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Yu J, Zhou Z, Pan H. Endovascular treatment for V3 segment direct vertebral-venous fistulas: A report of two cases and a literature review. Int J Surg Case Rep 2024; 119:109659. [PMID: 38678991 PMCID: PMC11067319 DOI: 10.1016/j.ijscr.2024.109659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Direct vertebrovertebral fistulas (VVFs) involving the V3 segment of the vertebral artery (VA) are rare. Endovascular treatment (EVT) can be used to obliterate these VVFs. CASE PRESENTATION Case 1 was a 30-year-old male with limb weakness. He had grade V muscle strength in his limbs. Angiography confirmed a low-flow direct VVF of the V3 segment. The right VA was well developed. Coiling of the VVF and its parent VA obliterated the VVF. The vertebrobasilar arteries had sufficient blood from the right VA. Postoperatively, the patient recovered well. Case 2 was a 51-year-old male with headache and weakness of the limbs. He had grade IV muscle strength in his limbs. Angiography revealed a high-flow direct VVF in the V3 segment. The left VA was well developed. Coiling of the VVF and its parent VA obliterated the VVF. The vertebrobasilar arteries had sufficient blood from the left VA. Postoperatively, the patient recovered well. CLINICAL DISCUSSION Direct VVF of the V3 segment is difficult to treat, and EVT, including reconstructive and deconstructive approaches, can be an effective treatment option. According to this case report and literature review, reconstructive EVT is ideal; however, it is difficult to perform. Currently, deconstructive EVT may be the mainstream option for treating direct VVF of the V3 segment. CONCLUSION In certain cases where the contralateral VA is well developed, coiling the fistula and the parent VA is still an effective treatment.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.
| | - Zibo Zhou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Hui Pan
- Department of Neurosurgery, Jilin City Hospital of Chemical Industry, Jilin City, China.
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2
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Chen KS, Williams DD, Iacobas I, McClugage SG, Gadgil N, Kan P. Spontaneous thrombosis of high flow pediatric arteriovenous fistulae: Case series of two patients and a comprehensive literature review. Childs Nerv Syst 2024; 40:1405-1414. [PMID: 38085366 DOI: 10.1007/s00381-023-06241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 04/19/2024]
Abstract
Pediatric pial arteriovenous shunts in the brain and spine are challenging to understand because of low incidence, variable presentation, and associations with genetic syndromes. What is known about their natural history comes from reviews of small series. To better understand the natural history and role for intervention, two cases are presented followed by a review of the literature. In the first case, an infant with a prior history of intracranial hemorrhage from a ruptured pial fistula returns for elective embolization for a second pial fistula which was found to be spontaneously thrombosed 2 weeks later. In the second case, a 5-year-old with a vertebro-vertebral fistula, identified on work up for a heart murmur and documented with diagnostic angiography, is brought for elective embolization 6 weeks later where spontaneous thrombosis is identified. In reviewing the literature on pediatric single-hole fistulae of the brain and spine, the authors offer some morphologic considerations for identifying which high-flow fistulae may undergo spontaneous thrombosis to decrease the potentially unnecessary risk associated with interventions in small children.
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Affiliation(s)
- Karen S Chen
- Edward B. Singleton Department of Radiology and Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 470, Houston, TX, 77030, USA.
| | - Daniel Davila Williams
- Department of Neurology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - Ionela Iacobas
- Department of Pediatrics, Baylor College of Medicine, Vascular Anomalies Center at Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, 6701 Fannin St, Suite 1510, Houston, TX, 77030, USA
| | - Samuel G McClugage
- Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1230, Houston, TX, 77030, USA
| | - Nisha Gadgil
- Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1230, Houston, TX, 77030, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, 1005 Harborside Dr, 5th floor, Galveston, TX, 77555, USA
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Dahl RH, Ghasemi-Rad M, Eskesen V, Frevert SC, Sølling C, Benndorf G. Vertebro-Vertebral Fistula Occlusion Using a Woven EndoBridgeTM-Device. Neurointervention 2023; 18:200-203. [PMID: 37867304 PMCID: PMC10626043 DOI: 10.5469/neuroint.2023.00430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Vertebro-vertebral fistulas (VVFs) are vascular lesions that may develop after trauma or spontaneously in association with connective tissue disorders. We present a rare case of a post-traumatic VVF in a young patient presenting with a painless swelling and a bruit in her left upper neck. Digital subtraction angiography showed an arteriovenous fistula between the left vertebral artery (VA) and the vertebral venous plexus with significant steal phenomenon. Endovascular therapy was performed using a Woven EndoBridgeTM (WEB)-device combined with coils that allowed preservation of the VA. The patient fully recovered from her symptoms and follow-up imaging showed stable occlusion. In conclusion, VVFs can be effectively treated using intrasaccular flow diverters such as the WEB-device, allowing for complete and stable occlusion while preserving the parent artery.
