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Zhao J, Zhao G, Lu L, Li C, Yang R. Vertebral arteriovenous fistulae (AVF) and vertebral artery aneurysms in neurofibromatosis type 1: A case report and a systematic review. Medicine (Baltimore) 2022; 101:e30952. [PMID: 36221365 PMCID: PMC9543027 DOI: 10.1097/md.0000000000030952] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is caused by mutations in the NF1 gene on the long arm of chromosome 17, which affects the skin, nervous system, eyes, and skeleton system. Vertebral arteriovenous fistula (AVF) associated with neurofibromatosis type I (NF-1) is rare. CASE PRESENTATION We report a 31-year-old postpartum woman with NF1 with vertebral arteriovenous fistulae (AVFs). She presented to our hospital because of neck pain, intracranial hypotension headache, and right upper limb weakness. She had a family history of NF1. After endovascular intervention, the AVF disappeared. However, a new aneurysm appeared on the right vertebral artery V5 dissection after 6 months of follow-up. CONCLUSIONS The presence of NF1 in patients who present with neurologic signs should prompt further angiography. Awareness of the coexistence between NF1 and AVF or aneurysm is crucial to avoiding diagnostic delays. Endovascular occlusion of VV-AVF in NF-1 patients is effective and safe.
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Affiliation(s)
- Jiali Zhao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
- *Correspondence: Jiali Zhao, Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan 250021, Shandong, China (e-mail: )
| | - Guangyu Zhao
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lin Lu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Chunxia Li
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Ruirui Yang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
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Endovascular treatment of vertebro-vertebral arteriovenous fistula in neurofibromatosis type I: A report of two cases and literature review with a focus on endovascular treatment. Clin Neurol Neurosurg 2021; 207:106806. [PMID: 34293658 DOI: 10.1016/j.clineuro.2021.106806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 11/22/2022]
Abstract
Vertebro-Vertebral arteriovenous fistula (VV-AVF) associated with neurofibromatosis Type I (NF-1) is rare. We presented two female NF-1 patients with a diagnosis of VV-AVF treated with endovascular approach. The fistula was completely obliterated with balloon assisted embolization and covered stent separately and VA patency was preserved in both cases. Reviewing the literature with a focus on endovascular treatment, endovascular occlusion of VV-AVF in NF-1 patients is safe and effective. To preserve the parent VA patency and obliterate the fistula simultaneously is challenging generally, but feasible in some cases.
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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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Swain SK, Arora RK, Sharma SK, Nandolia K, Basu G, Rekhapalli R, Arora P, Rajpal G, Sherwani P, Saxena S, Mittal RS. Vertebral arteriovenous fistulae in neurofibromatosis type1: a systematic review and meta-analysis. J Neurosurg Sci 2021; 66:54-61. [PMID: 33870666 DOI: 10.23736/s0390-5616.21.05232-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Vertebral Arterio-venous fistulas (VAVFs) are uncommon lesions that can arise spontaneously or secondarily to iatrogenic or mechanical trauma. Among spontaneous cases, it is most commonly found to be associated with Neurofibromatosis type 1 (NF1). EVIDENCE ACQUISITION We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities and outcome of VAVFs associated with NF1. A literature search was performed by using databases PubMed Central, Embase, Cochrane Library, and Ovid MEDLINE. Also, the grey area search was done using the "Google Scholar" search engine. On screening of the original full-text English language articles, a total of 48 cases were considered suitable for inclusion in this review. EVIDENCE ANALYSIS VAVFs in NF1 commonly present between 3rd and 6th decade of life affecting females 2.4 times more than males. Left-sided fistulae were more common than the right side and most seen in the upper V2 segment of the vertebral artery. Most VAVFs in NF 1 patients were treated with constructive (occlusion of fistula only) endovascular therapy (n =26) with a high success rate. Moreover, Pooled proportion of the outcome data have shown significant difference between the endovascular constructive and destructive procedure. CONCLUSIONS The spontaneous VAVF, commonly associated with NF-1, often requires treatment. Awareness of the coexistence between NF1 and VAVF is crucial to avoid diagnostic delays and unnecessary surgical intervention leading to disastrous outcomes. Endovascular treatment is the preferred treatment approach while open surgical treatment is required in some complex fistulae and failure of endovascular techniques.
