Vertebral arteriovenous fistulae. Report of two cases and review of the literature

Abstract

Two patients with vertebral arteriovenous fistulae were treated at the Neurosurgical Clinic of the City Hospital of Hannover between 1981 and 1988. Both patients were males, 19 and 29 year old. The fistulae were secondary to cervical gunshot wounds. Both patients complained of a loud cephalic noise; 1 patient had a non pulsating neck mass. A systolic cervical bruit was heard in both cases. One patient had an incomplete mid-cervical Brown-Sequard syndrome. The fistulae involved the second portion of the vertebral artery: 1 fistula was fed, in addition to the vertebral artery, by the deep cervical artery. Venous drainage was through intraspinal plexus, vertebral vein, deep cervical veins and internal jugular vein. One patient was treated with a direct surgical trapping of the vertebral artery proximal and distal to the fistula: the other patient, in addition to direct surgical vertebral artery trapping, received an endovascular balloon occlusion of the deep cervical artery. After treatment the fistulae disappeared, both clinically and angiographically.

Vertebral Arteriovenous Fistula: An Unwelcome Thrill

“…Due to the rarity of its clinical presentation, the morbidity and mortality of this disease are not well established but are thought to be high if left untreated. Vertebral AVFs are often traumatic in origin, resulting from penetrating neck wounds, blunt trauma with vertebral fracture, and iatrogenic injuries of the neck including those from jugular vein catheterization [1–3]. Infrequently, vertebral AVFs arise through atraumatic processes, either congenitally or spontaneously.…”

Case Report

“…4 This is due to its deep location, relatively small caliber, and the protection offered by overlying bone throughout most of its course. 5,6 A range of vascular injuries, including transection, dissection, occlusion, and false aneurysm formation can result. Because of the proximity of vertebral artery and adjacent vertebral veins, penetrating injuries can also result in arteriovenous fistula formation.…”

Vertebral arteriovenous fistula caused by angiography catheter: Case report

“…These channels m a y be occluded by an endovascular approach using detachable balloons or by a direct surgical approach 1,6,11,16 In other cases the fistula m a y be surgically excised trying to maintain patency of the V A 1 ' 6, 22. But when the channels are not well defined, as in our case, trapping of the fistula may be performed endovascularly using detachable balloons 1 ' 5, 8, 9,10, l a, 16 or by a direct surgical approach 1' 11, x7, 21 V A F are relatively benign lesions with a favourable outcome, when diagnosed in time and treated. This m a y be more easily attempted when there are well defined, single or multiple channels connecting the artery and veins.…”