title: Spinal intraosseous epidural arteriovenous fistula with perimedullary drainage obliterated with Onyx embolization: case report.
abstract: The authors report an extremely rare case of spinal intraosseous epidural arteriovenous fistula (AVF) with perimedullary vein reflux causing symptoms of myelopathy. The intraosseous fistula tracts were completely obliterated with Onyx embolic agent, resulting in a total resolution of symptoms. The unique features of this case include the rare location of the fistula in the vertebral body and the association of the fistula with a compressive fracture. Imaging studies confirmed these hemodynamic findings and provided clarity and direct evidence regarding the association of epidural AVF formation with the vertebral compressive fracture. The authors also propose a possible disease evolution based on the previously adduced reflux-impending mechanism.
authors.affiliation: Departments of 1 Neuroradiology and.
authors.forename: Chang-Hsien
authors.initials: CH
authors.lastname: Ou
authors.affiliation: Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung;
authors.forename: Hao-Kuang
authors.initials: HK
authors.lastname: Wang
authors.affiliation: Department of Radiology, Chia-Yi Christian Hospital, Chia-Yi;
authors.forename: Tzu-Hsien
authors.initials: TH
authors.lastname: Yang
authors.affiliation: Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung;
authors.forename: Cheng-Loong
authors.initials: CL
authors.lastname: Liang
authors.affiliation: Department of Imaging and Intervention, Chang Gung Memorial Hospital at Linkou; and.|College of Medicine and School of Medical Technology, Chang Gung University, Linkou, Taiwan.
authors.forename: Ho-Fai
authors.initials: HF
authors.lastname: Wong
mesh_terms: D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004322:Drainage; D004621:Embolization, Therapeutic / Q000379:methods; D004824:Epidural Space / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000601:surgery; D016103:Spinal Fractures / Q000601:surgery
keywords: AVF = arteriovenous fistula; LES = liquid embolic system; Onyx embolization; compressive fracture; intraosseous; myelopathy; spinal epidural arteriovenous fistula; vascular disorders