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Affiliation(s)
- Srikant K Swain
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Rajnish K Arora
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India -
| | | | - Khanak Nandolia
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Garga Basu
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Rajasekhar Rekhapalli
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Poonam Arora
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Rishikesh, India
| | - Girish Rajpal
- Neurointerventionist, Max Healthcare, New Delhi, India
| | - Poonam Sherwani
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Sudhir Saxena
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Radhey S Mittal
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
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Nishizawa T, Tsuchiya T, Terasawa Y, Osugi Y. Neurofibromatosis type 1 with subarachnoid haemorrhage from the left vertebral arteriovenous fistula: case presentation and literature review. BMJ Case Rep 2021; 14:14/2/e239880. [PMID: 33619142 PMCID: PMC7903112 DOI: 10.1136/bcr-2020-239880] [Citation(s) in RCA: 1] [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
We present the case of a 47-year-old woman with neurofibromatosis type 1 (NF1) with subarachnoid haemorrhage (SAH) from the left vertebral arteriovenous fistula, along with a review of previous cases. Our patient had a family history of NF1 and presented to the emergency department with a sudden-onset severe headache and neck pain. CT scan showed SAH. CT angiography revealed a left vertebral arteriovenous fistula and an epidural haematoma. She underwent direct surgery and was discharged without neurologic deficits. To our knowledge, this is the first case of SAH caused by perimedullary drainage of a vertebral arteriovenous fistula associated with NF1. In a literature search, we identified 40 cases of vertebral arteriovenous fistula associated with NF1. The majority of vertebral arteriovenous fistulas occurred on the left side and in women. Patients with vertebral arteriovenous fistula typically experience neck pain, radiculopathy, radiculomyelopathy and bruits.
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Affiliation(s)
- Toshinori Nishizawa
- Department of General Internal Medicine, St Luke's International University, Chuo-ku, Japan .,Department of General Internal Medicine, Toyota Regional Medical Center, Toyota, Aichi, Japan
| | - Takahiro Tsuchiya
- Department of Neurosurgery, Tokyo University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yoshihiro Terasawa
- Department of General Internal Medicine, Toyota Regional Medical Center, Toyota, Aichi, Japan,Department of General Internal Medicine, Kuchinotsu Hospital, Minamishimabara, Nagasaki, Japan
| | - Yasuhiro Osugi
- Department of General Internal Medicine, Toyota Regional Medical Center, Toyota, Aichi, Japan,Department of Community Based Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Kim ST, Brinjikji W, Lanzino G, Kallmes DF. Neurovascular manifestations of connective-tissue diseases: A review. Interv Neuroradiol 2016; 22:624-637. [PMID: 27511817 DOI: 10.1177/1591019916659262] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/22/2016] [Indexed: 12/20/2022] Open
Abstract
Patients with connective tissue diseases are thought to be at a higher risk for a number of cerebrovascular diseases such as intracranial aneurysms, dissections, and acute ischemic strokes. In this report, we aim to understand the prevalence and occurrences of such neurovascular manifestations in four heritable connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome, Neurofibromatosis Type 1, and Loeys-Dietz syndrome. We discuss the fact that although there are various case studies reporting neurovascular findings in these connective tissue diseases, there is a general lack of case-control and prospective studies investigating the true prevalence of these findings in these patient populations. Furthermore, the differences observed in the manifestations and histology of such disease pathologies encourages future multi-center registries and studies in better characterizing the pathophysiology, prevalence, and ideal treatment options of neurovascular lesions in patents with connective tissue diseases.
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Narayana RV, Pati R, Dalai S. Endovascular management of spontaneous vertebrovertebral arteriovenous fistula associated with neurofibromatosis 1. Indian J Radiol Imaging 2015; 25:18-20. [PMID: 25709160 PMCID: PMC4329681 DOI: 10.4103/0971-3026.150132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Extra cranial vertebrovertebral arteriovenous fistulas (VV AVF) are commonly associated with trauma. Their presentation may vary from palpable thrill and myelopathy or myeloradiculopathy. Sudden onset paraparesis is rare.
