PMC10282942_01
The patient's body surface features and imaging findings. (A) Multiple neurofibromas and typical cafe-au-lait spots; (B) Left skull bone destruction and occipital muscle swelling; (C) CTA showed subarachnoid hemorrhage; (D-F) CTA showed multiple vascular abnormalities in the left skull base and neck, and the thick venous lake compressed the spinal cord; (G) MRI showed the presence of an intracranial tumor; (H) Atlantoaxial dislocation, fluid void signal in the spinal canal and compression of the spinal cord.
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fig1
Clinical examination revealed multiple neurofibromas and typical cafe-au-lait spots on the patient's skin (Figure 1A). C3 to C4 (Figures 1G,H). CT angiography revealing a left cervical dural arteriovenous fistula, an aneurysm in the left internal carotid artery, multiple bone abnormalities in head and neck (Figures 1B-F).
First postoperative DSA and CTA examination. (A) DSA demonstrated multiple high-flow arteriovenous fistulae at the left CVJ (fistula A) and the C3-C4 level (fistula B); (B-D) Balloon combined with a coil and Onyx embolization, leaving an anastomotic muscular branch backflow vertebral artery supplying blood to fistula B; (E) CTA showed the disappearance of abnormal blood vessels in the left neck.
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Digital subtraction angiography demonstrated the presence of multiple high-flow arteriovenous fistulae at the left CVJ (fistula A) and the C3-C4 level (fistula B), a direct shunt between the left vertebral artery and the epidural vein, forming a huge venous lake connected to the paravertebral venous plexus on the left (Figure 2A); the right vertebral arteriography exhibited a leftward retrograde flow of blood.