Department of Neurosurgery, the First Hospital of Jilin University, Changchun, China.
Neuroradiol J. 2023 Jun;36(3):251-258. doi: 10.1177/19714009221126017. Epub 2022 Sep 9.
Spinal filum terminale pial arteriovenous fistulas (FT PAVFs) are uncommon. Most FT PAVFs are located in the lumbar region; far fewer are located in the sacral region. Due to the rarity of sacral FT PAVFs, the precise surgical dissection and removal of these lesions are challenging. Here, we report an FT PAVF in the sacral region. The patient was a 45-year-old male who suffered from progressive weakness and numbness of the bilateral lower limbs; his symptoms gradually worsened. Digital subtraction angiography (DSA) showed an AVF at the sacral canal at the S3-4 level. Microsurgical treatment with intraoperative DSA was performed, and the FT PAVF was resected. After the operation, the patient gradually recovered. Follow-up magnetic resonance imaging revealed a recession in the dilation of the spinal cord venous plexuses. A literature review was also performed, and a total of 14 FT PAVFs of the sacral region were identified. The patients identified in the literature review had an average age of 58.9 ± 12.9 years, and 92.9% of the patients were male. Spinal cord edema was present in 85.7% of the FT PAVF patients. Regarding treatment, 64.3% of the FT PAVF patients underwent microsurgical resection, 28.6% patients underwent endovascular treatment, and 7.1% patients underwent a hybrid operation; good outcomes were achieved with all three methods. Therefore, FT PAVF of the sacral region is a unique lesion whose angioarchitecture needs to be identified carefully; prompt treatment is necessary, and microsurgery can yield good outcomes.
终丝脊膜动静脉瘘（FT PAVF）并不常见。大多数 FT PAVF 位于腰椎区域；而位于骶骨区域的则要少得多。由于骶骨 FT PAVF 较为罕见，因此精确地进行这些病变的手术解剖和切除具有挑战性。在此，我们报告一例位于骶骨区域的 FT PAVF。患者为 45 岁男性，逐渐出现双侧下肢无力和麻木，且症状逐渐加重。数字减影血管造影（DSA）显示 S3-4 水平的骶管内存在动静脉瘘。采用术中 DSA 进行显微手术治疗，并切除了 FT PAVF。术后，患者逐渐恢复。随访磁共振成像显示脊髓静脉丛扩张有所消退。我们还进行了文献复习，共发现 14 例骶骨区 FT PAVF。文献中患者的平均年龄为 58.9±12.9 岁，92.9%为男性。85.7%的 FT PAVF 患者存在脊髓水肿。在治疗方面，64.3%的 FT PAVF 患者接受了显微切除术，28.6%的患者接受了血管内治疗，7.1%的患者接受了混合手术；三种方法均取得了良好的效果。因此，骶骨区 FT PAVF 是一种独特的病变，其血管构筑结构需要仔细识别；需要及时进行治疗，而显微手术可以获得良好的效果。
