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Endovascular treatment of high-flow cervical direct vertebro-vertebral arteriovenous fistula with detachable coils and Onyx liquid embolic agent

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Abstract

We report the first experience in the treatment of high-flow cervical direct vertebro-vertebral arteriovenous fistula (VVAVF), which was successfully occluded with detachable coils and Onyx through transarterial approach. A 20-year-old female presented with 2-month history of paresis of bilateral extremities. Magnetic resonance imaging (MRI) showed that the dilated ventral epidural veins as well as the dilated left paraspinal veins compressed the spinal cord. Digital subtraction angiography demonstrated high-flow VVAVF between the left vertebral artery (VA) and the surrounding venous plexus at the C3 cervical level. The fistulas were also fed by backward flow from the right VA and left ascending cervical arteries. Transarterial endovascular treatment was performed by using detachable coils and Onyx; immediate angiographic obliteration was achieved. VVAVF-related symptoms resolved gradually, and there was complete neurologic recovery without clinical consequences on clinical follow-up. The fistulas remained closed, as ascertained by 2-month follow-up computed tomography angiography and MRI. No new neurological deficit related to the procedure was detected. The endovascular treatment of direct VVAVF with combination of detachable coils and Onyx is feasible, safe, and highly effective with low morbidity and mortality.

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Abbreviations

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiography

MRI:

Magnetic resonance imaging

VA:

Vertebral artery

VAG:

Vertebral artery angiography

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Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Fudan University, No.12,Wulumuqi Mid Road, Shanghai, 200040, People’s Republic of China

    Qihong Wang, Donglei Song & Gong Chen

  2. Neurosurgical Department, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of China

    Qihong Wang, Donglei Song & Gong Chen

Authors
  1. Qihong Wang
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  2. Donglei Song
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  3. Gong Chen
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Corresponding author

Correspondence to Gong Chen.

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Comment

The author describes a case of successful treatment of a symptomatic high-flow cervical direct vertebro-vertebral arteriovenous fistula (VVAVF) via coil and Onyx embolizations. As part of the treatment, the left vertebral artery was sacrificed. Clinical follow-up evaluation showed recovery of symptoms, and follow-up imaging included 2-month computed tomography angiography and magnetic resonance imaging that did not show any sign of the fistula. This case is of interest because, to our knowledge, there is no other description in the literature of a case in which Onyx was used for VVAVF treatment.

David Orion MD and L. Nelson Hopkins MD

Buffalo, New York, USA

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National Natural Science Foundation of China; contract grant number 30872676.

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Wang, Q., Song, D. & Chen, G. Endovascular treatment of high-flow cervical direct vertebro-vertebral arteriovenous fistula with detachable coils and Onyx liquid embolic agent. Acta Neurochir 153, 347–352 (2011). https://doi.org/10.1007/s00701-010-0850-z

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