Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Aug;25(4):469-473.
doi: 10.1177/1591019919828135. Epub 2019 Mar 28.

Metameric spinal AVM: Long-term symptomatic relief achieved by embolization of the extradural component

B Drake  1 , S Patro  2 , A Quateen  1 , E A Cora  1 , S Finitsis  3 , J Sinclair  1 , H Lesiuk  1 , D Iancu  1
Affiliations
Case Reports

Metameric spinal AVM: Long-term symptomatic relief achieved by embolization of the extradural component

B Drake et al. Interv Neuroradiol. 2019 Aug.

Abstract

Background: Metameric spinal cord arteriovenous malformations (AVMs) are rare lesions characterized by an intradural and extradural component. They are difficult to treat surgically by the endovascular route. We report a case in which symptomatic relief was achieved by embolization of the extradural component only.

Case presentation: A 35-year-old woman presented with acute worsening of back pain, weakness in the left leg and urinary retention. Spinal angiography showed a metameric spinal cord AVM with partial common venous drainage of the extradural and intradural components.

Conclusions: Targeted embolization of the extradural component led to dramatic improvement of the patient's symptoms, probably by achieving venous decongestion. She remains neurologically stable at two years' follow-up.

Keywords: Arteriovenous malformation; embolization; juvenile; metameric; spinal cord.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
(a) Sagittal and (b) axial T2-weighted images of the lumbar spinal cord at presentation.
Figure 2.
Figure 2.
Preembolization diagnostic spinal angiography.
Figure 3.
Figure 3.
Drawing of the metameric arteriovenous malformation vascularization. The drawing shows two nidi (pink): one involving the spinal cord at the T12 level and one in the L3 vertebral body. The spinal cord nidus is fed by the anterior spinal artery, a branch of the left T12 radiculomedullary artery (red) and by a posterior spinal artery, a branch of the left L1 radiculomedullary artery (green). The L3 vertebral body nidus is fed by both L3 segmental arteries (red). Venous drainage of the spinal cord arteriovenous malformation is accomplished by two radicular veins (blue) that join the epidural venous plexus at the level of L3 and L4 (blue). The same epidural and perivertebral venous network is shared by the L3 vertebral body AVM.
Figure 4.
Figure 4.
(a) Embolization result and (b) sagittal T2-weighted image of the lumbar spinal cord at follow-up.
See this image and copyright information in PMC

References

    1. Krings T. Vascular malformations of the spine and spinal cord: Anatomy, classification, treatment. Clin Neuroradiol 2010; 20: 5–24. - PubMed
    1. Spetzler RF, Detwiler PW, Riina HA, et al. Modified classification of spinal cord vascular lesions. J Neurosurg Spine 2002; 96: 145–156. - PubMed
    1. Niimi Y, Uchiyama N, Elijovich L, et al. Spinal arteriovenous metameric syndrome: Clinical manifestations and endovascular management. AJNR Am J Neuroradiol 2013; 34: 457–463. - PMC - PubMed
    1. Bhattacharya JJ, Luo CB, Suh DC, et al. Wyburn-Mason or Bonnet-Dechaume-Blanc as cerebrofacial arteriovenous metameric syndromes (CAMS). A new concept and a new classification. Interv Neuroradiol 2001; 7: 5–17. - PMC - PubMed
    1. Cobb S. Haemangioma of the spinal cord: Associated with skin naevi of the same metamere. Ann Surg 1915; 62: 641–649. - PMC - PubMed

Publication types