Pediatric spontaneous vertebro-venous fistula coil occlusion with vertebral artery preservation and distal vertebral artery flow restoration.
Lucas Pari Mitre, Ishav Y Shukla, Rafael De Oliveira Sillero
✦ AI-curated · Sources linked
Case in brief
A 9-year-old boy had progressive cervical and upper thoracic pain for 8 months, without neurological deficit. MRI showed a left suboccipital vascular lesion, enlarged bilateral vertebral arteries, and a diminished distal left vertebral artery. Angiography demonstrated a high-flow direct fistula from the V3 segment into a large venous pouch, with no V4 visualization. Coil embolization markedly reduced fistula flow and immediately restored V4 visualization while preserving the vertebral artery. Follow-up angiography showed complete fistula obliteration without residual shunting.
What made this case unusual
The distal left vertebral artery was not visualized before treatment but became visible immediately after coil embolization, illustrating reversibility of a flow-related angiographic abnormality.
Diagnostic / clinical pearl
In a high-flow vertebro-venous fistula, diminished distal vertebral artery visualization may reflect altered flow; reassess the artery after fistula occlusion.