Vertebral arteriovenous fistula that developed in the same place as a previous ruptured aneurysm: A case report

BACKGROUND Aneurysms of the extracranial vertebral artery (VA) and vertebral arteriove nous fistulas (VAVFs) are relatively rare diseases. The most frequent cause of both diseases is trauma. Atraumatic lesions are less common. Presented here is a case of atraumatic AVF of the extracranial VA that developed in t he same location as a previous ruptured aneurysm of the ipsilateral VA that was originally treated by proximal occlusion 11 years earlier. METHODS A 40-year-old woman presented with a massive hematoma in the upper posterio r neck region caused by the rupture of an extracranial VA aneurysm. Proxima l occlusion of the VA was performed by use of a detachable balloon. She enj oyed good health for 11 years, then she noticed a pulsatile bruit. Angiogra ms revealed an AVF between the left VA that was fed by collateral circulati on and the paravertebral venous plexus. Incidentally found were soft tissue masses in the left retroauricular and the right suboccipital regions. Also , skull X-ray films showed multiple bony defects. Biopsy of the subcutaneou s mass was performed in the hope of obtaining clues as to which pathologica l processes had weakened the artery. RESULTS As direct transarterial access to the fistula was out of the question, the fistulous compartment of the paravertebral venous plexus was tightly packed with multiple platinum coils effected by the transfemoral approach. A hist ological examination of the specimen revealed features of a neurofibroma, a nd a diagnosis of neurofibromatosis Type 1 was established. CONCLUSIONS In this case, transvenous embolization of the VAVF was successfully perform ed. The fragility of the arterial wail, related to neurofibromatosis Type 1 , was considered to contribute to the development of the aneurysm and AVF, (C) 1999 by Elsevier Science Inc.