Neurological Surgery No Shinkei Geka Volume 22, Issue 1 (January 1994)

A Case Of Hangman's Fracture Associated with Vertebral Arteriovenous Fistula Treated With Trapping Kazuo OKUCHI 1 , Masayuki FUJIOKA 1 , Toshifumi KONOBU 1 , Akira FUJIKAWA 1 , Seiji MIYAMOTO 1 , Tetsuya MORIMOTO 2 , Toshisuke SAKAKI 2 , Toshiaki TAOKA 3 , Hiroyuki NAKAGAWA 3 , Satoru IWASAKI 3 1Department of Emergency and Critical Care Medicine, Nara Medical University 2Department of Neurosurgery, Nara Medical University 3Department of Radiology, Nara Medical University Keyword: Arteriovenous fistula , Vertebral artery , Hangman's fracture , Trapping , Pseudoaneurysm pp.55-59
Published Date 1994/1/10
  • Abstract
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A case of a traumatic vertebral arteriovenous fistula associated with a hangman's fracture is reported. A 45-year-old male fell down about 2 meters and struck his paiqetooccipital region against the ground. Profuse nasal bleeding developed. He was transferred to a local hospit-al, where his respiration was ataxic and blood pressure was low. After intubation, he was transferred to our emergency department. Cervical x-p revealed fracture of C1, C2 and subluxation of C2 body. Because of uncon-trollable nasal bleeding, the bilateral maxillar arteries were embolized with spongel. At this time, right verte-bral angiograms demonstrated a vertebral arteriovenous fistula with an pseudoaneurysm located at C2 level. On the 13th hospital day, direct balloon occlusion of the fis-tula was attempted; this could not be achieved because the subclavian and vertebral arteries were tortuous and the balloon catheter could not be introduced to the level of the fistula in the vertebral artery. The patient was only observed until follow-up angiogram on the 24th hos-pital day revealed enlargement of the pseudoaneurysm.We performed trapping of both the proximal and distal ends of the involved vertebral artery; from C5 to Cl. Postoperative course was uneventful, hangman's fracture was fixed with a Halo vest. Four months after operation, fistula and pseudoaneurysm were not opacified on angio-gram.

We believe that transvascular techniques are the treat-ment of choice for vertebral arteriovenous fistulas. However, as the next best thing, we can use trapping for the patient whose vessels are too tortuous to introduce the balloon catheter to the involved vessel.

Copyright © 1994, Igaku-Shoin Ltd. All rights reserved.


Neurological Surgery 脳神経外科
22巻1号 (1994年1月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院