Atraumatic Vertebral Arteriovenous Fistula: A Rare Entity with Two Case Reports

• Published in: World neurosurgery Vol. 120; pp. 66 - 71
• Main Authors: Rai, Rabjot, Iwanaga, Joe, Wang, Bill, Patel, Akil, Bentley, Joshua, Loh, Yince, Monteith, Stephen, Tubbs, R. Shane
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2018
• Subjects: Adult; Arteriovenous Fistula - complications; Arteriovenous Fistula - diagnostic imaging; Arteriovenous Fistula - therapy; Diagnosis, Differential; Female; Fistula embolization; Humans; Middle Aged; Neurofibromatosis; Neurofibromatosis 1 - complications; Spontaneous arteriovenous fistula; Vertebral artery; Vertebral Artery - abnormalities; Spontaneous arteriovenous fistula; Vertebral artery; CTA; VA; Fistula embolization; Neurofibromatosis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.08.160

A vertebral artery arteriovenous fistula is rare and usually due to trauma. Atraumatic cases are quite rare. We reported 2 cases and a review of other reported studies. A spontaneous vertebral–venous fistula is rare, and the 2 cases presented illustrate an underlying spontaneous etiology. The first patient presented with a spontaneous fistula, and the second case occurred in a patient with neurofibromatosis type 1. In both cases, the fistulas were diagnosed using computed tomography angiography and treated with occlusion via coil embolization. Vascular changes are known in patients with neurofibromatosis. A proposed pathogenesis of fistula is that the fragility and defective nature of the arterial wall could be a predisposing factor or it might be congenital. Understanding the clinical symptoms, diagnosis, and effective management strategies are important for physicians treating patients with a vertebral artery arteriovenous fistula. •Vertebral–venous fistulas are rare, mostly traumatic in origin, with few spontaneous cases reported.•A definitive diagnosis with CTA is required for treatment planning.•Both of our patients presented with spontaneous manifestations of their vertebral arteriovenous fistula.•Neurofibromatosis type 1 causes vessel vulnerability owing to abnormalities of the connective tissue.•A delay in treatment will complicate cases by recruitment of additional feeders to the fistula.