title: Exclusively epidural spinal metameric arteriovenous shunts: case report and literature review.
abstract: BACKGROUND
  Spinal arteriovenous metameric syndrome (SAMS) is a subgroup of spinal arteriovenous malformations (AVMs). Most SAMS cases have intra- and extradural AVMs and suffer from hematomyelia, subarachnoid hemorrhage, or venous congestive myelopathy.
  
  
  OBJECTIVE
  To present a rare case of SAMS in which spinal AVMs were exclusively epidural. We reviewed previous literature and evaluated the feasibility of a treatment strategy using endovascular interventions, followed by surgical obliteration.
  
  
  METHODS
  A case report and literature review of SAMS.
  
  
  METHODS
  We report a case of a 15-year-old boy suffering from SAMS in which epidural venous ectasia because of extradural AVMs caused spinal cord compression.
  
  
  RESULTS
  The patient was successfully treated with multiple sessions of transarterial embolization followed by open surgery. After the treatment, his neurologic deficits resolved. Postoperative angiography confirmed complete obliteration of extradural AVMs.
  
  
  CONCLUSIONS
  Although exclusively epidural spinal AVM is an uncommon type of SAMS, combined endovascular and surgical interventions can be an effective treatment for AVMs to achieve better radiologic outcomes and complete resolution of patient symptoms.
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan; Department of Neuroendovascular Therapy, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan; Neuroendovascular Section, Department of Neurology, Tanta University, 45 El-Geish St., Tanta 31111, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Elkordy
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan. Electronic address: endo@nsg.med.tohoku.ac.jp.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Endo
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan; Department of Neuroendovascular Therapy, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sonoda
authors.affiliation: Department of Neuroendovascular Therapy, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000293:Adolescent; D000792:Angiography; D001165:Arteriovenous Malformations / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D004824:Epidural Space / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D013117:Spinal Cord Compression / Q000209:etiology*; D013118:Spinal Cord Diseases / Q000601:surgery*; D013122:Spinal Diseases / Q000150:complications*; D016896:Treatment Outcome
keywords: Arteriovenous malformation; Cobb syndrome; Endovascular treatment; Epidural arteriovenous shunt; Metameric; Myelopathy; Spinal cord