2020 年 43 巻 1 号 p. 17-22
We report a case of traumatic vertebral arteriovenous fistula (AVF). A 75–year–old man presented with consciousness disturbance and left hemiparesis after falling. Computed tomography (CT) revealed hangman’s fracture, rib fractures and pneumothorax, but there was no intracranial traumatic lesion. Magnetic resonance imaging (MRI) demonstrated central spinal cord injury at the C2 position. External fixation using a halo vest was performed, and his symptoms improved gradually. Three–dimensional CT angiography (3D–CTA) revealed left vertebral artery (VA) injury at the C2 position, change in VA injury from pseudoaneurysm to AVF and reduced anterograde flow in the left VA. Therefore, endovascular trapping was performed for left VA AVF with coil embolization under a fitted halo vest, and shunt flow disappeared. The postoperative course was uneventful and no infarction or recanalization of the embolized area of the left VA was noted on postoperative MRI. Cervical spine fractures rarely cause VA injury, but patients with these or other blunt cerebrovascular injuries should be examined carefully and sufficiently treated in order to improve their outcomes. Furthermore, as it is difficult to gather similar cases at a single institute, joint studies among different institutes are needed to clarify the transition of vessel injury and the timing of treatment intervention.