title: Endovascular coil embolization of a spinal epidural arteriovenous fistula with associated cord compression from an enlarging venous varix.
abstract: Spinal arteriovenous fistulas (AVFs) completely isolated to the epidural compartment are exceedingly rare. As such, the optimal management of these lesions is poorly defined. The aim of this technical note is to describe our endovascular technique for the occlusion of a purely epidural AVF of the thoracic spine associated with cord compression from an associated enlarging venous varix. A 40-year-old male presented with severe right-sided back pain and anterior thigh numbness after a sports-related back injury six months previously. Spinal magnetic resonance imaging (MRI) showed an enhancing, extradural mass lesion at T12. Spinal angiography revealed an epidural AVF supplied by a radicular branch of the right T12 subcostal artery and draining into the paravertebral lumbar veins, as well as an adjacent 20 × 13 mm(2) contrast-filling sac, compatible with a dilated venous varix. There was no evidence of intradural venous drainage. We elected to proceed with endovascular treatment of the lesion. At the time of embolization five days later, the venous varix had enlarged to 26 × 16 mm(2). The T12 epidural AVF was completely occluded with two coils, without residual or recurrent AVF on follow-up angiography one month later. The patient made a full recovery, and complete resolution of the venous varix and cord compression were noted on MRI at three months follow-up. Endovascular coil embolization can be successfully employed for the treatment of appropriately selected spinal epidural AVFs. Cord compression from an enlarging venous varix can be treated concurrently with endovascular occlusion of an associated spinal epidural AVF.
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA dmd7q@hscmail.mcc.virginia.edu.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: HemoShear Therapeutics, Charlottesville, VA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Manka
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
authors.forename: R Webster
authors.initials: RW
authors.lastname: Crowley
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Liu
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D001265:Athletic Injuries / Q000150:complications*; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D014648:Varicose Veins / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Arteriovenous fistula; endovascular procedure; epidural; neurologic deficit; spinal cord; thoracic; vascular malformation; venous varix