Abstract
Background: A vertebral arteriovenous fistula (VAVF) is an abnormal shunt between an extracranial vertebral artery (VA) and the neighboring vein.
We had two patients with the diagnosis of spontaneous VAVF. One case was treated with parent artery occlusion (PAO), and another was treated with fistula embolization.
Case 1: A 31-year-old male with neurofibromatosis-1 (NF-1) presented with left cervical radiculopathy.
Digital subtraction angiography (DSA) through the right VA revealed large shunt flow through a huge fistula between the left VA and neighboring vein. Therefore, we performed PAO of the proximal and distal left VA using endovascular technique. The symptoms disappeared 1 year after intervention.
Case 2: A 41-year-old female presented with abnormal findings on screening magnetic resonance imaging/angiography (MRI/A) for headache. Imaging showed a blurred left VA signal and enlarged neighboring vein, forming a mass effect around the tissue. A single small fistula was clearly identified on DSA. Therefore, only the fistula was obliterated by endovascular coil embolization, and the patency of the left VA was successfully preserved.
Conclusion: When the entry zone of the feeder is selected as the appropriate occlusion point, it is often possible to preserve VA flow.
