Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan.
Interv Neuroradiol. 2021 Dec;27(6):763-769. doi: 10.1177/15910199211009121. Epub 2021 Apr 13.
Spontaneous spinal epidural hematoma (SSEH) is rare in children. Vascular malformation including arteriovenous fistulas and venous malformation is a rare cause of SSEH.
A 5-year-old girl presented with 2 episodes of SSEH at the upper thoracic spine and non-hemorrhagic episodes with spontaneous neurological recovery. Diagnostic study with MRI and spinal angiography demonstrated an unusual epidural arteriovenous fistula (AVF) with venous ectasia similar to venous malformation. She underwent embolization of the AVF with NBCA with mild transient neurological deterioration. Follow up angiography showed persistent occlusion of the embolized fistula and inconsistent visualization of another AVF to the patent venous ectasia.
This type of epidural AVF seems to be more common in children and tends to cause multiple neurologic episodes due to SSEH, venous expansion or thrombosis. Endovascular embolization with NBCA should be the first choice of treatment for this disease, unless emergent hematoma evacuation is necessary. Embolization should target at only the fistula site without significant penetration into the venous ectasia. Follow up is necessary for potential reappearance of AVF, even if AVF is occluded at the time of treatment. Time resolved MRI is useful to detect AVFs, thus for diagnosis and follow up of this disease.
自发性硬脊膜外血肿（SSEH）在儿童中较为罕见。血管畸形，包括动静脉瘘和静脉畸形，是 SSEH 的罕见病因。
一名 5 岁女孩因上胸段 SSEH 发作 2 次，且伴有非出血性发作和自发性神经恢复而就诊。MRI 和脊髓血管造影的诊断性研究显示，存在一种不常见的硬脊膜外动静脉瘘（AVF），伴静脉扩张，类似于静脉畸形。她接受了 NBCA 栓塞治疗，术后出现轻度短暂性神经恶化。随访血管造影显示栓塞瘘口持续闭塞，另一个通向未闭静脉扩张的 AVF 显示不一致。
这种类型的硬脊膜外 AVF 在儿童中似乎更为常见，由于 SSEH、静脉扩张或血栓形成，往往会导致多次神经系统发作。对于这种疾病，NBCA 血管内栓塞应作为首选治疗方法，除非需要紧急血肿清除。栓塞应仅针对瘘口部位，而不应显著穿透静脉扩张区。即使在治疗时 AVF 已经闭塞，也需要进行随访，以防止其再次出现。时间分辨 MRI 对检测 AVF 很有用，因此可用于该疾病的诊断和随访。
