Neurological Surgery No Shinkei Geka Volume 27, Issue 10 (October 1999)

A Case of Neurofibromatosis Type 1 Associated with Arteriovenous Fistula Caused by Re-bleeding of a Vertebral Dissecting Aneurysm Takeshi SAMPEI 1 , Haruki YUGAMI 1 , Toshihisa SUMII 1 , Kazuhide NIIYAMA 1 , Fumiharu AKAI 1 , Mamoru TANEDA 1 1Department of Neurosurgery, Kinki University School of Medicine Keyword: dissecting aneurysm , vertebral artery , arteriovenous fistula , subarachnoid hemorrhage , neurofibromatosis pp.927-931
Published Date 1999/10/10
  • Abstract
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We described a dissecting aneurysm of the vertebral artery (VA), which was associated with neurofibro-matosis type 1 (NF1). A 41-year-old man was referred to our hospital because of abrupt, severe headache.A CT scan revealed diffuse subarachnoid hemorrhage (SAH) predominantly in the prepontine cistern. Theangiograms showed a string sign in the left VA, just distal to the posterior inferior cerebellar artery(PICA). The vertebral dissection was considered responsible for SAH, and endovascular occlusion of theleft VA was attempted. During the intervention, the patient complained of severe neck pain at the time ofselective vertebral angiography, which revealed an arteriovenous fistula. The VA was occluded proximalto the PICA with GDC, which covered the fistula. Open surgery confirmed the two unruptured aneurysms. Intracranial dissection is rarely reported in association with NF1. However, ateriovenous fistula is not anuncommon combination with dissecting aneurysm and the extracranial segment of the VA is a characteris-tic target. Anatomical feasibility is conceivably the pathogenesis.

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Neurological Surgery 脳神経外科
27巻10号 (1999年10月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院