A case of spontaneous direct vertebral artery - External vertebral venous plexus fistula in the upper cervical portion

We report a rare case of upper cervical VA-EVVP fistula in a patient with no history of trauma and relevant medical conditions. Coil embolization of the fistula was performed using a combination of balloon-assisted and double-catheter techniques. Although the patient showed residual shunt flow after the intervention, follow-up DSA revealed complete obliteration. These findings should provide novel insights for the treatment strategy against VA-EVVP fistula.