Unstable Hangman Fracture Complicated by Vertebral–Venous Fistula: Surgical Considerations and Review of Literature

Chander, Venugopal Sarath; Govindasamy, Ramachandran; Rudrappa, Satish; Gopal, Swaroop

doi:10.1016/j.wneu.2020.09.109

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…4 To improve our understanding of this rare entity, we reviewed and summarized the literature on traumatic dAVFs of the VA (Table 1). [5][6][7][8][9][10][11][12][13][14][15][16] Fistulas involving the VA can be asymptomatic due to paired vessel perfusion compensation (Table 1; cases by Andersen et al 14 and Sarath Chander et al 15 ) or present with symptoms of vertebrobasilar insufficiency, including tinnitus (case by Karakoyun et al 16 ), vertigo, visual changes, ataxia, or lowered level of consciousness. 1,12,17 Enlarged or aneurysmatic fistulas with vascular steal manifest as radiculopathy, neck and occipital pain, or myelopathy (Table 1; cases by Avellanosa et al 5 and Karakoyun et al 16 ).…”

Section: Observationsmentioning

confidence: 99%

Late-developing posttraumatic dural arteriovenous fistula of the vertebral artery: illustrative case

Schenck,

Fodor,

Wagemans

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND A dural arteriovenous fistula (dAVF) involving the vertebral artery (VA) is a rare vascular pathology that can result from damage to the VA, most frequently following cervical spine trauma. In most traumatic cases, the dAVF develops and manifests shortly after trauma. OBSERVATIONS A patient was admitted after a fall from the stairs causing neck pain. Computed tomography of the cervical spine revealed a Hangman’s fracture, and angiography showed a left VA dissection. The patient was treated with a cervical brace and clopidogrel. Three weeks after trauma, the patient was admitted because of bilateral leg ataxia, dizziness, and neck pain. Repeat imaging revealed increased displacement of the cervical fracture and a dAVF from the left VA with retrograde filling of the dAVF from the right VA. Embolization of the dAVF using coils proximally and distally to the dAVF was performed prior to placing a halo brace. At 6 months, all symptoms had disappeared and union of the cervical spine fracture had occurred. LESSONS This case report emphasizes the need for follow-up angiography after traumatic VA injury resulting from cervical spine fracture and underlines important treatment considerations for successful obliteration of a dAVF of the VA.

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