Abstract
BACKGROUND CONTEXT
Most spinal arteriovenous malformations (AVMs) are dural arteriovenous fistulas in which a singularly intradural venous drainage emanates from an extradural nidus. A pure extradural spinal arteriovenous malformation (E-AVM), in the absence of a vertebral body (cavernous) hemangioma, is extremely rare, and full clinical, radiological, and operative descriptions are scant.
PURPOSE
To fully document the rare occurrence of a symptomatic E-AVM producing spinal claudication.
PATIENT SAMPLE
One patient.
OUTCOME MEASURES
Radiological and functional.
METHODS
This 62-year-old man presented with 6-month progressive spinal claudication, leg weakness, and diminished sensation. Electromyography revealed bilateral acute and chronic partial degeneration of L3-S1 nerve roots. Magnetic resonance imaging revealed moderate canal stenosis between L2-L4, with prominent epidural veins on the left at L3-L4. Spinal angiography was unsuccessful, and computed tomographic myelography merely confirmed minimal lumbosacral root filling. At decompressive L2-L4 laminectomy, inadvertent hemorrhage from varicose epidural veins released arterialized blood under considerable pressure. Only minor clinical improvement was noted after this procedure. Spinal angiography 6 weeks later subsequently confirmed an E-AVM on the left at L3-L4 which was successfully embolized.
RESULTS
Follow-up at 8 weeks after this procedure confirmed significantly increased walking distance, improved distal sensation, and normal power in both legs, with insignificant claudication.
CONCLUSIONS
When associated with canal stenosis, E-AVMs may exacerbate claudication by both compressive and venous-hypertensive mechanisms. Treatment should be by embolization, with laminectomy deferred.
TY - JOUR
T1 - Lumbar extradural arteriovenous malformation: case report and literature review.
AU - Marshman,Laurence A G,
AU - David,Karoly M,
AU - Chawda,Sanjiv J,
Y1 - 2006/11/20/
PY - 2006/01/12/received
PY - 2006/03/05/revised
PY - 2006/03/22/accepted
PY - 2007/5/8/pubmed
PY - 2007/7/13/medline
PY - 2007/5/8/entrez
SP - 374
EP - 9
JF - The spine journal : official journal of the North American Spine Society
JO - Spine J
VL - 7
IS - 3
N2 - BACKGROUND CONTEXT: Most spinal arteriovenous malformations (AVMs) are dural arteriovenous fistulas in which a singularly intradural venous drainage emanates from an extradural nidus. A pure extradural spinal arteriovenous malformation (E-AVM), in the absence of a vertebral body (cavernous) hemangioma, is extremely rare, and full clinical, radiological, and operative descriptions are scant. PURPOSE: To fully document the rare occurrence of a symptomatic E-AVM producing spinal claudication. STUDY DESIGN: Case report. PATIENT SAMPLE: One patient. OUTCOME MEASURES: Radiological and functional. METHODS: This 62-year-old man presented with 6-month progressive spinal claudication, leg weakness, and diminished sensation. Electromyography revealed bilateral acute and chronic partial degeneration of L3-S1 nerve roots. Magnetic resonance imaging revealed moderate canal stenosis between L2-L4, with prominent epidural veins on the left at L3-L4. Spinal angiography was unsuccessful, and computed tomographic myelography merely confirmed minimal lumbosacral root filling. At decompressive L2-L4 laminectomy, inadvertent hemorrhage from varicose epidural veins released arterialized blood under considerable pressure. Only minor clinical improvement was noted after this procedure. Spinal angiography 6 weeks later subsequently confirmed an E-AVM on the left at L3-L4 which was successfully embolized. RESULTS: Follow-up at 8 weeks after this procedure confirmed significantly increased walking distance, improved distal sensation, and normal power in both legs, with insignificant claudication. CONCLUSIONS: When associated with canal stenosis, E-AVMs may exacerbate claudication by both compressive and venous-hypertensive mechanisms. Treatment should be by embolization, with laminectomy deferred.
SN - 1529-9430
UR - https://www.unboundmedicine.com/medline/citation/17482125/Lumbar_extradural_arteriovenous_malformation:_case_report_and_literature_review_
L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(06)00195-1
DB - PRIME
DP - Unbound Medicine
ER -
