Complete obliteration of a spontaneous pediatric vertebral arteriovenous fistula with patency of the parent vertebral artery: A case report

RATIONALE: Vertebral arteriovenous fistulas (VAVFs) are depicted with anomalous connections between the vertebral artery, or its branches, and the adjacent venous system. Most VAVFs occur as a result of direct trauma during accidents, whereas others have iatrogenic origin. PATIENT CONCERNS: We report a case of 11-year-old male who presented with right limb weakness and walking instability. DIAGNOSIS: Magnetic resonance angiography as well as digital subtraction angiogram (DSA) of the neck demonstrated a right VAVF. The cervical medulla was compressed by a dilated vein in vertebral canal. The blood supply of the fistula was from the right vertebral artery, whereas drainage was via epidural and paraspinal venous plexus. INTERVENTIONS: We introduced the TransForm Occlusion Balloon Catheter into right vertebral artery, identified the VAVF, and occluded it with the balloon. OUTCOMES: We successfully obliterated the VAVF with patency of parent vertebral artery with a balloon. The symptoms of the patient were relieved after the procedure. Two years’ follow-up revealed no recurrence of the fistula. The patient is currently well. LESSONS: Patency of the parent artery following obliteration a VAVF is still a challenge. Obliteration of the VAVF with a balloon while the parent vertebral artery is still patent is very possible.