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Embolization Using Liquid Adhesive to Treat Perimedullary Spinal Arteriovenous Fistula (Type 2) of the Conus Medullaris in a Pediatric Patient 2007

Interventional Spine

Lien T Huynh, MD
Felix L Song, MD, Non ASSR Member
Daniel J Donovan, MD, Non ASSR Member

Excerpta Extraordinaire

Excerpta

Spinal arteriovenous malformations (AVM) occur in <0.1% of the population (1). Of those, perimedullary arteriovenous fistulas (AVF) are relatively rare and constitute approximately 8-19% of spinal AVMs and often present in the second to fourth decades of life with no gender predilection (2). We present a case of spinal AVF in a 4 year old female with hereditary hemorrhagic telangiectasia who developed acute onset of bilateral lower extremity paresis and bowel and bladder dysfunction. MR of the lumbar spine revealed a 2 cm hematoma of the conus. Spinal angiography demonstrated a conus fistula which was supplied by the anterior spinal artery that arises from the left T9 intercostal artery. Embolization was performed using liquid adhesive. Post-embolization angiogram demonstrated absence of filling of the fistula and psuedoanuerysm. Two month post-embolization follow-up demonstrated full recovery of bowel and bladder function and strength in the right lower extremity. Residual weakness and parathesias persisted in the left lower extremity. Knowledge and ability to use liquid adhesives may obviate the need for spinal surgery or instrumentation in young patients and prevent spinal column maldevelopment and future limitation of activities.

References

Authors: Lien T Huynh MD, Felix L Song MD, Daniel J Donovan MD

References:
1. Al-Shahi, R, Warlow, C. A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. Brain 124:1900, 2001.

2. Aydin et al. Angiography-induced closure of perimedullary spinal arteriovenous fistula. British Journal of Radiology 77:969-973, 2004.

3. Hida et al. Corpectomy: a direct approach to perimedullary arteriovenous fistulas of the anterior cervical spinal cord. Journal of Neurosurgery (Spine 2) 96:157-161, 2002.

4. Hida et al. Results of the surgical treatment of perimedullary arteriovenous fistulas with special reference to embolization. Neurosurgery Focus 5(4): Article 9, 1998.

5. Oran et al. Treatment of slow-flow (Type 1) perimedullary spinal arteriovenous fistulas with special reference to embolization. American Journal of Neuroradiology 26:2582-2586, 2005.

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