Intracranial vertebral arteriovenous fistula

Case report

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✓ True intracranial arteriovenous fistulas are rare. The authors report a case of a direct fistula between the intracranial portion of the vertebral artery and the lateral medullary venous system. The patient initially presented with a subarachnoid hemorrhage. An open surgical approach with clip obliteration of the lesion was used. The anatomy of this lesion and its surgical management are described.

Article Information

Address reprint requests to: Christopher S. Ogilvy, M.D., Neurosurgical Service, Massachusetts General Hospital, Fruit Street, Boston, Massachusetts 02114.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative arteriograms, anteroposterior (left) and oblique (right) views, demonstrating the fistulous component of the lesion (arrows). Small arterialized veins are seen on the lateral aspect of the brain stem.

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    Diagrams showing the surgical approach to the arteriovenous fistula on the lateral aspect of the brain stem and exposure of the fistula. A 5-mm straight aneurysm clip was placed adjacent to the vertebral artery on the fistulous component. After the clip was placed, the previously red arterialized vein turned blue.

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    Postoperative angiograms, anteroposterior (left) and lateral (right) views, demonstrating complete obliteration of the arteriovenous shunt on the lateral aspect of the brain stem. The arterialized veins do not appear.

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