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  • Images in Neurosurgery

    Type IVa Spinal Perimedullary Arteriovenous Fistula 

    A 70-year-old male presented to our neurosurgery clinic with a chronic history of thoracolumbar back pain with no radicular or urinary symptoms. On neurological examination, his lower extremity strength and reflexes were normal. MRI of the thoracolumbar spine demonstrated intradural flow voids dorsal and ventral to the spinal cord (Figure 1A, blue arrow) without evidence of spinal cord edema (Figure 1B). Dynamic MR angiogram of the thoracic spine was suggestive of an intradural spinal arteriovenous fistula with a perimedullary early draining vein (Figure 1C, red arrow).

    Figure 1: MRI of the thoracolumbar spine demonstrated intradural flow voids dorsal and ventral to the spinal cord (Figure 1A, blue arrow) without evidence of spinal cord edema (Figure 1B). Dynamic MR angiogram of the thoracic spine was suggestive of an intradural spinal arteriovenous fistula with a perimedullary early draining vein (Figure 1C, red arrow)

    Spinal angiogram of a selective injection at the left T11 intercostal artery demonstrated an arteriovenous fistula at the level of the conus medullaris (Figure 2B, black arrow) supplied by the posterior spinal artery (Figure 2A, blue arrow) draining into a single dorsal perimedullary draining vein (Figure 2C, red arrow). This spinal fistula is classified as a Type IVa perimedullary spinal arteriovenous fistula supplied by a single arterial feeder draining into a slow-flow, non-dilated vein. The patient was asymptomatic from the spinal fistula and is scheduled for a clinical follow up in three months.

    Figure 2: Spinal angiogram of a selective injection at the left T11 intercostal artery demonstrated an arteriovenous fistula at the level of the conus medullaris (Figure 2B, black arrow) supplied by the posterior spinal artery (Figure 2A, blue arrow) draining into a single dorsal perimedullary draining vein (Figure 2C, red arrow).

    Submitted by: Rimal H. Dossani MD, Muhammad Waqas MD, Justin Cappuzzo MD, Ashish Sonig MD,  Elad Levy MD, MBA  

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