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

ABSTRACT

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.