Chaturvedi Jitender, Sudhakar P Venkata, Gupta Mohit, Goyal Nishant, Mudgal Shiv Kumar, Gupta Priyanka, Burathoki Sandeep
Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Orthopedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Surg Neurol Int. 2022 May 6;13:189. doi: 10.25259/SNI_261_2022. eCollection 2022.
Vertebro-vertebral fistulas (VVF) are rare. Anatomically, they consist of an arteriovenous fistula, a direct pathological communication between vertebral veins (including the epidural vertebral venous plexus) and extradural vertebral artery. The various etiologies include trauma, iatrogenic, or spontaneous (e.g., NF-1 or Ehlers Danlos Syndrome). The clinical presentation may include acute/delayed onset of radiculopathy and/or myelopathy. They may further be characterized by the delayed onset hearing loss to tinnitus and/or the sensation of .
We report successful endovascular management for iatrogenic VVF in a 37-year-old female who was diagnosed with an odontoid fracture (Anderson type IIC). She underwent a posterior C1 lateral masses to C2 pedicle/laminar screw fixation. An intraoperative vertebro-vertebral fistulas (VVF) was recognized during the procedure and it was managed successfully with percutaneous transarterial endovascular coiling.
Iatrogenic VVF should immediately be suspected when the implant trajectory goes slightly off track during a C1-2 fixation. Immediate postoperative DSA and MRI are advisable, irrespective of whether the patient is symptomatic. These lesions are best managed with endovascular coiling with or without detachable balloons.
椎-椎瘘（VVF）较为罕见。从解剖学角度来看，它们由动静脉瘘组成，即椎静脉（包括硬膜外椎静脉丛）与硬膜外椎动脉之间的直接病理性交通。其病因多种多样，包括创伤、医源性或自发性（如神经纤维瘤病1型或埃勒斯-当洛综合征）。临床表现可能包括神经根病和/或脊髓病的急性/延迟发作。它们还可能以耳鸣和/或感觉异常的延迟性听力丧失为特征。
我们报告了一例37岁女性医源性VVF的成功血管内治疗，该患者被诊断为齿状突骨折（安德森IIC型）。她接受了C1侧块至C2椎弓根/椎板螺钉后路固定术。术中发现了椎-椎瘘（VVF），并通过经皮经动脉血管内栓塞成功处理。
在C1-2固定过程中，当植入物轨迹稍有偏离时，应立即怀疑医源性VVF。无论患者是否有症状，术后应立即进行数字减影血管造影（DSA）和磁共振成像（MRI）检查。这些病变最好采用血管内栓塞治疗，可使用或不使用可脱性球囊。
