Bahar Ashari, Halim Wijoyo, Gunawan Anthony, Akbar Muhammad, Bintang Andi Kurnia, Soraya Gita Vita
Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia.
Wahidin Sudirohusodo General Hospital, Makassar 90245, Indonesia.
Radiol Case Rep. 2024 Jun 15;19(9):3661-3666. doi: 10.1016/j.radcr.2024.05.060. eCollection 2024 Sep.
Peri-medullary arteriovenous fistula (PMAVF) is a rare spinal vascular malformation that manifests as progressive neurologic deficits or hemorrhage in the spinal canal. We report a case of high-flow PMAVF in a child, with a single feeder artery and a large venous pouch, which was successfully treated with transarterial endovascular intervention. A 2-year-old boy was referred with a progressive 2-year history of myelopathy. The MRI revealed a large venous pouch at the midthoracic spinal cord with segmental surrounding edema. A spinal angiogram confirmed high-flow PMAVF with a single feeder artery from the anterior radiculomedullary artery, draining into the peri-medullary vein. The patient underwent transarterial embolization at the distal feeder artery, resulting in gradual motor strength improvement. PMAVF is classified as type IV spinal vascular malformation, usually presenting as a large, high-flow fistula with multiple feeders, although there was only one in this case. PMAVFs are intradural and may cause severe neurologic deficits due to mass effect, venous congestion, or hemorrhage, hence requiring prompt treatment. Treatment options for PMAVF include microsurgery, endovascular intervention, or a combination of the 2. Endovascular intervention with coil or liquid embolic material is considered first-line treatment for IVc PMAVF, and effective in type IVb with good clinical outcome. PMAVF is a rare spinal vascular malformation commonly manifesting as severe neurologic deficits but has the potential of favorable outcomes with endovascular therapy. This case demonstrates a unique angioarchitecture of high-flow PMAVF with a single feeder artery and large venous pouch, treated successfully with endovascular therapy.
髓周动静脉瘘（PMAVF）是一种罕见的脊髓血管畸形，表现为脊髓内进行性神经功能缺损或出血。我们报告一例儿童高流量PMAVF病例，其具有单一供血动脉和一个大的静脉囊袋，通过经动脉血管内介入治疗获得成功。一名2岁男孩因进行性脊髓病病史2年前来就诊。MRI显示胸段脊髓中部有一个大的静脉囊袋，周围有节段性水肿。脊髓血管造影证实为高流量PMAVF，有一条来自前根髓动脉的单一供血动脉，引流至髓周静脉。患者在远端供血动脉进行了经动脉栓塞，运动力量逐渐改善。PMAVF被归类为IV型脊髓血管畸形，通常表现为有多个供血动脉的大的高流量瘘管，尽管本例只有一个供血动脉。PMAVF位于硬膜内，可能由于占位效应、静脉淤血或出血而导致严重的神经功能缺损，因此需要及时治疗。PMAVF的治疗选择包括显微手术、血管内介入或两者联合。使用弹簧圈或液体栓塞材料的血管内介入被认为是IVc型PMAVF的一线治疗方法，对IVb型也有效，临床效果良好。PMAVF是一种罕见的脊髓血管畸形，通常表现为严重的神经功能缺损，但血管内治疗有可能取得良好的效果。本例展示了一种具有单一供血动脉和大静脉囊袋的高流量PMAVF独特的血管结构，通过血管内治疗成功治愈。
