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Skull Base 2000; Volume 10(Number 1): 0035-0042
DOI: 10.1055/s-2000-6786
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212)760-0888 x132

Complex Vertebral Arteriovenous Fistula and Ruptured Aneurysm in Neurofibromatosis: A Therapeutically Challenging Case

Tori C. Roth, Wayne K. Manness, Beverly L. Hershey, Joseph Yazdi
  • Division of Diagnostic/Interventional Neuroradiology (TCR, WKM), Central Illinois Neuroscience Foundation, Bloomington, Illinois and Departments of Radiology (BLH), and Section of Neuroradiology and Neurosurgery (JY), Allegheny University Hospital, Hahnemann, Philadelphia, Pennsylvania
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Publication History

Publication Date:
31 December 2000 (online)

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ABSTRACT

-The objective and importance of this study was to describe the challenges encountered with treating a high-flow vertebral arteriovenous fistula (AVF) and ruptured aneurysm in a patient with life-threatening hemorrhage. A 36-year-old female with Neurofibromatosis type 1 (NF1) presented 2 weeks after uneventful cesarean section with a rapidly expanding pulsatile neck mass. Angiography demonstrated a complex left vertebral AVF and multiple associated vertebral artery aneurysms. Emergent endovascular coil embolization was performed using a retrograde and antegrade approach to occlude the fistulas and trap the ruptured aneurysm, successfully treating the acute hemorrhage. Subsequent definitive therapy was accomplished utilizing a combined neurointerventional and neurosurgical strategy of direct-puncture acrylic embolization and ligation of the vertebral artery. Recent advances in neurointerventional technology allow novel approaches in the primary and/or preoperative treatment of complex vascular lesions such as those seen in NF1.

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