Endovascular treatment for V3 segment direct vertebral-venous fistulas: A report of two cases and a literature review.

INTRODUCTION AND IMPORTANCE: Direct vertebrovertebral fistulas (VVFs) involving the V3 segment of the vertebral artery (VA) are rare. Endovascular treatment (EVT) can be used to obliterate these VVFs.

CASE PRESENTATION: Case 1 was a 30-year-old male with limb weakness. He had grade V muscle strength in his limbs. Angiography confirmed a low-flow direct VVF of the V3 segment. The right VA was well developed. Coiling of the VVF and its parent VA obliterated the VVF. The vertebrobasilar arteries had sufficient blood from the right VA. Postoperatively, the patient recovered well. Case 2 was a 51-year-old male with headache and weakness of the limbs. He had grade IV muscle strength in his limbs. Angiography revealed a high-flow direct VVF in the V3 segment. The left VA was well developed. Coiling of the VVF and its parent VA obliterated the VVF. The vertebrobasilar arteries had sufficient blood from the left VA. Postoperatively, the patient recovered well.

CLINICAL DISCUSSION: Direct VVF of the V3 segment is difficult to treat, and EVT, including reconstructive and deconstructive approaches, can be an effective treatment option. According to this case report and literature review, reconstructive EVT is ideal; however, it is difficult to perform. Currently, deconstructive EVT may be the mainstream option for treating direct VVF of the V3 segment.

CONCLUSION: In certain cases where the contralateral VA is well developed, coiling the fistula and the parent VA is still an effective treatment.