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Affiliation(s)
- Rasmus Holmboe Dahl
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Vagn Eskesen
- Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Christine Sølling
- Department of Neuroanaesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Goetz Benndorf
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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4
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Shima S, Sato S, Ryu B, Kushi K, Mochizuki T, Inoue T, Okada Y, Niimi Y. Angiographic Index for the Treatment Efficacy and Functional Outcomes of Spinal Cord Arteriovenous Shunts: the Vertebral Blush Sign. Clin Neuroradiol 2023; 33:721-727. [PMID: 36856787 DOI: 10.1007/s00062-023-01266-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/18/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND The functional outcomes in spinal cord arteriovenous shunts (SCAVSs) are usually unpredictable from current assessments of treatment results. We aimed to investigate and propose a new index marker, the vertebral blush (VB) sign, for assessing the treatment efficacy of SCAVSs. METHODS This retrospective cohort study enrolled patients diagnosed with SCAVSs between June 2012 and May 2021. The VB sign was defined as the angiographic finding of reappearance or enhanced contrast staining of the vertebral bodies fed by shunt-related arteries observed after shunt occlusion. The primary outcome was the improvement in motor/sensory disturbances or sphincter impairments within 1 year after treatment. The secondary outcome was shunt recanalization. VB sign characteristics and associations with outcomes were analyzed. RESULTS Of 65 patients with SCAVSs, 57 were eligible for VB sign assessment; among these, there were 26 with the VB sign and 31 without the VB sign. Among vascular shunts perimedullary arteriovenous fistula showed the greatest difference in prevalence rate between those with and without the VB sign (33.3%, n = 9/27 versus 10.0%, n = 3/30; P = 0.031). On multivariable logistic regression analysis, SCAVSs with the VB sign had significantly more favorable outcomes than those without the VB sign (adjusted odds ratio, 5.61; 95% confidence interval, 1.48-21.23; P = 0.01). There was no relationship between the VB sign and secondary outcomes (P = 0.35). CONCLUSION The VB sign is independently associated with functional recovery after shunt occlusion and could be an assessment tool for the treatment efficacy of SCAVSs.
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Affiliation(s)
- Shogo Shima
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan.
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan.
| | - Shinsuke Sato
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Bikei Ryu
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Kazuki Kushi
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Tatsuki Mochizuki
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
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Chaturvedi J, Sudhakar PV, Gupta M, Goyal N, Mudgal SK, Gupta P, Burathoki S. Endovascular management of iatrogenic vertebro-vertebral fistula: Black Swan event in C2 pedicle screw. Surg Neurol Int 2022; 13:189. [PMID: 35673671 PMCID: PMC9168301 DOI: 10.25259/sni_261_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Vertebro-vertebral fistulas (VVF) are rare. Anatomically, they consist of an arteriovenous fistula, a direct pathological communication between vertebral veins (including the epidural vertebral venous plexus) and extradural vertebral artery. The various etiologies include trauma, iatrogenic, or spontaneous (e.g., NF-1 or Ehlers Danlos Syndrome). The clinical presentation may include acute/delayed onset of radiculopathy and/or myelopathy. They may further be characterized by the delayed onset hearing loss to tinnitus and/or the sensation of water in the ear. Case Description: We report successful endovascular management for iatrogenic VVF in a 37-year-old female who was diagnosed with an odontoid fracture (Anderson type IIC). She underwent a posterior C1 lateral masses to C2 pedicle/laminar screw fixation. An intraoperative vertebro-vertebral fistulas (VVF) was recognized during the procedure and it was managed successfully with percutaneous transarterial endovascular coiling. Conclusion: Iatrogenic VVF should immediately be suspected when the implant trajectory goes slightly off track during a C1-2 fixation. Immediate postoperative DSA and MRI are advisable, irrespective of whether the patient is symptomatic. These lesions are best managed with endovascular coiling with or without detachable balloons.
