Unique sacral location of an arteriovenous fistula of the filum terminale associated with diastematomyelia and lowered spinal cords

Autor: Daniel Hänggi, Frank Bieniek, Bernd Turowski, René Chapot, Stephan Macht
Rok vydání: 2011
Předmět:
Zdroj: Neuroradiology. 54:517-519
ISSN: 1432-1920
0028-3940
Popis: Dear Sir, An arteriovenous fistula of the filum terminale arising from the artery of the filum terminale has recently been reported. Other authors report spinal dural and arteriovenous fistulae with lateral sacral artery supply [1–4]. We wish to bring to your attention an arteriovenous fistula of the filum terminale supplied by a lateral sacral artery associated with diastematomyelia and a tethered spinal cord in a 57-year old man. The patient suffered a progressive paraparesis for 3 weeks. At admission, the paraparesis was severe and accompanied by anal sphincter disturbances. MRI of the lumbar spinal canal (Fig. 1) showed a split and tethered spinal cord ending in the sacral spinal canal in an intraspinal lipoma. Moreover, there was extensive edema of the thoracic, lumbar, and sacral segments of the spinal cord as well as pathologic flow voids surrounding the myelum, suggesting a spinal arteriovenous fistula. A digital subtraction angiography (Fig. 2) revealed an arteriovenous fistula of the filum terminale at level S3-S4 fed by an enlarged anterior spinal artery, filling via a large sacral radicular artery arising from segment S2 with main supply from the left hypogastric artery. Drainage of the fistula occurred via enlarged perimedullary veins. At higher levels, no other segments of the artery of Adamkiewicz could be observed, but an additional tiny radicular artery filling the anterior spinal artery was found at level Th9 on the left. After introduction of a crossover sheath in the left internal iliac artery, a flow-directed microcatheter (MagicR, Balt Extrusion, Montmorency, France) was navigated via the supplying left S2-radicular artery into the anterior spinal artery up to the level of the shunt. Embolization was performed with a mixture of acrylic glue (Histoacryl, Braun, Tuttlingen, Germany) and lipiodol (Lipiodol UF, Guerbet, France) in a concentration of 1:4 enabling an angiographic cure of the fistula (Fig. 3). During the postoperative phase, there was some improvement of the paraparesis. Spinal vascular malformations are rare [5–7]. Seventy percent of all spinal vascular malformations are spinal dural arteriovenous fistulae that induce progressive neurologic symptoms [8]. The arteriovenous malformations can be divided into intramedullary and perimedullary types [7, 9]. Spinal cord arteriovenous malformations at the sacral level can be of two types: first, the dural arteriovenous fistulae arising at a sacral level as reported by Mhiri et al. [2] or at the conus medullaris [3, 4] and then the arteriovenous fistulae of the filum terminale, which are single-shunt arteriovenous fistulae fed by an anterior spinal S. Macht (*) :B. Turowski Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany e-mail: stephan.macht@med.uni-duesseldorf.de
Databáze: OpenAIRE
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