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. 2023 Aug 21;6(8):CASE23280.
doi: 10.3171/CASE23280. Print 2023 Aug 21.

Extradural lumbar arteriovenous fistula imitating a synovial cyst: illustrative case

Leonidas Trakolis  1 , Georgios Moutsianos  2 , Viktoras Gourvas  3 , Athanasios Petridis  1
Affiliations

Extradural lumbar arteriovenous fistula imitating a synovial cyst: illustrative case

Leonidas Trakolis et al. J Neurosurg Case Lessons. .

Abstract

Background: Spinal dural arteriovenous fistula is the most common spinal vascular malformation. It usually presents with neurological deficits due to venous congestive myelopathy. Sometimes, however, the symptoms are radicular and can imitate those of a disc hernia or synovial cyst.

Observations: In this illustrated case, a 34-year-old male patient presented with radicular pain due to nerve root compression. In the magnetic resonance imaging (MRI) examination of the spine, a synovial cyst was suspected, so the patient underwent no further examination before surgery. Intraoperatively, the authors were surprised to see a vascular malformation, which was shown to be an extradural arteriovenous fistula according to the histopathological examination.

Lessons: In atypical MRI findings of the spine, vascular malformations should be considered. In cases with a spinal dural arteriovenous fistula, the thrombosis risk can be high and lead to a need for prolonged anticoagulation.

Keywords: extradural; spinal fistula; synovial cyst.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
Preoperative axial T2-weighted sequence without contrast agent. Again, the high T2 signal lesion (arrow) seems to compress the left L5 nerve root at the level of the lateral recess.
FIG. 2.
FIG. 2.
Hematoxylin and eosin-stained tissue captured using the Gemini AS automated staining laboratory machine. Original magnification ×20.
FIG. 3.
FIG. 3.
Immunohistochemical staining using the CD34 Leica antibody (clone QBEnd/10) at 1:80 dilution, performed on the Leica Bond Max immunostaining machine. Original magnification ×20.
See this image and copyright information in PMC

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