Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Endovascular Treatment of Symptomatic High-Flow Vertebral Arteriovenous Fistula as a Complication after C1 Screw Insertion

  • Jang, Hyun Jun (Department of Neurosurgery, Inha University School of Medicine and Hospital) ;
  • Oh, Se-Yang (Department of Neurosurgery, Inha University School of Medicine and Hospital) ;
  • Shim, Yu Shik (Department of Neurosurgery, Inha University School of Medicine and Hospital) ;
  • Yoon, Seung Hwan (Department of Neurosurgery, Inha University School of Medicine and Hospital)
  • Received : 2014.08.08
  • Accepted : 2014.10.14
  • Published : 2014.10.28
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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.

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References

  1. Albuquerque FC, Javedan SP, McDougall CG : Endovascular management of penetrating vertebral artery injuries. J Trauma 53 : 574-580, 2002 https://doi.org/10.1097/00005373-200209000-00032
  2. Briganti F, Tortora F, Elefante A, Volpe A, Bruno MC, Panagiotopoulos K : An unusual case of vertebral arteriovenous fistula treated with electrodetachable coil embolization. Minim Invasive Neurosurg 47 : 386-388, 2004 https://doi.org/10.1055/s-2004-830131
  3. Coric D, Branch CL Jr, Wilson JA, Robinson JC : Arteriovenous fistula as a complication of C1-2 transarticular screw fixation. Case report and review of the literature. J Neurosurg 85 : 340-343, 1996 https://doi.org/10.3171/jns.1996.85.2.0340
  4. Crowley RW, Medel R, Dumont AS : Traumatic high flow vertebral-venous fistula presenting with delayed ischemic stroke : endovascular management with detachable coils and Amplatzer Vascular Plugs. Neurosurg Focus 26 : E5, 2009
  5. Halbach VV, Higashida RT, Hieshima GB : Treatment of vertebral arteriovenous fistulas. AJR Am J Roentgenol 150 : 405-412, 1988 https://doi.org/10.2214/ajr.150.2.405
  6. Herrera DA, Vargas SA, Dublin AB : Endovascular treatment of traumatic injuries of the vertebral artery. AJNR Am J Neuroradiol 29 : 1585-1589, 2008 https://doi.org/10.3174/ajnr.A1123
  7. Heuer GG, Gabel BC, Bhowmick DA, Stiefel MF, Hurst RW, Schuster JM : Symptomatic high-flow arteriovenous fistula after a C-2 fracture. Case report. J Neurosurg Spine 8 : 381-384, 2008 https://doi.org/10.3171/SPI/2008/8/4/381
  8. John S, Jaffari N, Lu M, Hussain MS, Hui F : Spontaneous vertebral arteriovenous fistula causing cervical myelopathy and acute ischemic strokes treated by endovascular balloon-assisted coiling and Onyx embolization. J Clin Neurosci 21 : 167-170, 2014 https://doi.org/10.1016/j.jocn.2013.01.016
  9. Li F, Song X, Liu C, Liu B, Zheng Y : Endovascular stent-graft treatment for a traumatic vertebrovertebral arteriovenous fistula with pseudoaneurysm. Ann Vasc Surg 28 : 489, 2014
  10. Luo CB, Teng MM, Chang FC, Chang CY : Endovascular treatment of intracranial high-flow arteriovenous fistulas by Guglielmi detachable coils. J Chin Med Assoc 69 : 80-85, 2006 https://doi.org/10.1016/S1726-4901(09)70118-2
  11. Madawi AA, Casey AT, Solanki GA, Tuite G, Veres R, Crockard HA : Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86 : 961-968, 1997 https://doi.org/10.3171/jns.1997.86.6.0961
  12. Neo M, Fujibayashi S, Miyata M, Takemoto M, Nakamura T : Vertebral artery injury during cervical spine surgery : a survey of more than 5600 operations. Spine (Phila Pa 1976) 33 : 779-785, 2008 https://doi.org/10.1097/BRS.0b013e31816957a7
  13. Peng CW, Chou BT, Bendo JA, Spivak JM : Vertebral artery injury in cervical spine surgery : anatomical considerations, management, and preventive measures. Spine J 9 : 70-76, 2009 https://doi.org/10.1016/j.spinee.2008.03.006
  14. Tenjin H, Kimura S, Sugawa N : Coil embolization of vertebro-vertebral arteriovenous fistula : a case report. Surg Neurol 63 : 80-83; discussion 83, 2005 https://doi.org/10.1016/j.surneu.2004.01.026
  15. Uchino A, Saito N, Watadani T, Okada Y, Kozawa E, Nishi N, et al. : Vertebral artery variations at the C1-2 level diagnosed by magnetic resonance angiography. Neuroradiology 54 : 19-23, 2012 https://doi.org/10.1007/s00234-011-0849-z
  16. Umebayashi D, Hara M, Nakajima Y, Nishimura Y, Wakabayashi T : Posterior fixation for atlantoaxial subluxation in a case with complex anomaly of persistent first intersegmental artery and assimilation in the C1 vertebra. Neurol Med Chir (Tokyo) 53 : 882-886, 2013 https://doi.org/10.2176/nmc.cr2012-0135
  17. Wakao N, Takeuchi M, Nishimura M, Riew KD, Kamiya M, Hirasawa A, et al. : Vertebral artery variations and osseous anomaly at the C1-2 level diagnosed by 3D CT angiography in normal subjects. Neuroradiology 56 : 843-849, 2014 https://doi.org/10.1007/s00234-014-1399-y
  18. Wang Q, Song D, Chen G : Endovascular treatment of high-flow cervical direct vertebro-vertebral arteriovenous fistula with detachable coils and Onyx liquid embolic agent. Acta Neurochir (Wien) 153 : 347-352, 2011 https://doi.org/10.1007/s00701-010-0850-z
  19. Wright NM, Lauryssen C : Vertebral artery injury in C1-2 transarticular screw fixation : results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg 88 : 634-640, 1998 https://doi.org/10.3171/jns.1998.88.4.0634
  20. Yamazaki M, Okawa A, Furuya T, Sakuma T, Takahashi H, Kato K, et al. : Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography : analysis of 100 consecutive surgical cases and review of the literature. Spine (Phila Pa 1976) 37 : E1389-E1397, 2012 https://doi.org/10.1097/BRS.0b013e31826a0c9f
  21. Yeom JS, Buchowski JM, Kim HJ, Chang BS, Lee CK, Riew KD : Risk of vertebral artery injury : comparison between C1-C2 transarticular and C2 pedicle screws. Spine J 13 : 775-785, 2013 https://doi.org/10.1016/j.spinee.2013.04.005
  22. Yoshida M, Neo M, Fujibayashi S, Nakamura T : Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine (Phila Pa 1976) 31 : E513-E517, 2006 https://doi.org/10.1097/01.brs.0000224516.29747.52

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