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
. 2020 Mar 3;13(3):e015268.
doi: 10.1136/bcr-2019-015268.

Spinal arteriovenous malformation without endovascular arterial access: is a combined neurosurgical approach and direct venous puncture an option?

Igor Pagiola  1   2 , Jildaz Caroff  3 , Cristian Mihalea  3 , Nozar Aghakhani  4 , Léon Ikka  3 , Vanessa Chalumeau  3 , Marta Iacobucci  3 , Augustin Ozanne  3 , Sophie Gallas  3 , Henrique Carrete  5 , Marcio Chaves Marques  2 , Darcio Nalli  2 , Jose Guilherme Caldas  6 , Michel Eli Frudit  2 , Jacques Moret  3 , Fabrice Parker  4 , Laurent Spelle  3
Affiliations
Case Reports

Spinal arteriovenous malformation without endovascular arterial access: is a combined neurosurgical approach and direct venous puncture an option?

Igor Pagiola et al. BMJ Case Rep. .

Abstract

This case report describes a combined neurosurgical and endovascular approach for the treatment of a conus medullaris arteriovenous malformation resulting in considerable improvement in the patient's neurological condition (modified Rankin Scale score 2).

Keywords: arteriovenous malformation; liquid embolic material; spinal cord; spine; technique.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
First digital subtraction angiogram after the first session of endovascular treatment in a previous healthcare setting. (A) Left T9 intercostal artery with radiculomedullary artery feeding the arteriovenous malformation. (B) Venous phase image of the same artery showing enlarged posterior vein. (C) Lateral view of the left T9 intercostal artery.
Figure 2
Figure 2
MR images after three endovascular treatments in a previous healthcare setting. (A) T2-weighted MRI sagittal view. (B) T1-weighted MRI sagittal view.
Figure 3
Figure 3
Digital subtraction angiogram of the left T9 intercostal artery with the radiculomedullary artery. (A) Unsubtracted image. (B) Arterial phase anteroposterior image of the left T9 intercostal artery. (C) Venous phase image of the same injection as (B). (D–F) Lateral images of the same artery.
Figure 4
Figure 4
Digital subtraction angiogram of the left T10 intercostal artery with the radiculo-pial artery. (A) Unsubtracted image. (B) Arterial phase anteroposterior image of the arterial phase of the left T10 intercostal artery. (C) Venous image of the same injection as (B). (D–F) Lateral images of the same artery.
Figure 5
Figure 5
Digital subtraction angiogram of the left T11 intercostal artery with the radiculo-pial artery. (A) Unsubtracted image. (B) Arterial phase anteroposterior image of the left T11 intercostal artery. (C) Venous image of the same injection as (B). (D–F) Lateral images of the same artery.
Figure 6
Figure 6
XperCT image of the left T9 intercostal artery. (A) Lateral view. (B, C) Anteroposterior views. (D) Lateral view.
Figure 7
Figure 7
Digital subtraction angiogram immediately before the surgical approach to the left T9 intercostal artery. (A) Unsubtracted image. (B) Arterial phase anteroposterior image of the left T11 intercostal artery. (C) Venous phase image of the same injection.
Figure 8
Figure 8
Patient in the prone position with laminectomy and midline dura incision to expose the enlarged vein. (A) Arrow shows the 5F Cobra catheter and the arrowhead shows the Headway Duo microcatheter. (B) Asterisk shows the 22 gauge needle. (C) Control injection. (D) Unsubtracted image showing the glue cast.
Figure 9
Figure 9
Digital subtraction angiogram (DSA) follow-up 5 months after surgical approach and endovascular treatment. (A, B) Arterial phase image immediately after surgical approach with endovascular treatment of the left T9 intercostal artery with the radiculomedullary artery. (C, D) Five-month DSA image of the left T9 intercostal artery (early arterial phase). (E, F) Five-month DSA control image of the venous phase of the left T9 intercostal artery. (G, H) Arterial phase image immediately after surgical approach with endovascular treatment of the left T10 intercostal artery. (I, J) Five-month DSA image of the left T10 intercostal artery. (K, L) Five-month DSA image of the T11 intercostal artery.
Figure 10
Figure 10
(A, B) MRI STIR (short-TI inversion recovery) follow-up 5 months after the surgical approach with endovascular treatment of the arteriovenous malformation.
See this image and copyright information in PMC

References

    1. Rodesch G, Hurth M, Alvarez H, et al. . Classification of spinal cord arteriovenous shunts: proposal for a reappraisal – the Bicêtre experience with 155 consecutive patients treated between 1981 and 1999. Neurosurgery 2002;51:374–80. 10.1227/00006123-200208000-00013 - DOI - PubMed
    1. Krings T, Mull M, Gilsbach JM, et al. . Spinal vascular malformations. Eur Radiol 2005;15:267–78. 10.1007/s00330-004-2510-2 - DOI - PubMed
    1. Kim LJ, Spetzler RF. Classification and surgical management of fistulae and arteriovenous malformations. Neurosurgery 2006;59:S195–201. - PubMed
    1. Gueguen B, Merland JJ, Riche MC, et al. . Vascular malformations of the spinal cord: intrathecal perimedullary arteriovenous fistulas fed by medullary arteries. Neurology 1987;37:969 10.1212/WNL.37.6.969 - DOI - PubMed
    1. Heros RC, Debrun GM, Ojemann RG, et al. . Direct spinal arteriovenous fistula: a new type of spinal AVM. Case report. J Neurosurg 1986;64:134–9. 10.3171/jns.1986.64.1.0134 - DOI - PubMed

Publication types