A case of spontaneous direct vertebral artery - External vertebral venous plexus fistula in the upper cervical portion.

Surgical neurology international Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI:10.25259/SNI_736_2024
Takayuki Morimoto, Kenta Fujimoto, Sungchul Ko, Toshikazu Nishioka, Hidemori Tokunaga
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Abstract

Background: Spontaneous direct vertebral artery-external vertebral venous plexus (VA-EVVP) fistula is a rare disease that presents in patients with neurofibromatosis type 1 (NF-1) or trauma.

Case description: An 82-year-old female patient with no neurological deficits or trauma presented to our hospital with right hemianopsia. Head magnetic resonance imaging (MRI) revealed left occipital cerebral infarction and magnetic resonance angiography demonstrated high signal intensity in the left transverse sinus (TS). The attending doctor diagnosed an old infarction on the left occipital lobe and dural arteriovenous fistula (AVF) in the TS. After 3 years after the first diagnosis, her new attending doctor re-checked the MRI and performed digital subtraction angiography (DSA). The DSA examination revealed a single-hole AVF between the vertebral artery and external vertebral plexus at the C2 level, which was diagnosed as upper cervical VA-EVVP. The patient presented with tinnitus due to a high-flow VA-EVVP fistula, so we performed coil embolization of the fistula under general anesthesia using a double-catheter technique and achieved subtotal embolization, which diminished the intracranial reflux. The 6-month follow-up DSA image revealed complete obliteration of the AVF.

Conclusion: We report a rare case of upper cervical VA-EVVP fistula in a patient with no history of trauma and relevant medical conditions. Coil embolization of the fistula was performed using a combination of balloon-assisted and double-catheter techniques. Although the patient showed residual shunt flow after the intervention, follow-up DSA revealed complete obliteration. These findings should provide novel insights for the treatment strategy against VA-EVVP fistula.

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一例自发性上颈部椎动脉-椎外静脉丛直接瘘。
背景:自发性直接椎动脉-椎体外静脉丛(VA-EVVP)瘘是一种罕见疾病,多见于神经纤维瘤病 1 型(NF-1)或外伤患者:一位82岁的女性患者因右半身不遂到我院就诊,她既无神经功能障碍,也无外伤。头部磁共振成像(MRI)显示左枕叶脑梗死,磁共振血管造影显示左侧横窦(TS)高信号强度。主治医生诊断为左枕叶陈旧性脑梗塞和 TS 硬膜动静脉瘘(AVF)。首次诊断 3 年后,她的新主治医生重新检查了核磁共振成像,并进行了数字减影血管造影(DSA)检查。数字减影血管造影(DSA)检查显示,在 C2 水平的椎动脉和椎体外神经丛之间有一个单孔 AVF,诊断为上颈椎 VA-EVVP。患者因VA-EVVP高流量瘘管而出现耳鸣,因此我们在全身麻醉下使用双导管技术对瘘管进行了线圈栓塞,实现了次全栓塞,减少了颅内反流。6 个月的随访 DSA 图像显示动静脉瘘完全闭塞:我们报告了一例罕见的上颈椎 VA-EVVP 管瘘管病例,患者无外伤史和相关疾病。我们采用球囊辅助和双导管技术对瘘管进行了线圈栓塞。虽然患者在介入治疗后出现了分流残留血流,但随访的 DSA 显示瘘管已完全阻塞。这些发现为VA-EVVP瘘的治疗策略提供了新的思路。
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