Management of Perimedullary Giant Arteriovenous Fistula(Type IV c)by Embolization Operative Ligation

Intradural perimedullary arteriovenous fistulas(type IV spinal cord arteriovenous malformations) that occur at cervical level are rarely reported in the literature. A twelve year-old male patient was presented with suddenly developed progressing quadriparesis. MR imaging and angiography demonstrated focal intramedullary hemorrage at C5 vertebral level and intradural perimedullary arteriovenous fistula at C4 vertebral level and ectatic endocranial venous drainage, fed by anterior spinal artery, radicular branch of right vertebral artery, right thyrocervical trunk. The large draining vein ascends toward and into the posterior fossa along route which was anterior to the lower brain stem. The initial treatment consisted of selective embolization of arterial feeders arising from the right thyrocervical trunk and anterior spinal artery. The embolization procedures were performed using GDC coil. Eight days after embolization, corpectomy was performed at the C4-5 level and fistula ligation was done. Following these procedures, the patient has progressively improved in motor and sensory function and post operative angiogram revealed disappearance of fistula and abnormal endocranial venous drainage.

Surgical Treatment of Arteriovenous Malformations of the Spinal Cord

Spinal arteriovenous malformations(AVM's) may subject patients to the risk of paraplegia or quadriplegia. To determine the clinical features of patients with spinal AVM's, the authors reviewed the medical records of 26 such patients diagnosed and treated in our department, between 1986 and 1996. Among these, there were two cases of dural arteriovenous fistula(dural AVF), eight of perimedullary fistula, twelve of intramedullary AVM, and three of intramedullary cavernous angioma. In one case, the type of AVM was not identified. The most common presenting symptom was acute or slowly progressive myelopathy. The patients were treated with embolization, surgery, or both, and because of residual or recurrent disease, treatment was repeated in six cases, five of which were intramedullary AVM. All patients with dural AVF improved after treatment. Among patients with intradural AVM(perimeudllary AVF or intramedullary AVM), 25% were improved and 25% deteriorated : two of three patients with cavernous angiomas improved. Diagnostic and therapeutic considerations in the cases of AVM of the spinal cord are discussed. Since recurrence or residual arteriovenous shunting is a common problem in the treatment of this condition, follow-up observation of clinical and angiographic findings is mandatory.

Intravascular Embolization of Spinal Cord Arteriovenous Malformation / 介入放射学杂志

Six spinal cord AVMs underwent intravascular embolization in our hospital between January 1993 and August 1994 were reported.All cases diagnosed by selective digital substract angiography.There were one cervical two thoracic intramedullar AVMs,and three lumbodorsal intradural perimedullary AVFs,Five cases received complete occlusion and one intramedullary AVM was partially embolized.Three perimedullary AVFs recovered markedly and partial improvement was also seen in three intramedullary AVMs during the follow-up period from 2 to 20 months.We concluded that intravascular embolization therapy is an alternative and effective manner in treating intramedullary AVM and type Ⅱ type Ⅲ perimedullary AVF.