Republished: Vertebral–venous fistula: an unusual cause for ocular symptoms mimicking a carotid cavernous fistula

Abstract

Vertebral-venous fistulas (VVF), or vertebral-vertebral arteriovenous fistulas, are an uncommon clinical entity. Typically, they present as a result of a direct vascular connection between an extracranial branch of the vertebral artery or its radicular components and the epidural venous plexus. These may manifest with signs and symptoms referable to cervical myelopathy secondary to compression or steal phenomenon. To our knowledge, this is the first case to identify a patient who presented with classic ocular symptoms attributable to a carotid cavernous fistula but secondary to a VVF. We present its treatment and clinical outcome. In addition, we present a brief literature review surrounding this uncommon disease.

Neuroendovascular Surgery Applications in Craniocervical Trauma

“…Extracranial AVF are rare lesions that may result from traumatic injury to the vessels in the neck, most commonly after penetrating neck injuries [ 69 , 70 ]. They typically arise from the vertebral artery, due to its close proximity to vertebral veins and the epidural venous plexus, but they can involve other vessels, such as the ECA branches, common carotid artery, and ICA [ 5 , 71 , 72 , 73 ]. Diagnosis of extracranial AVFs is challenging due to their often-delayed presentation and indolent course.…”

“…Patients can present with a variety of symptoms depending on the location of the AVF, the degree of shunting, and subsequent intracranial venous congestion. Symptoms can range from mild manifestations such as dizziness, bruit, and pulsatile tinnitus to more severe ones like cervical myelopathy, subarachnoid hemorrhage, and cranial nerve deficits [ 5 , 70 , 71 , 72 , 73 ].…”

“…Furthermore, as the majority of extracranial AVFs arise from the surgically challenging vertebral artery, endovascular repair has emerged as a safe and feasible option, with reported occlusion rates of up to 89% [ 69 ]. Endovascular treatment options include detachable coils, stent placement, coil embolization, and liquid embolization, with the primary goal of obliterating the fistulous point [ 5 , 69 , 71 , 72 , 73 ]. We identified a single systematic review analyzing penetrating extracranial vertebral artery injuries in 462 patients who experienced injuries, including gunshot wounds, stab wounds, and other miscellaneous mechanisms [ 76 ].…”