An Aneurysmal Dilatation of Cervical Intramedullary Arteriovenous Malformation: Case Report

ABSTRACT

A 14-year-old girl presenting with sudden onset of headache, neck pain, and quadriparesis was found to have a vascular lesion in the upper cervical cord(C2-C4) by the initial MRI examination. Vertebral angiography revealed a high-flow arteriovenous malformation which opacified rapidly and drained early. It was a direct spinal arteriovenous fistular consisted of a large aneurysmal dilatation 4x2.2x2.2 cm3 at the junction of a feeding artery and a draining vein. Superior anterior spinal artery and a mid-cervical radicular artery formed a common trunk to feed the lesion that drained entirely superiorly to the posterior fossa through a dilated draining vein. The intramedullary lesion was removed completely after surgical ligation of the feeding artery and draining vein through a posterior approach and myelotomy. She improved to the point of being able to walk alone and attended school one year after operation with acceptable posterior column signs. Spinal cord arteriovenous malformations are traditionally classified into three major categoriesType I, II, III. Our case seemed to fit to the new typeType IV, direct spinal arteriovenous fistula, proposed by Heros(JNS 64134-139, 1986).