Shimizu Kiyoharu, Mitsuhara Takafumi, Takeda Masaaki, Yamaguchi Satoshi
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Surg Neurol Int. 2021 Mar 17;12:103. doi: 10.25259/SNI_80_2021. eCollection 2021.
Filum terminale arteriovenous fistulas (FTAVFs) are rare and their pathogenesis remains unknown. The authors report two cases of FTAVF that arose in the lipoma of the filum terminale.
The two patients were 72 and 76 years of age, and both presented with a progressive paraparesis. The first patient had an arteriovenous fistula (AVF) located at L5 that was supplied by the anterior spinal artery originating from the left T10 intercostal artery. The second patient's AVF at L3-4 was fed by the anterior spinal artery originating from the left T8 intercostal artery. Both patients underwent partial resection of the filum terminale at the location of the shunts. The pathological examinations revealed that both the AVFs were embedded in the adipose tissue of the filum terminale, revealing the fatty fila that were not visible in preoperative magnetic resonance images.
Two cases of FTAVF were successfully treated by obliterating the fistulas through partial resection of the affected fatty filum terminale. The literature review revealed 13 cases of FTAVF concomitant with the lipomas of the filum terminale. Resection and histological evaluation of the filum terminale should be performed to treat and elucidate the pathogenesis of FTAVF.
终丝动静脉瘘（FTAVF）较为罕见，其发病机制尚不清楚。作者报告了两例发生在终丝脂肪瘤中的FTAVF病例。
两名患者年龄分别为72岁和76岁，均表现为进行性双下肢轻瘫。首例患者的动静脉瘘（AVF）位于L5，由发自左T10肋间动脉的脊髓前动脉供血。第二例患者位于L3 - 4的AVF由发自左T8肋间动脉的脊髓前动脉供血。两名患者均在分流部位进行了终丝部分切除术。病理检查显示，两个AVF均包埋于终丝的脂肪组织中，术前磁共振成像中未见明显的脂肪终丝。
通过部分切除受累的脂肪终丝闭塞瘘管，成功治疗了两例FTAVF。文献回顾显示有13例FTAVF合并终丝脂肪瘤。应进行终丝切除及组织学评估以治疗并阐明FTAVF的发病机制。
