{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:05:45Z","timestamp":1789517145002,"version":"build-2803163510"},"reference-count":13,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,9,14]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder with diverse systemic manifestations. Severe vertebral vascular complications are uncommon, and the combination of a vertebral arteriovenous fistula, ruptured aneurysm, and pseudoaneurysm is extremely rare and life-threatening. Management of these complex malformations remains challenging. Moreover, postoperative brainstem reperfusion injury after combined endovascular and surgical treatment has been poorly reported, and its clinical hazards are often underestimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>This case involves a 41-year-old female with clinically confirmed NF1 and a positive family history. She presented with a progressive cervical mass and left upper limb neurological deficits. CT angiography and digital subtraction angiography confirmed the vascular lesions. The patient underwent staged endovascular embolization and open resection. Imaging verified complete lesion occlusion and relieved mass compression. Nevertheless, she developed cerebral hyperperfusion syndrome postoperatively and died of delayed fatal brainstem reperfusion injury on postoperative day 10.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Staged endovascular surgical treatment is a viable option for complex NF1-related vertebral vascular lesions. Chronic hypoperfusion from arterial steal increases reperfusion injury risk, requiring strict perioperative monitoring. Routine vascular screening is recommended for NF1 patients to detect hidden vascular lesions and facilitate early intervention.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26583\">https:\/\/thejns.org\/doi\/10.3171\/CASE26583<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26583","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:49Z","timestamp":1789516849000},"source":"Crossref","is-referenced-by-count":0,"title":["Staged endovascular and surgical management of vertebral arteriovenous fistula with ruptured aneurysm and pseudoaneurysm in neurofibromatosis type 1 complicated by fatal reperfusion injury: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1375-1702","authenticated-orcid":true,"given":"Dapeng","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4832-6961","authenticated-orcid":true,"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong;"},{"name":"Center of Teaching Quality Monitoring and Assessment, Guangdong Pharmaceutical University, Guangzhou, Guangdong"},{"name":"Guangdong Provincial Engineering and Technology Research Center for Stem Cell Therapy for Pituitary Disease, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"40","key":"bib1","series-title":"Medicine (Baltimore)","first-page":"e30952","article-title":"Vertebral arteriovenous fistulae (AVF) and vertebral artery aneurysms in neurofibromatosis type 1: a case report and a systematic review","volume":"101","author":"Zhao","year":"2022","unstructured":"Zhao JZhao GLu LLi CYang R.Vertebral arteriovenous fistulae (AVF) and vertebral artery aneurysms in neurofibromatosis type 1: a case report and a systematic review. Medicine (Baltimore). 2022;101(40):e30952. doi:10.1097\/MD.0000000000030952"},{"issue":"2","key":"bib2","series-title":"BMJ Case Rep","first-page":"e239880","article-title":"Neurofibromatosis type 1 with subarachnoid haemorrhage from the left vertebral arteriovenous fistula: case presentation and literature review","volume":"14","author":"Nishizawa","year":"2021","unstructured":"Nishizawa TTsuchiya TTerasawa YOsugi Y.Neurofibromatosis type 1 with subarachnoid haemorrhage from the left vertebral arteriovenous fistula: case presentation and literature review. BMJ Case Rep. 2021;14(2):e239880. doi:10.1136\/bcr-2020-239880"},{"key":"bib3","series-title":"Front Neurol","first-page":"578797","article-title":"Case report: multi-orifices vertebral arteriovenous fistula with severe scoliosis in neurofibromatosis type 1: might be a congenital disease with mesodermal dysplasia","volume":"12","author":"Wang","year":"2021","unstructured":"Wang YYuan CShen SZhang YZhang JDuan H.Case report: multi-orifices vertebral arteriovenous fistula with severe scoliosis in neurofibromatosis type 1: might be a congenital disease with mesodermal dysplasia. Front Neurol. 2021;12:578797. doi:10.3389\/fneur.2021.578797"},{"issue":"8","key":"bib4","series-title":"J Formos Med Assoc","first-page":"647","article-title":"Ruptured extradural vertebral artery aneurysm in a patient with neurofibromatosis type 1","volume":"116","author":"Lin","year":"2017","unstructured":"Lin CYShih YHChuang MT.Ruptured extradural vertebral artery aneurysm in a patient with neurofibromatosis type 1. J Formos Med Assoc. 