Makhambetov Yerbol, Aiman Maidan, Okon Inibehe Ime, Kerimbayev Talgat, Kunakbayev Baurzhan, Shah Keyur, Abishev Nurzhan, Uteuova Saule, Chaurasia Bipin
Department of Vascular Neurosurgery, National Centre for Neurosurgery, Astana, Kazakhstan.
Department of Neurosurgery, Dell Medical School, University of Texas at Austin, Texas.
Ann Med Surg (Lond). 2025 Jan 9;87(1):351-354. doi: 10.1097/MS9.0000000000002786. eCollection 2025 Jan.
Conus medullaris arteriovenous fistulas (AVFs) are rare among spinal vascular malformations. This case report highlights the presentation, diagnostic work-up, and management of a patient with a perimedullary conus medullaris AVF type IVa.
A 29-year-old male presented with progressive weakness and numbness in the left leg. Thoracic magnetic resonance imaging (MRI) showed increased arterial supply in the dural membrane and large, smoldering, twisting spaces from T8 to L1 with a central point from which many abnormal vessels radiated. Angiographic findings showed an enlarged fistula fed by a radiculomedullary artery around the T10 level and draining through a medullary vein, draining into an aberrantly placed radicular vein at the posterior spinal venous plexus. The vein was mimicking nidus.
The microsurgical resection with intraoperative indocyanine green angiography and neuromonitoring was successful. A follow-up MRI showed postoperative resolution of the malformation, and clinically, the patient experienced gradual improvement of his symptoms confirming the surgical success with complete AVF obliteration on postoperative angiography.
Accurate detection and precise treatment are essential for managing conus medullaris AVFs. These complex lesions can be effectively addressed through both microsurgical and endovascular techniques. A successful treatment strategy necessitates thorough preoperative planning and a collaborative, multidisciplinary approach.
圆锥动静脉瘘（AVF）在脊髓血管畸形中较为罕见。本病例报告重点介绍了一名IVa型髓周圆锥动静脉瘘患者的临床表现、诊断检查及治疗情况。
一名29岁男性，出现左腿进行性无力和麻木。胸椎磁共振成像（MRI）显示硬脊膜动脉供血增加，T8至L1水平有大的、缓慢的、扭曲的间隙，有一个中心点，许多异常血管从该点呈放射状分布。血管造影结果显示，在T10水平附近有一个由根髓动脉供血的扩大瘘管，通过一条髓静脉引流，汇入脊髓后静脉丛中位置异常的根静脉。该静脉类似瘤巢。
采用术中吲哚菁绿血管造影和神经监测进行显微手术切除取得成功。随访MRI显示畸形术后消失，临床上，患者症状逐渐改善，术后血管造影证实动静脉瘘完全闭塞，手术成功。
准确检测和精确治疗对于圆锥动静脉瘘的管理至关重要。这些复杂病变可通过显微手术和血管内技术有效处理。成功的治疗策略需要全面的术前规划以及协作的多学科方法。
