title: Cervical spinal epidural arteriovenous fistula with coexisting spinal anterior spinal artery aneurysm presenting as subarachnoid hemorrhage--case report.
abstract: Hemorrhagic presentation of spinal epidural arteriovenous fistulas (AVFs) is rare in patients with cervical spinal vascular lesions. The present report describes a patient with cervical spine epidural AVFs associated with anterior spinal artery aneurysm at the same vertebral level presenting with subarachnoid hemorrhage. A 54-year-old man presented with sudden onset of headache. Computed tomography of the head showed subarachnoid hemorrhage. Diagnostic angiography revealed an epidural AVF located at the C1-2 level that was fed mainly by the dorsal somatic branches of the segmental arteries from the radicular artery and anterior spinal artery. This AVF drained only into the epidural veins without perimedullary venous reflux. Further, there was a 4-mm anterior spinal artery aneurysm in the vicinity of the fistula that was thought to be the cause of the hemorrhage. Endovascular transarterial fistulas embolization from the right radicular artery was performed to eliminate the AVF and to reduce hemodynamic stress on the aneurysm. No new symptoms developed after the treatment and discharged without neurological deficits. The aneurysm was noted to be reduced in size after the treatment and totally disappeared by 1 year later, according to follow-up angiography. Anterior spinal artery aneurysm from a separate vascular distribution may coexist with spinal epidural AVFs. In the setting of spinal subarachnoid hemorrhage, comprehensive imaging is indicated to rule out such lesions.
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara City, Japan. Electronic address: nakagawa@naramed-u.ac.jp.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara City, Japan.
authors.forename: Hun-Soo
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara City, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hironaka
authors.affiliation: Department of Radiology, Nara Medical University, Kashihara City, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Wada
authors.affiliation: Department of Radiology, Nara Medical University, Kashihara City, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara City, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
mesh_terms: D000783:Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D001158:Arteries; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D002533:Cerebral Angiography / Q000379:methods; D002574:Cervical Vertebrae; D004621:Embolization, Therapeutic; D004824:Epidural Space; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D013131:Spine / Q000098:blood supply*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aneurysm; anterior spinal artery; epidural arteriovenous fistula; subarachnoid hemorrhage; transarterial embolization