Tanioka Satoru, Toma Naoki, Sakaida Hiroshi, Umeda Yasuyuki, Suzuki Hidenori
Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Eur Spine J. 2018 Jul;27(Suppl 3):281-286. doi: 10.1007/s00586-017-5129-0. Epub 2017 May 13.
Arteriovenous fistula (AVF) of the cauda equina (CE) fed by the proximal radicular artery (PRA) is very rare, and the differentiation from that of the filum terminale (FT) is important to avoid treatment-related injury to the CE when endovascular treatment is selected. The authors describe a case of AVF of the CE fed by the PRA, demonstrate the anatomical features and discuss the treatment precautions.
A 69-year-old man presented with a transient weakness of lower limbs. Spinal angiography and magnetic resonance (MR) imaging revealed AVF, of which the feeding artery arose from the anterior spinal artery (ASA), forming the fistula at L2 level to be drained into the longitudinal venous trunk. Under a tentative diagnosis of AVF of the FT, endovascular treatment was attempted but failed due to impossible catheterization into the ASA. Therefore, surgery was performed.
Intraoperative finding revealed that the feeding artery and draining vein were not on the FT but on the CE, resulting in the proper diagnosis of AVF of the CE. Surgical clips were applied to the draining vein closest to the fistula, and postoperatively the symptom improved gradually. Although we thoroughly reevaluated spinal angiography and MR images postoperatively, AVF of the CE fed by the PRA and that of the FT were not distinguishable.
The authors described a case of AVF of the CE fed by the PRA and demonstrated the difficulty of the differentiation from that of the FT. The utmost precautions are necessary when endovascular treatment is selected.
由近端神经根动脉（PRA）供血的马尾神经（CE）动静脉瘘（AVF）非常罕见，在选择血管内治疗时，将其与终丝（FT）的动静脉瘘区分开来对于避免与治疗相关的马尾神经损伤很重要。作者描述了一例由PRA供血的CE动静脉瘘病例，展示了解剖特征并讨论了治疗注意事项。
一名69岁男性出现下肢短暂无力。脊髓血管造影和磁共振（MR）成像显示存在AVF，其供血动脉起源于脊髓前动脉（ASA），在L2水平形成瘘并引流至纵向静脉干。在初步诊断为FT的AVF后，尝试进行血管内治疗，但由于无法将导管插入ASA而失败。因此，进行了手术。
术中发现供血动脉和引流静脉不在FT上，而是在CE上，从而正确诊断为CE的AVF。将手术夹应用于最靠近瘘的引流静脉，术后症状逐渐改善。尽管我们在术后对脊髓血管造影和MR图像进行了全面重新评估，但由PRA供血的CE动静脉瘘和FT的动静脉瘘无法区分。
作者描述了一例由PRA供血的CE动静脉瘘病例，并展示了与FT的动静脉瘘区分的困难。选择血管内治疗时必须采取最大程度的预防措施。
