J Korean Neurosurg Soc.  2014 Oct;56(4):348-352. 10.3340/jkns.2014.56.4.348.

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

• Jang HJ
• Oh SY
• Shim YS
• Yoon SH

• KMID: 2018088
• DOI: http://doi.org/10.3340/jkns.2014.56.4.348

Abstract

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.

Keyword

Vertebral arteriovenous fistula; C1 screw; Endovascular treatment

MeSH Terms

Angiography, Digital Subtraction
Arteries
Arteriovenous Fistula*
Cerebellum
Consciousness
Diffusion Magnetic Resonance Imaging
Dysarthria
Embolization, Therapeutic
Extremities
Humans
Hypesthesia
Infarction
Occipital Lobe
Spine
Tinnitus
Vertebral Artery

Figure

• 

  Fig. 1 Case 1. The pretreatment angiography (A) demonstrates high-flow arteriovenous fistula at the V3 segment of the left vertebral artery above the screw inserted left C1 pedicle. The left V3 segment including the fistulous segment was complete occluded by endovascular coil embolization (B). The posttreatment angiography (C) demonstrates a complete obliteration of the fistula and occlusion of the V3 segment.

• 

  Fig. 2 Case 2. The pretreatment angiography (A) demonstrates a high-flow arteriovenous fistula with transection between the V3 segment of the left vertebral artery and the paravertebral venous plexus with the venous regurgitations extending into the left sigmoid and inferior petrosal sinus. The 3D image (A, right) reveals the left posterior inferior cerebellar artery (PICA) originating from extradural segment near the fistula. The two microcatheters were navigated to the distal and proximal protion of the fistula for saving the left PICA and supporting coil-frames (B). The posttreatment angiography (C) demonstrates a complete obliteration of the fistula with saving the left PICA.

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