2017;116(8):647-648. doi:10.1016\/j.jfma.2016.12.004"},{"issue":"4","key":"bib5","series-title":"Diagnostics (Basel)","first-page":"414","article-title":"Vertebro-\u00advertebral arteriovenous fistulae: a case series of endovascular management at a single center","volume":"14","author":"Withayasuk","year":"2024","unstructured":"Withayasuk PWichianrat RSangpetngam BVertebro-\u00advertebral arteriovenous fistulae: a case series of endovascular management at a single center. Diagnostics (Basel). 2024;14(4):414. doi:10.3390\/diagnostics14040414"},{"key":"bib6","series-title":"Front Genet","first-page":"1331278","article-title":"Mutation analysis and clinical profile of South African patients with neurofibromatosis type 1 (NF1) phenotype","volume":"15","author":"Mudau","year":"2024","unstructured":"Mudau MMDillon BSmal CMutation analysis and clinical profile of South African patients with neurofibromatosis type 1 (NF1) phenotype. Front Genet. 2024;15:1331278. doi:10.3389\/fgene.2024.1331278"},{"issue":"1","key":"bib7","series-title":"J Biomed Sci","first-page":"72","article-title":"Genetic diagnosis of neurofibromatosis type 1: targeted next-generation sequencing with multiple ligation-dependent probe amplification analysis","volume":"25","author":"Wu-Chou","year":"2018","unstructured":"Wu-Chou YHHung TCLin YTGenetic diagnosis of neurofibromatosis type 1: targeted next-generation sequencing with multiple ligation-dependent probe amplification analysis. J Biomed Sci. 2018;25(1):72. doi:10.1186\/s12929-018-0474-9"},{"key":"bib8","series-title":"World Neurosurg","first-page":"609.e13","article-title":"Neurofibromatosis type 1\u2013associated extracranial vertebral artery aneurysm complicated by vertebral arteriovenous fistula after rupture: case report and literature review","volume":"96","author":"Uneda","year":"2016","unstructured":"Uneda ASuzuki KOkubo SHirashita KYunoki MYoshino K.Neurofibromatosis type 1\u2013associated extracranial vertebral artery aneurysm complicated by vertebral arteriovenous fistula after rupture: case report and literature review. World Neurosurg. 2016;96:609.e13-609.e18. doi:10.1016\/j.wneu.2016.09.036"},{"issue":"1","key":"bib9","series-title":"J Neurosurg","first-page":"37","article-title":"Combined transarterial and percutaneous coiling of a spontaneous vertebrovertebral fistula associated with neurofibromatosis type 1. Case report","volume":"111","author":"Patro","year":"2009","unstructured":"Patro SNGupta AKArvinda HRJolapara MBSaini J.Combined transarterial and percutaneous coiling of a spontaneous vertebrovertebral fistula associated with neurofibromatosis type 1. Case report. J Neurosurg. 2009;111(1):37-40. doi:10.3171\/2008.12.JNS081209"},{"issue":"4","key":"bib10","series-title":"J Neurosurg Case Lessons","first-page":"CASE22537","article-title":"Endovascular embolization and needle aspiration of a life-threatening cervical hematoma due to a neurofibromatosis type 1-associated arteriovenous fistula: illustrative case","volume":"5","author":"Kojima","year":"2023","unstructured":"Kojima DAkamatsu YAso KEndovascular embolization and needle aspiration of a life-threatening cervical hematoma due to a neurofibromatosis type 1-associated arteriovenous fistula: illustrative case. J Neurosurg Case Lessons. 2023;5(4):CASE22537. doi:10.3171\/case22537"},{"issue":"8","key":"bib11","series-title":"J Neurointerv Surg","first-page":"788","article-title":"Update on cerebral hyperperfusion syndrome","volume":"12","author":"Lin","year":"2020","unstructured":"Lin YHLiu HM.Update on cerebral hyperperfusion syndrome. J Neurointerv Surg. 2020;12(8):788-793. doi:10.1136\/neurintsurg-2019-015621"},{"key":"bib12","series-title":"Front Neurol","first-page":"1097252","article-title":"Case report: medulla oblongata and cervical cord reperfusion injury after intracranial vertebral artery angioplasty and stenting","volume":"14","author":"Wang","year":"2023","unstructured":"Wang GZuo BJia JHuang JXi GYang Z.Case report: medulla oblongata and cervical cord reperfusion injury after intracranial vertebral artery angioplasty and stenting. Front Neurol. 2023;14:1097252. doi:10.3389\/fneur.2023.1097252"},{"issue":"2","key":"bib13","series-title":"Eur Arch Otorhinolaryngol","first-page":"661","article-title":"Arteriovenous fistula in the head and neck\u2014a systematic review and meta-analysis of clinical presentation","volume":"283","author":"Embrechts","year":"2025","unstructured":"Embrechts JLASnoeren RJBot JCJArteriovenous fistula in the head and neck\u2014a systematic review and meta-analysis of clinical presentation. Eur Arch Otorhinolaryngol. 2025;283(2):661-669. doi:10.1007\/s00405-025-09644-x"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/11\/article-CASE26583.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/11\/article-CASE26583.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/11\/article-CASE26583.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:49Z","timestamp":1789516849000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/11\/article-CASE26583.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":13,"journal-issue":{"issue":"11"},"URL":"https:\/\/doi.org\/10.3171\/case26583","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]}}}