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Affiliation(s)
- Jitender Chaturvedi
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,
| | - P. Venkata Sudhakar
- Department of Orthopedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,
| | - Mohit Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,
| | - Nishant Goyal
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,
| | - Shiv Kumar Mudgal
- College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand, India,
| | - Priyanka Gupta
- Department of Neuroanesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,
| | - Sandeep Burathoki
- Department of Neurointervention, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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6
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Kim JH, Yoon SH, Park SQ, Ban SP, Cho BK. Clinical features and treatment strategy of paraspinal arteriovenous shunt (PAVS): a systematic review with individual participants data meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2385-2400. [PMID: 33893553 DOI: 10.1007/s00586-021-06831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Because of the rarity of the disease, paraspinal arteriovenous shunt (PAVS) is not well recognized, and therapeutic options remain controversial. To introduce a rare disease of PAVS and demonstrate its etiology, clinical features, treatment options, and outcomes, we presented a case report and conducted a systematic review and individual participants data (IPD) meta-analysis. METHODS Studies regarding on PAVS were integrated and IPD were obtained including patients' demographics, disease etiology, clinical and radiologic features, clinical courses and outcomes. Clinical manifestation and treatment outcomes were reviewed, and comparison analysis (cervical versus thoracolumbar) were performed. Further, logistic regression analyses were conducted to identify the poor prognostic factors (incomplete obliteration). RESULTS Fifty-two articles were selected, and 88 patients enrolled. General and location-specific characteristics of PAVSs were identified: '3/4 of the isolated and 1/4 of the associated etiology', 'bruit, thrill, or murmur (cervical) and weakness (thoracolumbar) as common symptoms', '40% multiple feeders', and '22% intradural venous involvement'. Endovascular treatment was usually preferred (75%). Of 88 enrolled patients, 18 patients showed incomplete obliteration (20.5%). In multivariate analysis, 'etiologies of systematic genetic dysplasia (P = 0.031) and trauma (negatively, 0.038)' were significantly associated with incomplete obliteration. The parameters of 'multiple feeders (0.066)' and 'combined approach (negatively, 0.065)' are verified only in univariate analysis. CONCLUSION General as well as location-specific characteristics of PAVS is successfully demonstrated. Approximately 20% of the incomplete obliteration is noted, and three potential poor prognostic factors are identified, namely, 'etiology of systematic genetic dysplasia (positive) and trauma (negative)', 'combined approach (negative), and 'multiple feeders'.
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Affiliation(s)
- Jang Hun Kim
- Department of Neurosurgery, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Hoon Yoon
- Department of Neurosurgery, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea.
| | - Suhk Que Park
- Department of Neurosurgery, Sooncheonhyang Seoul University Hospital, Seoul, Republic of Korea
| | - Seung-Pil Ban
- Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea
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7
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Park JS, Kwon MY, Lee CY. Cervical spinal extradural arteriovenous fistula successfully treated using transarterial balloon-assisted coil embolization. J Cerebrovasc Endovasc Neurosurg 2020; 22:182-189. [PMID: 32971577 PMCID: PMC7522392 DOI: 10.7461/jcen.2020.22.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
We present the case of a patient who developed compressive radiculopathy that was found to be associated with a spinal extradural arteriovenous fistula. The fistula was successfully obliterated with transarteiral balloon-assisted coiling, after which the patient was symptom-free. Although spinal extradural arteriovenous fistula is rare, this pathology should be considered in the differential diagnosis of spinal radiculopathy or myelopathy. Endovascular treatment appears to have been successful in resolving the symptoms associated with this pathology.
