Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sappoo, Hokkaido, Japan.
Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sappoo, Hokkaido, Japan.
World Neurosurg. 2020 Jun;138:404-407. doi: 10.1016/j.wneu.2020.03.138. Epub 2020 Apr 3.
Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations; they frequently cause progressive myelopathy including gait disturbances and sensory disorders.
We report a rare case of a middle-aged man who experienced right-sided chest pain and Th4 radiculopathy, without any other neurologic presentations. Magnetic resonance imaging showed a flow void sign on the dorsal aspect of the spinal cord; spinal angiography revealed an arteriovenous shunt between a radicular artery and an intradural vein. Suspecting SDAVF as the cause of the chest pain, we performed surgical resection. Intraoperatively, we observed compression of the rootlet by the draining vein. Right chest pain disappeared completely after obliteration of the SDAVF. The present patient had vascular compression of the spinal nerve rootlet without any venous congestion.
Our experience shows that SDAVF can present not only as a myelopathy but also as a radiculopathy, indicating that radiculopathy may become a main symptom of SDAVF.
硬脊膜动静脉瘘（SDAVF）是最常见的脊髓动静脉畸形类型；它们常导致进行性脊髓病，包括步态障碍和感觉障碍。
我们报告了一例罕见的中年男性病例，该患者出现右侧胸痛和 Th4 神经根病，无其他神经系统表现。磁共振成像显示脊髓背侧有血流空信号；脊髓血管造影显示根动脉和硬脊膜内静脉之间存在动静脉分流。考虑到胸痛是由 SDAVF 引起的，我们进行了手术切除。术中观察到引流静脉对神经根的压迫。SDAVF 闭塞后，右侧胸痛完全消失。本患者存在脊神经根受压而无静脉淤血。
我们的经验表明，SDAVF 不仅可以表现为脊髓病，还可以表现为神经根病，表明神经根病可能成为 SDAVF 的主要症状。
