Transarterial coil embolization of a high-flow vertebrojugular fistula due to penetrating craniocervical trauma: case report.
BACKGROUND
Vertebrojugular fistulas after penetrating cervical trauma (gunshot or stab wounds) are rarely reported. Successful endovascular coil embolization of an acute fistulizing vertebral artery pseudoaneurysm involving an obstructed internal jugular vein is presented and the various treatment strategies for such a lesion are described.


METHODS
A 23-year-old man presented from an outside institution after sustaining 2 gunshot wounds in a civilian conflict. Neuroimaging revealed a right vertebral artery pseudoaneurysm, which formed a fistulous connection with the internal jugular vein. Because venous outflow obstruction was present just below the fistula, a high-flow shunt was directed intracranially. Both the pseudoaneurysm and arteriovenous fistula were accessed percutaneously via a transfemoral route and coil embolization was performed. Perfusion of the basilar artery circulation was assumed by the contralateral vertebral artery. The ipsilateral posteroinferior cerebellar artery filled through retrograde flow down the vertebral confluence.


CONCLUSIONS
Coil embolization is a safe and reliable strategy by which to obliterate an acute traumatic vertebrojugular fistula as well as pseudoaneurysm. Serial angiographic follow-up is mandatory to document a persistent cure.
O'Shaughnessy
Brian A
BA
Department of Neurological Surgery, The Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Bendok
Bernard R
BR
Parkinson
Richard J
RJ
Shaibani
Ali
A
Batjer
H Hunt
HH
D000328:Adult; D017541:Aneurysm, False / Q000209:etiology / Q000473:pathology / Q000601:surgery; D001164:Arteriovenous Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical; D001488:Basilar Artery / Q000502:physiology; D020526:Brain Stem Infarctions / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D007601:Jugular Veins / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods / Q000639:trends; D019736:Prostheses and Implants; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000639:trends; D014711:Vertebral Artery / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D014948:Wounds, Gunshot / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*