Perimedullary arteriovenous fistula of the filum terminale: case report.
OBJECTIVE
Although a dural or intramedullary arteriovenous fistula involving the conus medullaris and fed by the lateral sacral artery has been reported, a case of perimedullary fistula arising from an artery in the filum terminale has not been described in the literature. The authors report the first case of perimedullary arteriovenous fistula located in the filum terminale.


METHODS
A 61-year-old man presented with a 10-year history of leg pain. Thoracolumbar magnetic resonance imaging scans revealed multiple perimedullary signal voids from T10 to L3. Angiography showed engorged perimedullary veins and a fistula fed by the anterior spinal artery from the right ninth segmental artery and by 2 branches of the left lateral sacral artery. The anterior spinal artery was also regarded as the artery of the filum terminale.


METHODS
Transarterial embolization was performed to occlude the feeders from the left lateral sacral artery, and an L5 total laminectomy was subsequently performed to obliterate residual fistulous material from the artery of the filum terminale. The thickened, yellowish filum, surrounded by tortuous, engorged veins, was coagulated and resected. Postoperatively, the patient's symptoms gradually resolved and were not aggravated during long periods of walking.


CONCLUSIONS
It must be noted that a fistula can be located in the filum terminale and can be successfully treated using multidisciplinary approaches.
Jin
Yong Jun
YJ
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea.
Kim
Ki-Jeong
KJ
Kwon
O Ki
OK
Chung
Sang Ki
SK
D000792:Angiography / Q000379:methods; D001164:Arteriovenous Fistula / Q000473:pathology* / Q000601:surgery; D002420:Cauda Equina / Q000473:pathology* / Q000601:surgery; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014711:Vertebral Artery / Q000473:pathology