Vertebral Arterio-Venous Fistulas

Sanjeev Kumar 
 Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India

Correspondence Address:
Sanjeev Kumar
Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh
India

Full Text

[INLINE:1]

The vertebral Arterio-venous fistulas are rare and direct communications between the extradural segment of the vertebral artery and paravertebral venous plexus. They may arise spontaneously or, more commonly, after mechanical injury. Most cases present with bruit, and in severe cases, the engorged vein may compress the cord, producing compressive myelopathy and radiculopathy. Neurological symptoms are also contributed by hypertensive venopathy.

Endovascular intervention is the preferred mode of treatment, while open surgery is reserved for failed endovascular interventions. The ideal goal is the selective occlusion of the fistulous communication and preservation of the parent vessel flow. This is possible only when the fistulous communications are single or very few with clear demarcation on the angiogram. The interventional approach may be trans-arterial, trans-venous or combined. In cases where fistulas are multiple and unclear, the parent vessel may be occluded. The contralateral vertebral artery's patency should be ensured first with a balloon occlusion test before the sacrifice of the parent artery.

The first illustration depicts the anatomy of the multiple vertebral arterio-venous fistulas in the anteroposterior view. The second illustration shows the endovascular treatment by parent vessel occlusion with the coils. The balloon is placed distal to the fistulas to prevent coil migration. The reversal of the venous congestion is illustrated. The thecal sac is shown to regain its position, which happens slowly over time.

Device: iPad Pro 15.5

Software: Procreate