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Affiliation(s)
- Jung-Sik Park
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Min-Yong Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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8
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Inoue T, Endo T, Sato K, Fesli R, Ogawa Y, Fujimura M, Matsumoto Y, Tominaga T. Massive Intramedullary Hemorrhage After Subarachnoid Hemorrhage in Patient with Vertebrovertebral Arteriovenous Fistula. World Neurosurg 2019; 129:432-436. [PMID: 31226458 DOI: 10.1016/j.wneu.2019.06.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hemorrhagic presentations are rare in vertebrovertebral arteriovenous fistula (VVAVF). To the best of our knowledge, this is the first report of a patient initially presenting with subarachnoid hemorrhage and progressing to intramedullary hemorrhage. CASE DESCRIPTION The authors report on a 59-year-old man with VVAVF who developed massive intramedullary hemorrhage. Twelve months before ictus, the patient presented with subarachnoid hemorrhage. Although we recommended endovascular surgery, the patient refused treatment. Twelve months after the initial attack, the massive intramedullary hemorrhage in cervical spinal cord caused complete spinal cord injury. Emergent endovascular intervention was performed after the intramedullary hemorrhage, but there was no neurologic improvement. CONCLUSIONS Identification of this phenomenon is important in VVAVF because intramedullary hemorrhage dramatically degrades patient outcome. Prompt surgical intervention is mandatory for VVAVF cases presenting with subarachnoid hemorrhage.
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Affiliation(s)
- Tomoo Inoue
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan; Department of Neurosurgery, Sendai Medical Center, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan; Department of Neurosurgery, Sendai Medical Center, Kohnan Hospital, Sendai, Miyagi, Japan.
| | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Ramazan Fesli
- Department of Neurosurgery, Medical Park Private Hospital, Mersin, Turkey
| | - Yoshikazu Ogawa
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan
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9
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Aljobeh A, Sorenson TJ, Bortolotti C, Cloft H, Lanzino G. Vertebral Arteriovenous Fistula: A Review Article. World Neurosurg 2018; 122:e1388-e1397. [PMID: 30458324 DOI: 10.1016/j.wneu.2018.11.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Vertebrovertebral fistulas (VVFs) are uncommon lesions that can arise spontaneously or secondarily to iatrogenic or mechanical trauma. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, outcome, and complications associated with treatment. METHODS A literature search was performed by a reference librarian and after screening, 128 case reports and 16 case series were left for inclusion in the review. All possible data were abstracted by 3 authors, results were tabulated, and descriptive statistics (mean, range, and proportions) were reported. No formal statistical analysis was performed as part of this study. RESULTS A total of 280 patients were analyzed. VVFs can be categorized in 3 subgroups (iatrogenic, spontaneous, and traumatic), based on the mechanism of formation, and these different causes share different underlying demographics that bear important treatment considerations. Traumatic VVFs are more commonly seen in young men; the spontaneous form is more commonly seen in young women. Iatrogenic VVFs are more commonly seen in elderly people. Spontaneous VVFs are most commonly located between C1 and C2. Most iatrogenic (n = 39; 57%), spontaneous (n = 106; 82%), and traumatic (n = 53; 73%) VVFs were treated with deconstructive (defined as occlusion of fistula and feeding vessels) endovascular therapy. Overall treatment-related permanent morbidity was 3.3% (9/270) and mortality was 1.5% (4/270). CONCLUSIONS VVFs are uncommon lesions, and treatment is often indicated, even in patients without retrograde venous drainage. When treatment is undertaken, the cause of presentation and associated patient demographics should be considered when planning the treatment strategy.
