title: Multimodal endovascular treatment of a vertebrovertebral fistula presenting with subarachnoid hemorrhage and hydrocephalus.
abstract: Vertebrovertebral fistulae are rare vascular malformations that uncommonly can rupture to present clinically as intracranial subarachnoid hemorrhage. We report a 69-year-old man presenting following spontaneous apoplectic collapse. Initial workup revealed diffuse, intracranial subarachnoid hemorrhage, intraventricular hemorrhage and hydrocephalus. However, the etiology was not apparent on CT angiography of the head. Catheter-based angiography was performed, demonstrating a single-hole, high-flow vertebrovertebral fistula, arising from the V2 segment and decompressing into both cervical and skull base venous structures. Definitive treatment consisted of endovascular fistula obliteration with a combination of coil and liquid embolic material. The patient made a full neurological recovery. High cervical and skull base fistulae are rare causes of intracranial hemorrhage; endovascular treatment is effective at disconnection of the arteriovenous shunt.
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA. walcott.brian@mgh.harvard.edu
authors.forename: Brian P
authors.initials: BP
authors.lastname: Walcott
authors.forename: Olvert A
authors.initials: OA
authors.lastname: Berkhemer
authors.forename: Thabele M
authors.initials: TM
authors.lastname: Leslie-Mazwi
authors.forename: Ronil V
authors.initials: RV
authors.lastname: Chandra
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
mesh_terms: D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Cervical; Endovascular; Hydrocephalus; Stroke; Subarachnoid; Vertebral artery; Vertebrovertebral fistula