertebral arteriovenous fistulas were occluded by endovascular coil positioning (patient 1) and surgical ligation of the fistulas (patient 2). Although endovascular approaches are increasing in popularity and considered well-tolerated treatments, open surgical treatment is still reserved for the most complex cases and those not feasible for endovascular treatment.

Spontaneous superficial arteriovenous malformation causing pulsatile tinnitus: A case report

Superficial arteriovenous fistulae in the absence of other complicating features can be easily treatable with simple surgical excision. In this case, the patient's troublesome symptoms were completely cured with a straightforward procedure.

Successful balloon-assisted coil embolization for a diagnostically difficult case of spontaneous vertebrovertebral arteriovenous fistula

BACKGROUND

We describe a rare case of idiopathic lower cervical vertebro-vertebral arteriovenous fistula (VVAVF) with compression of the nerve roots and spinal cord, successfully treated with detachable coils utilizing the transarterial balloon-assisted technique without complication of coil mass.

CASE DESCRIPTION

A 68-year-old woman was admitted for numbness of the left upper limb and pain in the left neck. Cervical magnetic resonance imaging (MRI) revealed compression of nerve roots and spinal cord by a large vascular lesion. The left vertebral angiography demonstrated a VVAVF draining into the vertebral venous plexus at C5 level. Under general anesthesia, the fistula site was accessed with a microcatheter through the right femoral artery, and successful embolization performed by compactly placing several detachable coils using balloon-assisted technique. The patient made a full recovery, with long-term MRI-documented left vertebral artery patency and no fistular leakage, and without postoperative complications.

CONCLUSION

Target occlusion utilizing the balloon-assisted technique in this case of VVAVF with compression of nerve roots and spinal cord, was effective in improving neurological symptoms, and achieved long-term occlusion when preservation of the VA was desired.

Endovascular treatment of V3 segment vertebro-vertebral arteriovenous fistula with Willis covered stent: Case report and literature review

A 46-year-old male presented to our hospital suffering from right mastoid pulsatile tinnitus secondary to traffic trauma. Digital subtraction angiography was remarkable for a vertebro-vertebral arteriovenous fistula fed by the right vertebral artery at the C1 level. Dual platelet therapy was administrated before and after the operation, then a Willis covered stent was deployed at the orifice of the fistula. Post-operative angiography showed proper stent localization but some contrast agent leaking from the fistula. Angiography performed 6 months post-operatively demonstrated no leak from the fistula and the patency of the right vertebral artery. This case demonstrated that an intracranial covered stent could be used as an alternative, successful treatment for vertebro-vertebral arteriovenous fistula.

Corrigendum to "Vertebral Arteriovenous Fistula: An Unwelcome Thrill"

[This corrects the article DOI: 10.1155/2017/8386459.].