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Affiliation(s)
- Ahmad Aljobeh
- School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Carlo Bortolotti
- Department of Neurologic Surgery, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Harry Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
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10
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Mitchell P, Thomas P, Anderson D. Spontaneous resolution of a non-traumatic vertebro-vertebral arteriovenous fistula in a paediatric patient. J Clin Neurosci 2018; 53:220-222. [PMID: 29706420 DOI: 10.1016/j.jocn.2018.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/21/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
We report the case of a 10 year old male who presented with right sided tinnitus and a pulsatile neck mass. MRI of the neck demonstrated a vertebro-vertebral arteriovenous fistula (VAVF), with supply from the right vertebral artery and drainage into a paraspinal venous plexus at C1/2. Endovascular treatment would have necessitated vertebral artery sacrifice with significant risk of complication, therefore a conservative approach was adopted; the patient was lost to follow up but presented 5 years later with complete resolution. We therefore advocate a role for conservative management when treatment would pose undue risk.
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Affiliation(s)
- Paul Mitchell
- Department of Neurosurgery, The Townsville Hospital, Townsville, Queensland, Australia.
| | - Piers Thomas
- Department of Neurosurgery, The Townsville Hospital, Townsville, Queensland, Australia
| | - David Anderson
- Department of Neurosurgery, The Townsville Hospital, Townsville, Queensland, Australia
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11
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Wendl CM, Aguilar Pérez M, Felber S, Stroszczynski C, Bäzner H, Henkes H. Paraspinal arteriovenous fistula: Stuttgart classification based on experience and a review of the literature. Br J Radiol 2018; 91:20170337. [PMID: 29376731 DOI: 10.1259/bjr.20170337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The term "paraspinal arteriovenous shunts" (PAVSs) summarizes an inhomogeneous variety of rare vascular disorders. PAVSs have been observed as congenital or acquired lesions. The clinical course of PAVSs may be asymptomatic or present with life-threatening symptoms. Based on a collection of individual cases from three institutions and a literature evaluation, we propose the following classification: PAVSs that are part of a genetic syndrome are separated from "isolated" PAVSs. Isolated PAVSs are subdivided into "acquired", "traumatic" and "congenital" without an identifiable genetic hereditary disorder. The subgroups are differentiated by the route of venous drainage, being exclusively extraspinal or involving intraspinal veins. PAVSs associated to a genetic syndrome may either have a metameric link or occur together with a systemic genetic disorder. Again extra-vs intraspinal venous drainage is differentiated. The indication for treatment is based on individual circumstances (e.g. myelon compression, vascular bruit, high volume output cardiac failure). Most PAVSs can be treated by endovascular means using detachable coils, liquid embolic agents or stents and derivates.
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Affiliation(s)
- C M Wendl
- 1 Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart , Stuttgart , Germany.,2 Institut für Röntgendiagnostik, Universitätsklinikum Regensburg , Regensburg , Germany
| | - M Aguilar Pérez
- 1 Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart , Stuttgart , Germany
| | - S Felber
- 3 Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Gemeinschaftsklinikum Mittelrhein , Koblenz , Germany
| | - C Stroszczynski
- 2 Institut für Röntgendiagnostik, Universitätsklinikum Regensburg , Regensburg , Germany
| | - H Bäzner
- 4 Neurologische Klinik, Neurozentrum, Klinikum Stuttgart , Stuttgart , Germany
| | - H Henkes
- 1 Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart , Stuttgart , Germany.,5 Medizinische Fakultät der Universität Duisburg-Essen , Essen , Germany
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12
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Breda MS, Amorim J, Rocha J, Dias L. Vertebro-vertebral fistula presenting as a pulsatile tinnitus. BMJ Case Rep 2018; 2018:bcr-2017-222815. [PMID: 29437736 DOI: 10.1136/bcr-2017-222815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus, resulting in an estimated prevalence of 10% to 15% in adults. Tinnitus may be classified as pulsatile (PT) or continuous (non-PT), and may be subjective (heard only by the patient) or objective (also audible to the examiner). PT is usually related to vascular causes and is pulse synchronous (coinciding with the patient's heartbeat). PT is much less common affecting approximately 4% of patients with tinnitus, but unlike non-PT, usually has a specific identifiable cause. We present a case of a man without previous otological disease or head trauma, with a left-ear subjective PT. MR angiography detected a left vertebro-vertebral arteriovenous fistula, which was treated by endovascular embolisation with important symptomatic relief.
