Endovascular Treatment of Symptomatic High-Flow Vertebral Arteriovenous Fistula as a Complication after C1 Screw Insertion

High-flow vertebral arteriovenous fistulas (VAVF) are rare complications of cervical spine surgery and characterized by iatrogenic direct-communication of the extracranial vertebral artery (VA) to the surrounding venous plexuses. The authors describe two patients with VAVF presenting with ischemic presentation after C1 pedicle screw insertion for a treatment of C2 fracture and nontraumatic atlatoaxial subluxation. The first patient presented with drowsy consciousness with blurred vision. The diffusion MRI showed an acute infarction on bilateral cerebellum and occipital lobes. The second patient presented with pulsatile tinnitus, dysarthria and a subjective weakness and numbness of extremities. In both cases, digital subtraction angiography demonstrated high-flow direct VAVFs adjacent to C1 screws. The VAVF of the second case occurred near the left posterior inferior cerebellar artery originated from the persistent first intersegmental artery of the left VA. Both cases were successfully treated by complete occlusion of the fistulous portion and the involved segment of the left VA using endovascular coil embolization. The authors reviewed the VAVFs after the upper-cervical spine surgery including C1 screw insertion and the feasibility with the attention notes of its endovascular treatment.

Endovascular Treatment for Spontaneous Vertebral Arteriovenous Fistula in Neurofibromatosis Type 1: A Case Report / 신경중재치료의학

We report the case of a 42- year-old woman with spontaneous, right vertebral arteriovenous fistula associated with neurofibromatosis type 1. The patient presented with neck pain, retroauricular bruit, quadriparesis, and cervical spinal cord compression caused by an enlarged epidural vein. Endovascular treatment using coils and a balloon resulted in successful occlusion of the fistula. At six months post-embolization, the patient had improved significantly and was ambulant with support.

Coil Embolization of Spontaneous Vertebral Arteriovenous Fistula Associated with Neurofibromatosis Type 1: A Case Report / 신경중재치료의학

We present a case of 44-year-old male with spontaneous right vertebral arteriovenous fistula associated with neurofibromatosis type 1. The symptom of this patient was myeloradiculopathy of which was due to compressed cervical spinal cord by enlarged epidural vein. Complete occlusion of the fistula using coils resulted in relief of the patient symptom and complete disappearance of enlarged epidural vein on follow-up MR image one month later.