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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 1041-1049
DOI: 10.4103/ajns.AJNS_353_20
Case Report

Spontaneous spinal osseous epidural arteriovenous fistula with long segments of prominent epidural venous drainage causing severe compressive thoracic myelopathy successfully treated with combined endovascular and surgical treatments: A case report and review of the literature

Prasert Iampreechakul
Department of Neurosurgery, Prasat Neurological Institute, Bangkok
,
Wuttipong Tirakotai
Department of Neurosurgery, Prasat Neurological Institute, Bangkok
,
Punjama Lertbutsayanukul
1   Department of Neuroradiology, Prasat Neurological Institute, Bangkok
,
Samasuk Thammachantha
2   Department of Pathology, Prasat Neurological Institute, Bangkok
,
Somkiet Siriwimonmas
3   Department of Radiology, Bumrungrad International Hospital, Bangkok
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The authors describe an extremely rare case of spinal osseous epidural arteriovenous fistulas (SOEAVFs) with unique characteristic features. A 25-year-old man presented with progressive weakness and paresthesia of the lower extremities for 1 month. Magnetic resonance imaging of the thoracic spine showed an extradural dilated vascular flow void structure extending from T4 to T8 levels with abnormal hyperintense T2 signal from T6 to T8 levels. Magnetic resonance angiography and spinal angiography revealed unique features of SOEAVF supplied by multiple small arterial feeders of intercostal arteries converging into a dilated round venous sac corresponding to a bony defect of T7 lamina and spinous process. The venous drainage directly drained into prominent epidural venous plexus extending from the level of T4 to T8 without intradural venous drainage, causing severe compressive myelopathy. Transarterial embolization was performed using N-butyl cyanoacrylate through the main feeder. Subsequently, he successfully underwent laminectomy and total excision of the fistula and large epidural draining venous plexus. Histopathology confirmed spinal vascular malformations with evidence of previous embolization. He gradually improved until being ability to walk independently 3 months later. Follow-up spinal angiography confirmed complete resection of SOEAVF. The patient has remained clinically asymptomatic 5 years after operation.

Key-words:

Compressive myelopathy - round venous sac - spinal osseous epidural arteriovenous fistula - surgical treatment - thoracic spine

Financial support and sponsorship

Nil.




Publikationsverlauf

Eingereicht: 19. Juli 2020

Angenommen: 18. August 2020

Artikel online veröffentlicht:
16. August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Koizumi S, Takai K, Shojima M, Kunimatsu A, Ishii K, Imai H, et al. Spinal extradural arteriovenous fistulas with retrograde intradural venous drainage: Diagnostic features in digital subtraction angiography and time-resolved magnetic resonance angiography. J Clin Neurosci 2017;45:276-81.
  • 2 Hiramatsu M, Sugiu K, Yasuhara T, Hishikawa T, Nishihiro S, Kidani N, et al. Comparison between spinal dural arteriovenous fistula and spinal epidural arteriovenous fistula. J Neuroendovascular Ther 2018;12:1-8.
  • 3 Kiyosue H, Matsumaru Y, Niimi Y, Takai K, Ishiguro T, Hiramatsu M, et al. Angiographic and clinical characteristics of thoracolumbar spinal epidural and dural arteriovenous fistulas. Stroke 2017;48:3215-22.
  • 4 Clarke MJ, Patrick TA, White JB, Cloft HJ, Krauss WE, Lindell EP, et al. Spinal extradural arteriovenous malformations with parenchymal drainage: Venous drainage variability and implications in clinical manifestations. Neurosurg Focus 2009;26:E5.
  • 5 Rangel-Castilla L, Holman PJ, Krishna C, Trask TW, Klucznik RP, Diaz OM. Spinal extradural arteriovenous fistulas: A clinical and radiological description of different types and their novel treatment with Onyx. J Neurosurg Spine 2011;15:541-9.
  • 6 Byun JS, Tsang AC, Hilditch CA, Nicholson P, Fang YB, Krings T, et al. Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas: A systematic review and meta-analysis. J Neurointerv Surg 2019;11:95-8.
  • 7 Brinjikji W, Yin R, Nasr DM, Lanzino G. Spinal epidural arteriovenous fistulas. J Neurointerv Surg 2016;8:1305-10.
  • 8 Jeng Y, Chen DY, Hsu HL, Huang YL, Chen CJ, Tseng YC. spinal dural arteriovenous fistula: Imaging features and its mimics. Korean J Radiol 2015;16:1119-31.
  • 9 Chibbaro S, Gory B, Marsella M, Tigan L, Herbrecht A, Orabi M, et al. Surgical management of spinal dural arteriovenous fistulas. J Clin Neurosci 2015;22:180-3.
  • 10 Takai K, Taniguchi M. Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: A systematic literature review. Neurosurg Focus 2012;32:E8.
  • 11 Song Y, Cho SH, Lee DW, Sheen JJ, Shin JH, Suh DC. Osseous versus nonosseous spinal epidural arteriovenous fistulas: Experiences of 13 patients. AJNR Am J Neuroradiol 2019;40:129-34.
  • 12 Chul Suh D, Gon Choi C, Bo Sung K, Kim KK, Chul Rhim S. Spinal osseous epidural arteriovenous fistula with multiple small arterial feeders converging to a round fistular nidus as a target of venous approach. AJNR Am J Neuroradiol 2004;25:69-73.
  • 13 Iizuka Y, Suzuki M, Suzuki K, Shimoji K, Komura S. High-flow paraspinal osseous epidural arteriovenous fistula. A case report. Neuroradiol J 2008;21:433-9.
  • 14 Willinsky R, terBrugge K, Montanera W, Wallace MC, Gentili F. Spinal epidural arteriovenous fistulas: Arterial and venous approaches to embolization. AJNR Am J Neuroradiol 1993;14:812-7.
  • 15 Rispoli R, Mastrostefano R, Passalacqua G, Filauri P, Fontana M. Epidural hematoma caused by a spinal osseous epidural arteriovenous fistula in a 14-year-old patient. A case report. Neuroradiol J 2009;22:452-7.
  • 16 Jin YJ, Chung SK, Kwon OK, Kim HJ. Spinal intraosseous arteriovenous fistula in the fractured vertebral body. AJNR Am J Neuroradiol 2010;31:688-90.
  • 17 Ou CH, Wang HK, Yang TH, Liang CL, Wong HF. Spinal intraosseous epidural arteriovenous fistula with perimedullary drainage obliterated with Onyx embolization: Case report. J Neurosurg Spine 2015;23:250-3.
  • 18 Gjertsen O, Nakstad PH, Pedersen H, Dahlberg D. Percutaneous intravertebral body embolization of a traumatic spinal epidural arteriovenous fistula with secondary perimedullary venous reflux. A case report. Interv Neuroradiol 2010;16:97-102.