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Japanese

Conus Perimedullary Arteriovenous Fistula with Multiple Shunt Points Including the Cauda Equina: A Case Report Hisayasu SAITO 1 , Kazutoshi HIDA 1 , Takeshi ASANO 1 , Shunsuke YANO 2 , Takeshi AOYAMA 1 , Yoshinobu IWASAKI 2 , Kiyohiro HOUKIN 1 1Department of Neurosurgery,Hokkaido University Graduate School of Medicine 2Sapporo Azabu Neurosurgical Hospital Keyword: perimedullary arteriovenous fistula , spinal AVM , cauda equina , conus medullaris , multiple AV shunt pp.375-380
Published Date 2011/4/10
DOI https://doi.org/10.11477/mf.1436101404
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 Perimedullary arteriovenous fistula (AVF) is usually located on the surface of the spinal cord and is fed by the anterior spinal artery and/or the posterior spinal artery. We report a rare case of Conus perimedullary AVF with multiple shunt points including the cauda equina.

 A 68-year-old man presented with leg pain when walking long distances. Magnetic resonance imaging at the thoracic and lumbar level revealed multiple signal voids with marked cord signal change. Angiography showed the perimedullary AVF fed by the anterior spinal artery from the right T9 intercostal artery at the level of the conus medullaris and the fistula fed by the left lateral sacral artery from the left internal iliac artery at the level of the cauda equina. In the first surgery, we performed surgical interruption of feeding arteries from the filum terminale and coagulated AV shunt of the conus medullaris. However residual perimedullary AVF was found at the conus medullaris in the postoperative angiography. Secondary surgery was carried out to treat residual AVF. Follow-up angiography showed complete disappearance of all AVFs. Postoperatively, the patient`s symptoms were improved.

 Because the Conus perimedullary AVF has the characteristics of multiple feeding arteies,multiple shunt points,and complex venous drainage,it must be kept in mind that other fistula could exist in the cauda equina or filum terminale.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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