A Rare Case of Post-Traumatic Cervical Ligamentous Tear Complicated by Vertebral Arteriovenous Fistula (vAVF), with Successful Endovascular Treatment

• Published in: Diagnostics
• Main Author: Fazdlin A.R.N.; Rizuana I.H.; Ch’ng L.S.
• Format: Article
• Language: English
• Published: Multidisciplinary Digital Publishing Institute (MDPI) 2023
• Online Access: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85169029071&doi=10.3390%2fdiagnostics13162693&partnerID=40&md5=8cbe0615cfe4cb5444be423841af3002

Post-traumatic vertebral arteriovenous fistula (vAVF) caused by motor vehicle accidents (MVA) is a rare condition in which there is abnormal communication between the vertebral artery and its adjacent veins. In a post-MVA setting, it is commonly associated with vertebral body fracture. In this paper, we report a case of a 19-year-old girl with a complete C2/C3 anterior and posterior ligament tear post MVA without any cervical bony injury. Initial plain computed tomography (CT) cervical scan showed a prevertebral hematoma. A CT angiogram (CTA) raised the suspicion of a pseudo-aneurysm at the right posterior C3 vertebral body. Further imaging with magnetic resonance imaging (MRI) demonstrated traumatic AVF at the C2/C3 level involving the V2/V3 right vertebral artery to the vertebral venous plexus. Digital Subtraction Angiography (DSA) further revealed a transected right vertebral artery at the C2/C3 level with an arteriovenous fistula and an enlarged vertebral venous plexus. The fistulous communication was successfully occluded with coils from a cranial and caudal approach to the transected segment right vertebral artery, with a total of eight coils. Post-MVA vertebral arteriovenous fistula (vAVF) is a rare sequela of vertebral bony injury at the cervical region, and is an even rarer association with an isolated ligamentous injury, whereby endovascular treatment with ipsilateral vertebral artery closure is a feasible treatment of vAVF. © 2023 by the authors.