Neurofibromatosis Type 1に合併した椎骨動静脈瘻に対するtandem balloon technique

Endovascular Trapping Using a Tandem Balloon Technique for a Spontaneous Vertebrovertebral Fistula Associated with Neurofibromatosis Type 1

Ⅰ．はじめに

　脊髄神経圧迫による左頚部痛と左上肢しびれ感を呈したneurofibromatosis Type 1（NF-1）患者に認められたhigh flowの椎骨動静脈瘻に対し，tandem balloon techniqueにて治療し得たので，文献的考察を加えて報告する．

　We report a rare case of a young man who had spontaneous left vertebrovertebral fistula associated with neurofibromatosis Type 1. His complaints were severe pain in the left neck and numbness in the left upper extremity. Cervical MR images showed a large abnormal flow void to the left of the spinal canal. An angiogram demonstrated a fusiform aneurysm and a high flow arteriovenous fistula in the left vertebral artery that drained into the internal vertebral plexus and formed a large venous varix. The occipital artery, the thyrocervical artery and the contralateral vertebral artery were associated with the fistula. The arteriovenous fistula was treated by endovascular coil embolization, using a tandem balloon technique. For this fistula, exhibiting the combination of high flow and multiple associated arteries, the flow control technique during the coil embolization, using tandem balloons in both the subclavian artery and the distal portion of the fistula of the vertebral artery, was safe and feasible for preventing coil migration.