This section refers to Vertebral arteriovenous fistula (without dural involvement):
Diagnosis:
Clinical:
- Vertebrobasilar insufficiency, lower cranial nerve compression, neck pain, or asymptomatic
- Usually post trauma.
- Spontaneous fistula occur in fibromuscular dysplasia and neurofibromatosis. i.e. usually a complication of dissection
Catheter angiography DSA:
- Arterial supply: Vertebral artery directly fills veinous plexus. Fistula point is usually at the level of C1, C2 or C3
- Venous drainage: variable, depends on the fistula point
Treatment:
Endovascular embolisation:
- Arterial or venous approach
- Coil embolization
- Occationally covered stents or multiple overlapping stents
- Occationally fistula point occlusionw with concurrent vessel sacrifice