Presentation
A patient with a progressively worsening upper and lower limb weakness over the past 2 years presented to the hospital. An MRI of the entire spine revealed no disc disease; however, multiple flow voids were observed in the neck and both intra- and extraspinal locations of the cervical spine.
Patient Data
CT angiogram of the neck and brain showed extensively dilated vertebral and paraveterbal venous plexus it the left half of the spinal canal and left side of neck, with both intraspinal and extraspinal extensions.
Arterial feeders are from left vertebral artery (coronal, axial), left external carotid artery branches and 1st and 2nd part of left subclavian artery.
Vascular channels are compressing the spinal cord and causing bone remodeling.
Diagnostic DSA from left vertebral artery, left external carotid artery and ascending cervical artery showing arteriovenous high flow fistula with enlarged draining veins.
Right vertebral artery is patent, also supplying the fistula across the vertebrobasilar junction to left vertebral artery; no right vertebral artery feeding branches.
Case Discussion
Vertebrovenous fistulas (VVFs) are rare conditions involving abnormal arteriovenous communication between a vertebral artery and the paravertebral venous plexus. Although the definition is narrow, there are feeding branches that can be observed from internal and external carotid arteries, as well as the 1st and 2nd branches of subclavian arteries.
Similarly, draining veins can include anterior and internal jugular veins, in addition to paravertebral venous plexuses.
The etiology of VVFs is mostly idiopathic but can be associated with a previous history of trivial or major trauma. Patients can present with progressive weakness, paraparesis, or other symptoms of spinal compression.
Treatment of VVFs is performed with an endovascular approach, where the decision to perform complete occlusion of the vertebral artery and other feeder arteries is based on the patency of the opposite vertebral artery; embolization is then carried out.
Unfortunately, further clinical or imaging follow-up is not available for this case.
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