[Multiple spinal arteriovenous fistulas occurring at conus medullaris and dura of the sacral region: a case report].No Shinkei Geka. 2001 Dec; 29(12):1177-81.NS
Multiple arteriovenous fistulas (AVFs) of the spine are rare. The authors reported a case of spinal AVFs occurring at two separate sites including the conus medullaris and the dura of the sacral region. A 31-year-old man had a two-week history of progressive low back pain, mild gait disturbance and dysuria. Examination revealed mild motor weakness of both legs, disturbance of superficial sensibility below the L4 dermatome on both sides and dysuria. Sensory disturbance was most obvious in the perianal region, although deep sensibility was not disturbed. Magnetic resonance images (MRIs) of the spine showed many serpentine flow void signals from the lower thoracic region to the sacral region, and spinal arteriovenous malformations were suspected. Selective spinal angiography revealed two AVFs at the separate sites including intradural perimedullary AVF at the conus medullaris and dural AVF at the sacral region. The dural AVF of the sacral region was fed by the left lateral sacral artery and drained through the dilated coronal venous plexus to Th11 level. Embolization with N-butylcyanoacrylate (NBCA) was performed using an endovascular procedure for both AVFs. Although recanalization of the dural AVF of the sacral region was confirmed by angiography two weeks later, it was treated successfully by the surgical approach.