Complex vertebral arteriovenous fistula and ruptured aneurysm in Neurofibromatosis: A therapeutically challenging case

The objective and importance of this study was to describe the challenges e ncountered with treating a high-flow vertebral arteriovenous fistula (AVF) and ruptured aneurysm in a patient with life-threatening hemorrhage. A 36-y ear-old female with Neurofibromatosis type 1 (NF1) presented 2 weeks after uneventful cesarean section with a rapidly expanding pulsatile neck mass. A ngiography demonstrated a complex left vertebral AVF and multiple associate d vertebral artery aneurysms. Emergent endovascular coil embolization was p erformed using a retrograde and antegrade approach to occlude the fistulas and trap the ruptured aneurysm, successfully treating the acute hemorrhage. Subsequent definitive therapy was accomplished utilizing a combined neuroi nterventional and neurosurgical strategy of direct-puncture acrylic emboliz ation and ligation of the vertebral artery. Recent advances in neurointerve ntional technology allow novel approaches in the primary and/or preoperativ e treatment of complex vascular lesions such as those seen in NFI.