PMC5288984_01
(a) Schematic representing a DAVF (arrowhead) and 2 PAVFs (arrow and double arrow). (b) Left vertebral angiogram showing one PAVF (arrow) that was fed by the branch of the anterior spinal artery. (c) A second angiogram that was performed 28 days after the onset of an SAH revealed an aneurysm on the distal side of the artery feeding the PAVF. (d) Another PAVF (double arrow) that was fed by the descending artery from the left vertebral artery. (e and f) Selective angiogram of the left C2 radicular artery showing a DAVF (arrowhead) and transarterial coil embolization (white arrowhead)
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F1
Left vertebral artery (VA) angiography demonstrated a DAVF and two PAVFs at the C2 level [Figure 1a]. One PAVF was fed by a branch of the anterior spinal artery [Figure 1b]. An aneurysm on the distal side of the feeding artery was observed in the second angiogram that was performed 28 days after the onset of the SAH [Figure 1c]. Another PAVF was fed by the descending artery from the left VA [Figure 1d], and the DAVF was fed by the C2 radicular artery [Figure 1e]. Surgery was performed after transarterial embolization (TAE) of the DAVF with a coil [Figure 1f].
Intraoperative photograph (a), schematic (b), and indocyanine green videoangiography (c) demonstrating the location of 2 PAVFs (arrow and double arrow), a DAVF (arrowhead), an aneurysm on the distal side of the feeding artery, and draining veins of the DAVF and PAVFs. The histopathological features of the aneurysm (d) hematoxylin and eosin, x20; (e) hematoxylin and eosin, x100 demonstrating a thickened wall composed of fibrous tissue. The aneurysm retained a luminal structure
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F2
After gentle rotation of the spinal cord with the dentate ligament, the draining vein and an aneurysm on the distal side of the feeding artery could be observed [Figure 2a and b]. Two fistulous points of the PAVFs were detected with indocyanine green (ICG) videoangiography [Figure 2c]. The histopathological features of the aneurysm demonstrated a thickened wall that was composed of fibrous tissue [Figure 2d and e].