Ruptured Extracranial Vertebral Artery Aneurysm Associated With Neurofibromatosis Type 1

Abstract

A 31-year-old man presented with a ruptured right extracranial vertebral artery aneurysm associated with neurofibromatosis type 1, manifesting as acute onset of right neck and shoulder pain, and right supraclavicular mass. Three-dimensional computed tomography angiography showed a large aneurysm involving the right extracranial vertebral artery associated with a pseudoaneurysm. The aneurysm was successfully treated by transarterial endovascular trapping with detachable coils. Extracranial vertebral artery aneurysm is rare, but the mortality of ruptured cases is extremely high, so early diagnosis and early treatment are important. The present case shows that endovascular treatment was very effective.

Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

“…Only nine patients have been described so far with extracranial VA aneurysms associated with NF1 and none of them presented with recurrent ischemic stroke due to embolization. However it is known that performing the sole proximal occlusion of the parent artery carries over time the risk of aneurysm revascularization by reverse blood flow coming from the patent vertebrobasilar axis [5], but, in previously described cases, this recanalization was asymptomatic except for one patient who developed a vertebral arteriovenous fistula [6]. …”

A Patient with Cervical Vertebral Arteriovenous Fistula Which Manifested as Radiculopathy: A Case Complicated by Neurofibromatosis Type 1

“…Neck pain and vascular murmur disappeared immediately after treatment, radiculopathy also improved, the patient became able to elevate the left upper limb after For treatment, endovascular treatment was performed in many cases and favorable outcomes have been reported. 4) Proximal occlusion was performed using a detachable balloon in the first four cases, and internal coil trapping mainly with coils was performed in the other cases. The objective of treatment is to prevent rupture and alleviate symptoms.…”

“…2,3) On the other hand, cervical vertebral artery aneurysm less frequently develops and only 22 cases have been reported so that many points, such as the incidence and natural course, remain unclear. 4,5) Eleven of these 22 cases were unruptured and the most frequent symptom was radiculopathy (54.5%), followed by neck pain (18.2%). No case was complicated by AVF.…”

“…The outcome was poor (three patients died) in four ruptured cases (36.4%) ( Table 1). [3][4][5][8][9][10][11][12][13][14][15] In our patient, the lesion was incidentally discovered in the close examination of headache. It was asymptomatic at the beginning but ruptured during the course.…”

Successful endovascular coil embolisation of a ruptured V1-segment vertebral artery dissecting aneurysm making a fistula with the adjacent vein

“…Both surgical and endovascular treatments carry potential risks and technical difficulties. The best treatment options are still controversial in such aneurysms 3–6. Here we present a case of a successfully treated ruptured dissecting V1 vertebral artery aneurysm making a fistula with the adjacent vein using endovascular coils and placement of a distal plug to close the fistula and proximally occlude the parent artery.…”