Total occlusion of a conus medullaris pial arteriovenous malformation obtained with one session of superselective embolization.
The authors report about a case of the endovascular treatment of a pial arteriovenous malformation (AVM). The lesion was located on the conus medullaris. This injury is a rare spinal AVM. The diagnostic management and surgical treatment was chosen with a collaboration between neurosurgeons and neuroradiologists. The diagnostic management was based on clinical validation and magnetic resonance with angiographic technique as a gold standard. With regard to the surgical treatment of spinal AVM, endovascular and radiotherapy is a decision which should be taken multidisciplinarily. The treatment is crucial in resolving this lesion. The authors describe the case of a 38-year-old girl with clinical findings of progressive radiculomedullary ischemic process caused by the presence of spinal AVM. The angiographic images showed a pial AVM of the conus medullaris fed by an anterior radiculomedullary artery (Adamckiewiz artery) originated from a left T11 dorsospinal artery and by a posterior radiculopial artery originated from the left L1 artery. The draining veins were posterior pial veins, and accessory anterior subpial veins. Even if the first treatment of a pial arteriovenous malformation (AVM) of conus medullaris can be the surgical treatment for posterior localization, a neurointerventional angiographic and modern materials make it possible to reach pial AVMS of conus medullaris avoiding surgery. The authors describe a successful treatment of conus medullaris arteriovenous malformation with a one session of superselective embolization.
Carangelo
B
B
Department of Neurosurgery, University of Siena, Siena, Italy.
Casasco
A E
AE
Vallone
I
I
Peri
G
G
Cerase
A
A
Venturi
C
C
Palma
L
L
D001165:Arteriovenous Malformations / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008875:Middle Aged; D010841:Pia Mater / Q000098:blood supply* / Q000473:pathology; D013116:Spinal Cord / Q000098:blood supply; D013904:Thoracic Vertebrae / Q000473:pathology