Arteriovenous fistula of the filum terminale: radiological diagnosis and therapeutic management by embolization

Abstract

A 60-year-old man had progressive paraparesis, paresthesia of both lower limbs and sphincter dysfunction. He underwent MRI, which revealed perimedullar abnormal vascular channels associated with a hypersignal in the thoracolumbar cord. Because of the patient's age and symptomatology, a dural arteriovenous shunt was first suspected. MRA confirmed dilatation of the perimedullary venous channels, but also revealed an enlarged anterior spinal artery, a finding incompatible with a diagnosis of dural arteriovenous fistula. A lesion, vascularized by the anterior spinal axis and draining secondarily into the perimedullary veins, was thus suspected. Angiography diagnosed a microfistula of the filum terminale; selective distal catheterization of the arterial feeder from T11 to S1 was achieved, and the shunt closed by embolization with acrylic glue. The patient improved after endovascular treatment.