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| Name | Multimodal Treatment of Spinal Arteriovenous Malformation |
| Video Uploader | Video From NEUROSURGERY Journal |
| Upload Date | This Video Uploaded At 27-02-2018 16:46:26 |
| Video Discription | Vascular malformations of the conus medullaris are complex lesions, which can be classified as Type II intradural arteriovenous malformations (AVMs). The natural history of intradural AVMs is typically that of myelopathy or myeloradiculopathy warranting treatment. Conus AVMs are supplied by medullary arteries via the anterior spinal artery and occasionally by posterior spinal arteries, making treatment difficult. We describe a case of a 33 year old female presenting with a five year history of worsening lower back pain radiating to the left lower extremity, paraesthesia in the L4 dermatome and minor balance disturbance. Imaging demonstrated a type II intradural AVM of the conus with venous congestion and ascending cord oedema. Spinal angiography confirmed a glomus AVM supplied from a left L2 Adamkiewicz type medullary artery and located on the posterolateral surface of the conus. Endovascular embolization was attempted, however, follow-up angiography demonstrated persistent shunting with new feeders both from the anterior and posterior spinal arteries. Therefore, the patient underwent laminectomy and microsurgical resection with intraoperative neuromonitoring and ICG angiography followed by a second endovascular embolization of further inferiorly located fistulae not visible during surgery. Postoperatively the patient recovered well with reduced pain and paraesthesia and no new neurological deficits. Surveillance angiography confirmed complete obliteration of the AVM. Combined endovascular and surgical management of intradural AVMs allows for successful treatment with minimal morbidity. |
| Category | Science & Technology |
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