title: Filum terminale arteriovenous fistulas: the role of endovascular treatment.
abstract: OBJECTIVE
  The authors describe the clinical presentation, imaging features, and management of patients presenting with filum terminale arteriovenous fistulas (FTAVFs) and the role of transarterial treatment in their management.
  
  
  METHODS
  The authors retrospectively reviewed data obtained in 10 patients with FTAVFs diagnosed between January 1990 and December 2011.
  
  
  RESULTS
  Most patients (70%) were male, and the age of the population ranged from 31 to 72 years (mean 58.2 years). Clinical presentation was progressive paraparesis and sensory loss in the lower extremities in 9 cases, back pain in 7, radicular pain in 3, bowel/bladder disturbance in 5, and impotence in 1. The duration of symptoms varied between 2 and 24 months. Initial MRI studies showed intramedullary increased T2 signal, swollen cord, and dilated perimedullary veins in all patients. One patient had syringomyelia, presumably caused by venous hypertension transmitted by the perimedullary venous system. Embolization was attempted in 7 patients and was curative in 6 patients. Surgery was performed in the other 4 patients in whom embolization was unsuccessful or deemed not feasible. There was no treatment-related complication in either group. Symptoms, venous congestion in the cord, and syringomyelia improved on follow-up in all patients.
  
  
  CONCLUSIONS
  Embolization should be considered the treatment of choice for FTAVFs and can effectively treat the majority of patients presenting with an FTAVF. In a smaller group of patients in whom the angioarchitecture is unfavorable, open surgery is recommended.
authors.affiliation: Department of Radiology, Division of Interventional Neuroradiology, Ramathibodi Hospital Medical School, Mahidol University, Bangkok, Thailand. potter_ra@hotmail.com
authors.forename: Ekachat
authors.initials: E
authors.lastname: Chanthanaphak
authors.forename: Sirintara
authors.initials: S
authors.lastname: Pongpech
authors.forename: Pakorn
authors.initials: P
authors.lastname: Jiarakongmun
authors.forename: Chai
authors.initials: C
authors.lastname: Kobkitsuksakul
authors.forename: Cuong Tran
authors.initials: CT
authors.lastname: Chi
authors.forename: Karel G
authors.initials: KG
authors.lastname: Terbrugge
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D001164:Arteriovenous Fistula / Q000601:surgery / Q000628:therapy*; D002420:Cauda Equina / Q000098:blood supply*; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage; D004998:Ethiodized Oil; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D003287:Contrast Media; D004998:Ethiodized Oil; D004659:Enbucrilate