Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
Spinal Cord Ser Cases. 2021 Apr 13;7(1):29. doi: 10.1038/s41394-021-00400-x.
Although spinal arteriovenous fistula (AVF) has been reported widely, AVF at the cauda equina is quite rare. We described a case of AVF at the cauda equina that was fed by the distal radicular artery (DRA).
A 50-year-old woman presented with sudden weakness of the lower extremities. Magnetic resonance imaging (MRI) revealed a lesion with a highly intense signal at the conus medullaris, which was surrounded by several low-intensity signals (flow voids). Digital subtraction angiography revealed AVF at the cauda equina and that it was fed by the DRA, which was directly fed by the L3 segmental artery. We performed surgical resection of the AVF while monitoring motor-evoked potentials. The patient's postoperative course was uneventful, and her neurological symptoms gradually resolved. MRI 2 years after surgery showed the disappearance of both intramedullary edema and the flow voids.
For the AVF, located at the cauda equina and fed by the DRA in this case, surgical resection or endovascular embolization could have been selected. We performed open surgery to achieve complete obliteration of the AVF, which led to postoperative functional recovery without any adverse events. However, only a limited number of AVFs at the level of the cauda equina have been reported, and treatment standards have not been established. Further studies of AVFs at the cauda equina are necessary to clarify the epidemiological characteristics and clinical outcomes with an appropriate sample size.
尽管脊髓动静脉瘘（AVF）已有广泛报道，但马尾部的 AVF 却相当罕见。我们描述了一例由远端神经根动脉（DRA）供血的马尾部 AVF 病例。
一名 50 岁女性突发下肢无力。磁共振成像（MRI）显示在终丝处有一个高强度信号的病变，周围有几个低强度信号（血流空影）。数字减影血管造影显示马尾部存在 AVF，由 DRA 供血，而 DRA 则直接由 L3 节段动脉供血。我们在监测运动诱发电位的情况下进行了 AVF 的手术切除。患者术后恢复顺利，神经症状逐渐缓解。术后 2 年的 MRI 显示，脊髓内水肿和血流空影均消失。
对于本例中位于马尾部、由 DRA 供血的 AVF，可以选择手术切除或血管内栓塞。我们进行了开放性手术，以实现 AVF 的完全闭塞，从而导致术后功能恢复，无任何不良事件发生。然而，仅有少数位于马尾部的 AVF 得到了报道，且尚未确立治疗标准。需要进一步研究马尾部的 AVF，以明确其流行病学特征和临床结局，并采用适当的样本量。
