ABSTRACT
Vertebro-vertebral fistulas (VVFs) are uncommon vascular pathology. It can be either primary (spontaneous) or secondary (iatrogenic or mechanical trauma). Spontaneous vertebral arteriovenous malformation is often associated with connective tissue disorders. Cases associated with neurofibromatosis type I (NF I) are even rarer. Management of VVF with covered stent is an emerging option for construction of vertebral artery. It not only preserves the flow of the parent artery but also has immediate exclusion of the fistula from the parent artery. A 30-year-old pregnant female patient presented with cervical bruit and left upper limb radiculopathy. She was a known case of NF I. Magnetic resonance imaging cervical spine revealed multiple flow voids compressing the cervical spinal cord and nerve roots. Digital subtraction angiography revealed a vertebral artery arteriovenous fistula. She underwent endovascular treatment in the form of a covered stent. Her clinical symptoms immediately improved. She was asymptomatic at the 1-year follow-up.
ABSTRACT
Understanding the anatomy of the vertebral artery is essential while manipulating the craniovertebral joint during surgery. Its anomalous course in congenital atlantoaxial dislocation makes it more vulnerable to injury. Preoperative dedicated computed tomography (CT) angiography helps identify the artery's position and plan for surgical procedure. A 13-year-boy presented with neck pain and spastic quadriparesis for 1 year. Radiological imaging of the craniovertebral junction revealed atlantoaxial instability with basilar invagination. His CT angiography of neck and brain vessels revealed an anomalous course of the vertebral artery due to a persistent second intersegment artery. He underwent posterior atlantoaxial fixation after mobilization of the vertebral artery. His clinical condition significantly improved after surgery. We report a case of management of an atlanto axial dislocation with persistent second intersegment artery and describe the role of vertebral artery mobilization during surgery.
ABSTRACT
Cranial dural arteriovenous (AV) fistulas are abnormal connections between the branches of dural arteries to dural veins or venous sinuses. They are most frequently located at the transverse sinus and cavernous sinus. They can occur at every cranial dural sinus. Dural AV fistula of falx cerebri is rare. A 62-year-old female presented with signs and symptoms of raised intracranial pressure. Radiological imaging revealed a dural AV fistula at the posterior one-third falx cerebri. She underwent transarterial embolization, and complete obliteration of the fistula was achieved. A detailed digital subtraction angiography study is warranted in patients with seemingly benign complaints like recurrent headaches, and falcine dural AV fistula should be identified and treated in the nick of time. We describe a very rare falcine dural AV fistula case and its management.
