Vertebral arteriovenous fistule due to blunt neck trauma: case report

Abstract

The arteriovenous fistulas (AVFs) of the vertebral artery are usually caused by iatrogenic and penetrating traumas. Vertebral AVF is rarely seen after blunt cervical trauma. A 65-year-old male patient applied to the emergency clinic due to falling from a height of about 3 m. In his neurological examination, he had weakness in the left upper limb and tinnitus in the left ear. The cervical computed tomography examination showed a Hangman’s fracture, a C3 vertebra corpus compression fracture, and a C1 anterior arch fracture. There was a separation on the C1-2 transverse foramen due to the fracture, and there was a fracture in the left C3-4 transverse foramen. In cervical magnetic resonance imaging (MRI), the presence of a contusion in the spinal cord at the C2 corpus level was observed. Through an MRI angiography examination of the vertebral artery, it was determined that the left vertebral artery had developed an AVF at the V2-3 segment level. Stabilization surgery was performed with a posterior approach for unstable vertebrae. Then, vertebral AVF was then closed endovascularly using a stent coil. Improvement in neurological deficit was seen after surgery and endovascular treatment. There were no complications related to the procedure. Transverse foramen should be carefully evaluated, especially in the upper cervical trauma. Vertebral artery imaging should be performed before instability surgery in the presence of a separation in the fracture line to determine whether the damage to the vertebral artery is iatrogenic.

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

“…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 ).…”

“…[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 ). In all but one case, the dAVFs were diagnosed within a few hours to 3 days after admission.…”