Surgical Treatment of Intradural Perimedullary Arteriovenous Fistula (Type IV Spinal Cord Arteriovenous Malformation)

ABSTRACT

Type IV spinal cord arteriovenous malformation is a spinal vascular anomaly supplied by the anterior spinal artery and drained directly into an enlarged venous outflow. Direct fistula lies completely outside the spinal cord and pia mater. We report a case of intradural perimedullary arteriovenous fistula in 58-years-old man who presented with progressive paraparesis. Angiographically single fistulous perimedullary communication with moderate-sized abnormal venous engorgement was demonstrated through anterior spinal artery. Direct surgical obliteration of the fistulous site was performed. Spinal angiographic evaluation and recognition of their exact pathophysiology according to individual types of spinal AVMs is the most important in successful execution of planned surgery and to achieve the good outcome.