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Conus perimedullary arteriovenous fistula in a child: unusual angio-architectural features and pathophysiology.
Childs Nerv Syst. 2008 Sep; 24(9):1071-6.CN

Abstract

INTRODUCTION

The perimedullary arteriovenous fistulas are located on the pial surface and are usually supplied by spinal medullary arteries, that is, either by the anterior or posterior spinal arteries, with no intervening nidus between the feeder arteries and the venous drainage. The clinical findings are, more commonly, caused by progressive radiculomedullary ischemic processes secondary to steal vascular mechanism. As the vascular supply to the spinal cord and to the arteriovenous fistulas (AVF) is not shared with one another, the vascular steal phenomenon cannot be implicated in this case's physiopathology. Most probably, the mass effect caused by the giant venous dilatation was the pathophysiological mechanism involved in this lesion.

CASE REPORT

The authors describe the case of a 6-year-old girl with an intradural ventral arteriovenous fistula, with a giant venous dilatation, fed directly by L2 and L3 radiculomedullary arteries at the conus medullaris. There was no arterial supply to the fistula from the anterior or posterior spinal arteries. Selective spinal angiography showed an arteriovenous fistula supplied directly by two radiculomedullary arteries, with a large draining vein caudally. Interposing the arterial and venous vessels was a giant venous aneurysmal dilatation located ventral to the conus medullaris and extending from L3 to T6. The patient was successfully treated by a surgical approach through a laminotomy from L3 to T11.

CONCLUSION

The type IV-C spinal arteriovenous malformations or perimedullary AVFs are rare lesions predominately described at the conus medullaris with various types of angio-architecture and controversial treatment.

Authors+Show Affiliations

Division of Pediatric Neurosurgery, Department of Neurosurgery, São Paulo University Medical School, São Paulo, Brazil. matushita@uol.com.brNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

18560838

Citation

Matushita, Hamilton, and Jose Guilherme Caldas. "Conus Perimedullary Arteriovenous Fistula in a Child: Unusual Angio-architectural Features and Pathophysiology." Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, vol. 24, no. 9, 2008, pp. 1071-6.
Matushita H, Caldas JG. Conus perimedullary arteriovenous fistula in a child: unusual angio-architectural features and pathophysiology. Childs Nerv Syst. 2008;24(9):1071-6.
Matushita, H., & Caldas, J. G. (2008). Conus perimedullary arteriovenous fistula in a child: unusual angio-architectural features and pathophysiology. Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, 24(9), 1071-6. https://doi.org/10.1007/s00381-008-0663-z
Matushita H, Caldas JG. Conus Perimedullary Arteriovenous Fistula in a Child: Unusual Angio-architectural Features and Pathophysiology. Childs Nerv Syst. 2008;24(9):1071-6. PubMed PMID: 18560838.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conus perimedullary arteriovenous fistula in a child: unusual angio-architectural features and pathophysiology. AU - Matushita,Hamilton, AU - Caldas,Jose Guilherme, Y1 - 2008/06/17/ PY - 2008/01/18/received PY - 2008/03/09/revised PY - 2008/6/19/pubmed PY - 2008/11/19/medline PY - 2008/6/19/entrez SP - 1071 EP - 6 JF - Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery JO - Childs Nerv Syst VL - 24 IS - 9 N2 - INTRODUCTION: The perimedullary arteriovenous fistulas are located on the pial surface and are usually supplied by spinal medullary arteries, that is, either by the anterior or posterior spinal arteries, with no intervening nidus between the feeder arteries and the venous drainage. The clinical findings are, more commonly, caused by progressive radiculomedullary ischemic processes secondary to steal vascular mechanism. As the vascular supply to the spinal cord and to the arteriovenous fistulas (AVF) is not shared with one another, the vascular steal phenomenon cannot be implicated in this case's physiopathology. Most probably, the mass effect caused by the giant venous dilatation was the pathophysiological mechanism involved in this lesion. CASE REPORT: The authors describe the case of a 6-year-old girl with an intradural ventral arteriovenous fistula, with a giant venous dilatation, fed directly by L2 and L3 radiculomedullary arteries at the conus medullaris. There was no arterial supply to the fistula from the anterior or posterior spinal arteries. Selective spinal angiography showed an arteriovenous fistula supplied directly by two radiculomedullary arteries, with a large draining vein caudally. Interposing the arterial and venous vessels was a giant venous aneurysmal dilatation located ventral to the conus medullaris and extending from L3 to T6. The patient was successfully treated by a surgical approach through a laminotomy from L3 to T11. CONCLUSION: The type IV-C spinal arteriovenous malformations or perimedullary AVFs are rare lesions predominately described at the conus medullaris with various types of angio-architecture and controversial treatment. SN - 0256-7040 UR - https://www.unboundmedicine.com/medline/citation/18560838/Conus_perimedullary_arteriovenous_fistula_in_a_child:_unusual_angio_architectural_features_and_pathophysiology_ L2 - https://doi.org/10.1007/s00381-008-0663-z DB - PRIME DP - Unbound Medicine ER -