Alwahdy Ahmad Sulaiman
Department of Neurology, Interventional Neurology Subdivision, Fatmawati General Central Hospital, Jakarta, Indonesia.
Front Neurol. 2024 Feb 12;15:1326182. doi: 10.3389/fneur.2024.1326182. eCollection 2024.
Spinal epidural arteriovenous fistulas with sacral arteriovenous malformation (AVM) are a rare type of spinal arteriovenous fistulas. There are two varieties of spinal epidural arteriovenous fistulas (SEDAVFs), with type 1 involving intradural venous drainage and type 2 not involving intradural venous drainage. We present a case of transarterial embolization for type 1 SEDAVFs with sacral AVM. Within 8 months, a 14-year-old boy presented with progressively weaker lower extremities and bladder-bowel dysfunction. Magnetic resonance imaging (MRI) of the whole spine revealed thoracic spinal cord congestion, a single dilated flow void running from the lumbosacral area to the conus medullaris, and continuing cranial draining up to the C5 level via the perimedullary vein. Filling of the venous sac through a preferential feeder after embolizing the AVM nidus was performed. After 3 months, the clinical follow-up showed improvement of motoric function, although mild. Endovascular treatment for SEDAVF type 1 might have achieved total obliteration without any procedural complications. Nevertheless, it can be very challenging due to multiple feeders and the presence of an AVM nidus like in this case. However, the most difficult thing in fistula cases is establishing the diagnosis and finding the fistula point. Early treatment is required, due to the fact that longstanding lesions could cause irreversible damage.
合并骶部动静脉畸形（AVM）的脊髓硬膜外动静脉瘘是一种罕见的脊髓动静脉瘘类型。脊髓硬膜外动静脉瘘（SEDAVF）有两种类型，1型涉及硬膜内静脉引流，2型不涉及硬膜内静脉引流。我们报告一例1型SEDAVF合并骶部AVM的经动脉栓塞治疗病例。8个月内，一名14岁男孩出现双下肢进行性无力及膀胱直肠功能障碍。全脊柱磁共振成像（MRI）显示胸段脊髓充血，一条单一扩张的流空信号从腰骶部延伸至脊髓圆锥，并通过脊髓周围静脉向上引流至C5水平。在栓塞AVM病灶后，通过优势供血动脉对静脉囊进行了填充。3个月后临床随访显示运动功能有所改善，尽管改善程度轻微。1型SEDAVF的血管内治疗可能已实现完全闭塞，且无任何手术并发症。然而，由于存在多个供血动脉以及像本例中的AVM病灶，治疗可能极具挑战性。然而，瘘管病例中最困难的是明确诊断并找到瘘管点。由于长期病变可能导致不可逆损害，因此需要早期治疗。
