title: Completely extradural intraspinal arteriovenous malformation in the lumbar spine: a case report.
abstract: BACKGROUND
  Spinal vascular malformations can be classified in arteriovenous malformations, cavernomas, and capillary telangiectasias. Arteriovenous malformations are the most common spinal vascular anomaly and may be located intra- and/or perimedullary. According to their nidus type and hemodynamic flow patterns, they can be differentiated into fistulous, glomerular and juvenile categories. In our case, a hyperintense extradural mass was misinterpreted as a neurinoma. The histological analysis revealed typical signs of an arteriovenous malformation.
  
  
  METHODS
  A 57-year-old Caucasian woman presented with back pain and hypesthesia in digiti two to four of her left foot. Magnetic resonance imaging showed a long-segment intraspinal extradural soft-tissue mass in the left L4 - S1 paravertebral region with homogeneous enhancement of contrast medium. Due to another similar lesion in the lower ankle and additional cutaneous manifestations, the suspected diagnosis was a systemic disease with neurinomas (e.g. Recklinghausen's disease). To clear up the origin and type of this lesion exploratory surgery with a hemilaminectomy of L5 was performed. This showed abnormally arterialized, dilated, and tortuous vessels. After complete resection, the intra-operative impression of an arteriovenous malformation was confirmed by a neuropathologist.
  
  
  CONCLUSIONS
  Completely extradural intraspinal arteriovenous malformations in the lumbar spine are extremely rare. In magnetic resonance imaging they are often misinterpreted as a tumor. Arteriovenous malformations can cause compression and venous congestion, or mask symptoms like a spinal disk herniation.In cases presenting with these symptoms and magnetic resonance imaging findings, an extradural intraspinal arteriovenous malformation should be considered as a possible diagnosis. Pre-operative angiography or magnetic resonance imaging angiography can be used to verify the diagnosis.
authors: Department of Radiology and Neuroradiology, University Hospital Essen, Hufelandstr, 55, 45122 Essen, Germany. Saravanabavaan.Suntharalingam@uk-essen.de.
authors: Saravanabavaan
authors: S
authors: Suntharalingam
authors: Adrian
authors: A
authors: Ringelstein
authors: Michael
authors: M
authors: Forsting
authors: Ulrich
authors: U
authors: Sure
authors: Johannes
authors: J
authors: van de Nes
authors: Oliver
authors: O
authors: Gembruch
mesh_terms: D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000601:surgery