Endovascular treatment of epidural arteriovenous fistula associated with sacral arteriovenous malformation: case report

TL;DR

A 14-year-old boy with a rare spinal arteriovenous fistula and malformation was successfully treated with endovascular embolization, showing some motor improvement.

Contribution

This case report presents a successful endovascular treatment of a rare type 1 SEDAVF with sacral AVM in a pediatric patient.

Findings

Endovascular embolization achieved total obliteration of the fistula without complications.

The patient showed mild motoric function improvement after three months of treatment.

Diagnosis and identification of the fistula point remain the most challenging aspects of such cases.

Abstract

Spinal epidural arteriovenous fistulas with sacral arteriovenous malformation (AVM) are a rare type of spinal arteriovenous fistulas. There are two varieties of spinal epidural arteriovenous fistulas (SEDAVFs), with type 1 involving intradural venous drainage and type 2 not involving intradural venous drainage. We present a case of transarterial embolization for type 1 SEDAVFs with sacral AVM. Within 8 months, a 14-year-old boy presented with progressively weaker lower extremities and bladder-bowel dysfunction. Magnetic resonance imaging (MRI) of the whole spine revealed thoracic spinal cord congestion, a single dilated flow void running from the lumbosacral area to the conus medullaris, and continuing cranial draining up to the C5 level via the perimedullary vein. Filling of the venous sac through a preferential feeder after embolizing the AVM nidus was performed. After 3 months, the clinical follow-up showed improvement of motoric function, although mild. Endovascular treatment for SEDAVF type 1 might have achieved total obliteration without any procedural complications. Nevertheless, it can be very challenging due to multiple feeders and the presence of an AVM nidus like in this case. However, the most difficult thing in fistula cases is establishing the diagnosis and finding the fistula point. Early treatment is required, due to the fact that longstanding lesions could cause irreversible damage.

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