Artikel
Spontaneous vertebral arteriovenous fistula simulating a cervical spine tumour
Einen spinalen Tumor simulierende spontane arteriovenöse Fistel der Arteria vertebralis
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Autoren
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A. Boström
- Department of Neurosurgery, Aachen University, Aachen
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F.-J. Hans
- Department of Neurosurgery, Aachen University, Aachen
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W. Möller-Hartmann
- Department of Neuroradiology, Aachen University, Aachen
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B. Sellhaus
- Department of Neuropathology, Aachen University, Aachen
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V. Rohde
- Department of Neurosurgery, Aachen University, Aachen
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J.M. Gilsbach
- Department of Neurosurgery, Aachen University, Aachen
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E. Uhl
- Department of Neurosurgery, Munich University, Munich
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
Text
Objective
Most of the vertebral fistulae described in the literature are of post-traumatic or iatrogenic origin. Spontaneous or congenital fistula may appear with other diseases such as neurofibromatosis. Among the different treatments available, selective embolisation with balloons or detachable coils are the most common. We will illustrate a case of a vertebral fistula with a complicated clinical course leading to the death of the patient.
Methods
A 58-year-old male was admitted to our hospital because of rapidly progressive tetraparesis, ataxia and bladder-dysfunction. The patient had been well until one week earlier and had not suffered from any major illness except a carcinoma of the testicles 25 years ago. A MRI of the cervical spine revealed a tumour-like structure extending from C2-C7. A CT of the cervical spine showed no typical infiltration of the osseous structure but widening of the vertebral laminae and arrosion of the third and fourth vertebral body Angiography showed a simple and direct fistula between the second segment of the right vertebral artery and the epidural veins. Due to this fistula a large venous sac was extending from C2-C7 simulating an intraspinal tumour on MRI and CT. Different treatment options where considered and coil embolisation in two steps was decided as the best treatment form. First the proximal segment of the right vertebral artery was occluded by platinum coils. The second and final embolisation was planned one week later. In the mean time the patient developed a severe pneumonia of the right middle lobe, followed by severe septicemia and died 4 weeks later. The autopsy showed that the venous sac was located intradurally and extramedullary and compressed the spinal cord.
Conclusions
Retrospectively the pneumonia was considered to be the consequence of a reduced ventilation of the right lung secondary to a paresis of the right phrenic nerve. Therefore the immediate microneurosurgical treatment with complete occlusion of the fistula and reduction of the mass effect of the venous sac might have been the better treatment option for this patient and inhibition of ventilation should be considered as a serious complication of vertebral fistula with mass effect.