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Affiliation(s)
- Miguel Sá Breda
- Otorhinolaryngology-Head and Neck Surgery, Hospital de Braga, Braga, Portugal
| | - José Amorim
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - Jaime Rocha
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - Luis Dias
- Otorhinolaryngology-Head and Neck Surgery, Hospital de Braga, Braga, Portugal
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Guneyli S, Cinar C, Bozkaya H, Korkmaz M, Oran I. Endovascular management of congenital arteriovenous fistulae in the neck. Diagn Interv Imaging 2016; 97:871-5. [PMID: 26972281 DOI: 10.1016/j.diii.2015.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/10/2015] [Accepted: 08/26/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate congenital arteriovenous fistulae in the neck, including vertebrovertebral and carotico-jugular arteriovenous fistula, with their endovascular management. MATERIALS AND METHODS Six patients with congenital arteriovenous fistulae in the neck who underwent endovascular treatment between March 2001 and December 2013 at the Department of Radiology, Ege University School of Medicine were enrolled into this retrospective study. There were four men and two women, with a mean age of 8.6 (range 4-17)years. Patients' demographics and symptoms were noted. Diagnostic computed tomography and/or magnetic resonance angiography were available in all patients. Parent artery and vein of the arteriovenous fistula, location of the fistula, the other features of fistula, endovascular occlusion site, number and type of endovascular materials, and length of follow-up were reviewed. RESULTS Four patients had vertebrovertebral fistula, while two patients had carotido-jugular fistula (fistula between maxillary artery and external jugular vein). Four patients underwent detachable balloon occlusion together with coil embolization, while two patients underwent detachable balloon occlusion only. The parent artery was occluded in five patients without clinical consequences, and the remaining fistula was occluded with preservation of the parent artery. The patients did not have any complication in the follow-up period (mean follow-up, 9months). CONCLUSION Congenital arteriovenous fistulae in the neck are extremely rare. Endovascular fistula occlusion with parent vessel sacrifice appears to be a safe and minimally invasive treatment option with good results during the follow-up period.
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Affiliation(s)
- S Guneyli
- The University of Chicago Medicine, Department of Radiology, 5841, S. Maryland Avenue, MC 2026, 60637 Chicago, Illinois, USA.
| | - C Cinar
- Université Caddesi, Ege University School of Medicine, Department of Radiology, 35040 Bornova, Izmir, Turkey
| | - H Bozkaya
- Université Caddesi, Ege University School of Medicine, Department of Radiology, 35040 Bornova, Izmir, Turkey
| | - M Korkmaz
- Ok Meydani Caddesi, Dumlupinar University School of Medicine, Department of Radiology, 43050 Kutahya, Turkey
| | - I Oran
- Université Caddesi, Ege University School of Medicine, Department of Radiology, 35040 Bornova, Izmir, Turkey
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Ashour R, Orbach DB. Lower vertebral-epidural spinal arteriovenous fistulas: a unique subtype of vertebrovertebral arteriovenous fistula, treatable with coil and Penumbra Occlusion Device embolization. J Neurointerv Surg 2015; 8:643-7. [PMID: 25964377 DOI: 10.1136/neurintsurg-2015-011677] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/17/2015] [Indexed: 11/03/2022]
Abstract
A vertebral-epidural spinal arteriovenous fistula (AVF) is an abnormal arteriovenous shunt connecting the vertebral artery to the spinal epidural venous plexus, and may occur spontaneously or secondary to a variety of causes. These unique lesions are uncommon in adults and rarer still in children. Previous reports have grouped together a heterogeneous collection of such arteriovenous lesions, including arterial contributions from the upper and lower vertebral artery, with venous drainage into a variety of spinal and paraspinal collectors. Here, through two cases, we delineate a distinct entity, the lower vertebral-to-epidural AVF. The salient clinical and anatomic features are summarized and contextualized within the broader constellation of vertebrovertebral AVF, the utility of a transarterial intravenous/retrograde intra-arterial endovascular approach is highlighted, and a new use of the Penumbra Occlusion Device (Penumbra Inc) for this purpose is reported.
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Affiliation(s)
- Ramsey Ashour
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Darren B Orbach
- Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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