Symptomatic high-flow arteriovenous fistula after a C-2 fracture

Case report

Gregory G. Heuer Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania

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 M.D., Ph.D.
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Brandon C. Gabel Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania

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 B.S.
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Deb A. Bhowmick Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania

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 M.D.
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Michael F. Stiefel Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania

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 M.D., Ph.D.
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Robert W. Hurst Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania

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 M.D.
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James M. Schuster Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania

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 M.D., Ph.D.
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✓Spinal arteriovenous fistulas (AVFs) are relatively uncommon lesions that are often diagnosed in a delayed fashion. The authors present a cause of a symptomatic high-flow AVF that developed in a patient after traumatic injury to the upper cervical spine. The patient presented to the trauma bay after a motor vehicle collision, and was found to have a C-2 fracture involving the transverse foramen. Although the patient was neurologically intact on presentation, 6 hours after admission weakness developed on his left side. Imaging studies demonstrated complete transection of the distal cervical aspect of the right vertebral artery (VA) at the base of C-2, with antegrade and retrograde flow into a direct AVF, resulting in early filling of the right internal jugular vein and other external draining veins. The patient was treated endovascularly with coil occlusion of the VA both proximal and distal to the transection. The patient's weakness improved over the next 7 days. At the 12-week follow-up examination, the patient's fractures had healed and he was neurologically intact.

Abbreviations used in this paper:

AVF = arteriovenous fistula; AVM = arteriovenous malformation; MR = magnetic resonance; VA = vertebral artery.
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  • 1

    American Society for Interventional and Therapeutic Neuroradiology: Embolization of spinal arteriovenous fistulae, spinal arteriovenous malformations, and tumors of the spinal axis. AJNR Am J Neuroradiol 22:8 Suppl S28S30, 2001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Aminoff MJ, , Barnard RO, & Logue V: The pathophysiology of spinal vascular malformations. J Neurol Sci 23:255263, 1974

  • 3

    Aminoff MJ, & Logue V: Clinical features of spinal vascular malformations. Brain 97:197210, 1974

  • 4

    Bürger T, , Tautenhahn J, , Grote R, & Halloul Z: Diagnosis and management of trauma and iatrogenic induced arteriovenous fistulas in the neck. Vasa 28:297300, 1999

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Debrun G, , Legre J, , Kasbarian M, , Tapias PL, & Caron JP: Endovascular occlusion of vertebral fistulae by detachable balloons with conservation of the vertebral blood flow. Radiology 130:141147, 1979

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Di Chiro G, , Doppman JL, , Dwyer AJ, , Patronas NJ, , Knop RH, & Bairamian D, et al.: Tumors and arteriovenous malformations of the spinal cord: assessment using MR. Radiology 156:689697, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Dormont D, , Gelbert F, , Assouline E, , Reizine D, , Helias A, & Riche MC, et al.: MR imaging of spinal cord arteriovenous malformations at 0.5 T: study of 34 cases. AJNR Am J Neuroradiol 9:833838, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Gelbert F, , Riche MC, , Reizine D, , Merland JJ, & Cormier JM: Direct arteriovenous fistula of the external carotid artery: treatment with detachable balloon. Ann Vasc Surg 2:358361, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Goodman SJ, , Hasso A, & Kirkpatrick D: Treatment of vertebro-jugular fistula by balloon occlusion. Case report. J Neurosurg 43:362367, 1975

  • 10

    Halbach VV, , Higashida RT, & Hieshima GB: Treatment of vertebral arteriovenous fistulas. AJR Am J Roentgenol 150:405412, 1988

  • 11

    Hung CL, , Wu YJ, , Lin CS, & Hou CJY: Sequential endovascular coil embolization for a traumatic cervical vertebral AV fistula. Catheter Cardiovasc Interv 60:267269, 2003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Hurst RW, , Kenyon LC, , Lavi E, , Raps EC, & Marcotte P: Spinal dural arteriovenous fistula: the pathology of venous hypertensive myelopathy. Neurology 45:13091313, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Inamasu J, & Guiot BH: Iatrogenic vertebral artery injury. Acta Neurol Scand 112:349357, 2005

  • 14

    Kataoka H, , Miyamoto S, , Nagata I, , Ueba T, & Hashimoto N: Venous congestion is a major cause of neurological deterioration in spinal arteriovenous malformations. Neurosurgery 48:12241230, 2001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Liu JK, , Decker D, , Tenner MS, , Couldwell WT, & Chiles BW III: Traumatic arteriovenous fistula of the posterior inferior cerebellar artery treated with endovascular coil embolization: case report. Surg Neurol 61:255261, 2004

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Muraszko KM, & Oldfield EH: Vascular malformations of the spinal cord and dura. Neurosurg Clin N Am 1:631652, 1990

  • 17

    Oldfield EH, , Di Chiro G, , Quindlen EA, , Rieth KG, & Doppman JL: Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula. J Neurosurg 59:10191030, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Rich NM, , Hobson RW II, & Collins GJ Jr: Traumatic arteriovenous fistulas and false aneurysms: a review of 558 lesions. Surgery 78:817828, 1975

  • 19

    Rosenblum B, , Oldfield EH, , Doppman JL, & Di Chiro G: Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM's in 81 patients. J Neurosurg 67:795802, 1987

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Sener RN, , Larsson EM, , Backer R, & Jinkins JR: MRI of intradural spinal arteriovenous fistula associated with ischemia and infarction of the cord. Clin Imaging 17:7376, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Symon L, , Kuyama H, & Kendall B: Dural arteriovenous malformations of the spine. Clinical features and surgical results in 55 cases. J Neurosurg 60:238247, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Thron AK: Neuroradiological Anatomy and Clinical Syndromes Vienna, Springer-Verlag, 1988

  • 23

    Willinsky RA, , terBrugge K, , Montanera W, , Mikulis D, & Wallace MC: Posttreatment MR findings in spinal dural arteriovenous malformations. AJNR Am J Neuroradiol 16:20632071, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation

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