title: A case of spinal epidural venous malformation with mediastinal extension: management with combined surgery and percutaneous sclerotherapy.
abstract: While spinal epidural arteriovenous malformations, fistulas, and shunts are well reported, the presence of a venous malformation in the spinal epidural space is a rare phenomenon. Herein, the authors report the clinical presentation, imaging findings, pathological features, and the outcome of surgical and percutaneous interventional management of a mediastinal and spinal epidural venous malformation in a young woman who presented clinically with neurogenic claudication from presumed venous hypertension precipitating the formation of a syrinx. The patient underwent a C6-T5 osteoplastic laminectomy for decompression of the spinal canal and subtotal resection of the epidural venous malformation, followed by percutaneous sclerotherapy of the mediastinal and residual anterior spinal venous malformation. She developed transient loss of dorsal column sensation, which returned to baseline within 3 weeks of the surgery. A 6-month postoperative MRI study revealed complete resolution of the syrinx and the mediastinal venous malformation. Twelve months after the surgery, the patient has had resolution of all neurological symptoms with the exception of her premorbid migraine headaches. A multidisciplinary approach with partial resection and the use of percutaneous sclerotherapy for the residual malformation can be used to successfully treat a complex venous malformation.
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Gurpreet S
authors.initials: GS
authors.lastname: Gandhoke
authors.affiliation: Interventional Radiology.|Vascular Anomalies Center, Children's Hospital of Pittsburgh, Pennsylvania.
authors.forename: Sabri
authors.initials: S
authors.lastname: Yilmaz
authors.affiliation: Plastic and Reconstructive Surgery, and.|Vascular Anomalies Center, Children's Hospital of Pittsburgh, Pennsylvania.
authors.forename: Lorelei
authors.initials: L
authors.lastname: Grunwaldt
authors.affiliation: Pathology, and.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Hamilton
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: David J
authors.initials: DJ
authors.lastname: Salvetti
authors.affiliation: Departments of 1 Neurological Surgery.|Vascular Anomalies Center, Children's Hospital of Pittsburgh, Pennsylvania.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Greene
mesh_terms: D001139:Arnold-Chiari Malformation / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D002574:Cervical Vertebrae / Q000601:surgery; D019299:Decompression, Surgical; D004824:Epidural Space; D005260:Female; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D010348:Patient Care Team; D015911:Sclerotherapy / Q000379:methods; D013595:Syringomyelia / Q000601:surgery; D013904:Thoracic Vertebrae / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: ISSVA = International Society for the Study of Vascular Anomalies; epidural; mediastinal; sclerotherapy; spine; syringomyelia; vascular disorders; venous malformation