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Affiliation(s)
- Randhi Venkata Narayana
- Department of Neurology and Interventional Neuroradiology, Seven Hills Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Rajesh Pati
- Department of Neurology and Interventional Neuroradiology, Seven Hills Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Sibasankar Dalai
- Department of Neurology and Interventional Neuroradiology, Seven Hills Hospital, Visakhapatnam, Andhra Pradesh, India
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Abstract
Object
Our understanding of spinal extradural arteriovenous fistulas (eAVFs) is relatively limited. In this study the authors aimed to provide the demographics, natural history, and treatment results of these rare lesions.
Methods
The authors performed a pooled analysis of data in the PubMed database through December 2012. Individualized patient data were extracted to elucidate demographic, clinical, and angioarchitectural features of spinal eAVFs as well as outcomes following different treatment strategies.
Results
Information on 101 patients was extracted from 63 eligible studies. The mean patient age was 45.9 years, and there was no significant overall sex predilection. Only 3% of the lesions were incidental, whereas 10% occurred in patients who had presented with hemorrhage. None of the 64 patients with at least 1 month of untreated follow-up sustained a hemorrhage over a total of 83.8 patient-years. Patients with lumbosacral eAVFs were significantly older (mean age 58.7 years, p < 0.0001), were significantly more often male (70% male, p = 0.02), had significantly worse presenting Aminoff-Logue motor and bladder scores (p = 0.0008 and < 0.0001, respectively), and had the greatest prevalence of lesions with intradural venous drainage (62% of cases, p < 0.0001). Neurofibromatosis Type 1 (30% of cases, p < 0.0001) and subarachnoid hemorrhage (9% of cases, p = 0.06) were associated with and exclusively found in patients with cervical eAVFs. The overall complete obliteration rate was 91%. After a mean follow-up of 1.7 years, the clinical condition was improved in 89% of patients, the same in 9%, and worse in 2%. Obliteration rates and outcome at follow-up did not significantly differ between surgical and endovascular treatment modalities.
Conclusions
Spinal eAVFs are rare lesions with a low risk of hemorrhage; they cause neurological morbidity as a result of mass effect and/or venous hypertension. Their treatment is associated with a high rate of complete obliteration and improvement in preoperative symptoms.
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Briganti F, Tedeschi E, Leone G, Marseglia M, Cicala D, Giamundo M, Napoli M, Caranci F. Endovascular treatment of vertebro-vertebral arteriovenous fistula. A report of three cases and literature review. Neuroradiol J 2013; 26:339-46. [PMID: 23859293 DOI: 10.1177/197140091302600315] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/02/2013] [Indexed: 11/16/2022] Open
Abstract
This report describes endovascular approaches for occlusion of vertebro-vertebral arteriovenous fistula (VV-AVF) in a series of three cases and a review of the literature. Complete neuroimaging assessment, including CT, MR and DSA was performed in three patients (two female, one male) with VV-AVF. Based on DSA findings, the VV-AVF were occluded by endovascular positioning of detachable balloons (case 1), coils (case 2), or a combination of both (case 3) with parent artery patency in two out of three cases. In this small series, endovascular techniques for occlusion of VV-AVF were safe and effective methods of treatment. To date, there are no guidelines on the best treatment for VV-AVF. Detachable balloons, endovascular coiling, combined embolization procedures could all be considered well-tolerated treatments.
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Affiliation(s)
- F Briganti
- Department of Diagnostic Imaging, University of Naples, Naples, Italy.
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Fukuda W, Taniguchi S, Fukuda Md Phd I. Endovascular treatment of ruptured intercostal arteriovenous fistulas associated with neurofibromatosis type 1. Ann Vasc Dis 2012; 5:109-12. [PMID: 23555499 DOI: 10.3400/avd.cr.11.00078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/27/2011] [Indexed: 11/13/2022] Open
Abstract
Wereport a rare case of ruptured intercostal arteriovenous fistula in a patient with neurofibromatosis type 1. The patient presented with severe back pain. Angiography revealed ruptured intercostal arteriovenous fistulas. Successful coil embolization to occlude the fistulas and the aneurysm resulted in successful recovery of the patient.
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Affiliation(s)
- Wakako Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
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