title: Lumbar spinal epidural arteriovenous fistula with perimedullary venous drainage after endoscopic lumbar surgery.
abstract: Spinal epidural arteriovenous fistulas (AVFs) with perimedullary venous drainage are rare. This report describes a case of lumbar epidural AVF in a patient with a history of endoscopic lumbar discectomy at the same level 8 years prior to presenting with progressive myelopathy secondary to retrograde venous reflux into the perimedullary vein. A 69-year-old man presented with progressive lower extremity weakness and sensory disturbance and loss of sphincter control 8 years after endoscopic lumbar discectomy for a disc herniation at L4-5 level. Magnetic resonance imaging showed spinal cord edema and dilated intradural perimedullary vessels. Spinal angiography revealed an epidural AVF at the site of the previous endoscopic lumbar surgery with intradural perimedullary venous drainage. The fistula was successfully occluded via endovascular transarterial embolization, and the patient had stabilization of his neurological deficits. Lumbar spinal epidural AVFs, especially those associated with iatrogenic trauma, are rare. Endoscopic surgical procedure can occlude the epidural venous plexus and disturb venous drainage, thereby inducing local venous hypertension and leading to epidural AVF with perimedullary venous drainage. This type of pathology should be considered within the differential diagnosis of delayed neurological deterioration after spinal surgery.
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan nakagawa@naramed-u.ac.jp.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakagawa
authors.affiliation: Department of Radiology, Nara Medical University, Nara, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Wada
authors.affiliation: Department of Radiology, Nara Medical University, Nara, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D017586:Diskectomy / Q000009:adverse effects; D004487:Edema / Q000000981:diagnostic imaging / Q000209:etiology; D004621:Embolization, Therapeutic / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects*; D004824:Epidural Space; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D013116:Spinal Cord / Q000098:blood supply; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Endoscopic lumbar surgery; epidural arteriovenous fistula; perimedullary venous drainage; transarterial embolization