Vertebral arteriovenous fistula due to blunt neck trauma: A case report

The arteriovenous fistulas (AVFs) of the vertebral artery are usually caused by iatrogenic and penetrating traumas. Vertebral AVF is rarely seen after blunt cervical trauma. A 65-year-old male patient applied to the emergency clinic due to falling from a height of about 3 m. In his neurological examination, he had weakness in the left upper limb and tinnitus in the left ear. The cervical computed tomog-raphy examination showed a Hangman’s fracture, a C3 vertebra corpus compression fracture, and a C1 anterior arch fracture. There was a separation on the C1-2 transverse foramen due to the fracture, and there was a fracture in the left C3-4 transverse foramen. In cervical magnetic resonance imaging (MRI), the presence of a contusion in the spinal cord at the C2 corpus level was observed. Through an MRI angiography examination of the vertebral artery, it was determined that the left vertebral artery had developed an AVF at the V2-3 segment level. Stabilization surgery was performed with a posterior approach for unstable vertebrae. Then, vertebral AVF was then closed endovascularly using a stent coil. Improvement in neurological deficit was seen after surgery and endovascular treatment. There were no complications related to the procedure. Transverse foramen should be carefully evaluated, especially in the upper cervical trauma. Vertebral artery imaging should be performed before instability surgery in the presence of a separation in the fracture line to determine whether the damage to the vertebral artery is iatrogenic.

Künt boyun travmasýna baðlý vertebral arteriovenöz fistül: Olgu sunumu

Vertebral arterin arteriyovenöz fistüllerine (AVF) genellikle iyatrojenik ve penetran travmalar neden olur. Vertebral AVF, künt servikal travmadan sonra nadiren görülür. Altmýþ beþ yaþýnda erkek hasta yaklaþýk üç metre yükseklikten düþtüðü için acil servise baþvurdu. Nörolojik muayenesinde; sol üst ekstremitede zayýflýk ve sol kulakta kulak çýnlamasý vardý. Servikal bilgisayarlý tomografi (BT) incelemesinde Hangman’s kýrýðý, C3 vertebra korpus kompresyon kýrýðý ve C1 anterior ark kýrýðý görüldü. C1-2 transvers foramenleri kýrýk nedeniyle ayrýþma ve sol C3-4 transvers foramenlerinde de kýrýk vardý. Servikal manyetik rezonans görüntülemede (MRG), omurilikte C2 korpus düzeyinde bir kontüzyon varlýðý gözlendi. Vertebral arterin MRG anjiyografi incelemesi ile sol vertebral arterin V2-3 segment seviyesinde bir AVF geliþtirdiði belirlendi. Ýnstabil vertebra kýrýklarý için posterior yaklaþýmla stabilizasyon uygulandý. Daha sonra vertebral AVF bir stent/coil kullanýlarak endovasküler olarak kapatýldý. Cerrahi ve endovasküler te-daviden sonra nörolojik defektte düzelme görüldü. Ýþlemle ilgili herhangi bir komplikasyon görülmedi. Üst servikal travmalarda transvers foramenler, özellikle deðerlendirilmelidir. Vertebral arter görüntülemesi, vertebra arter hasarýnýn iyatrojenik olup olmadýðýný belirlemek için kýrýk hattýnda bir ayýrma varlýðýnda instabilite cerrahisi öncesinde yapýlmalýdýr.