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Sacral intradural arteriovenous fistula treated indirectly by transection of the filum terminale: technical case report.
Neurosurgery. 2011 Sep; 69(3):E780-4; discussion E784.N

Abstract

BACKGROUND AND IMPORTANCE

Type A intradural arteriovenous fistulae of the sacral filum terminale are rare lesions fed primarily by the distal anterior spinal artery. The artery is frequently too narrow or tortuous for endovascular obliteration, and direct surgical resection of the fistula requires an invasive sacrectomy. We present a less invasive indirect surgical approach through an L4 laminectomy and transection of the filum terminale rostral to the fistula.

CLINICAL PRESENTATION

A 62-year-old man presented with a 6-month history of progressive bilateral lower extremity paresthesias and weakness and associated incontinence and impotence. Spinal magnetic resonance imaging demonstrated perimedullary flow voids. Selective spinal angiography revealed a fistula at S2-3 between the distal anterior spinal artery and an early draining vein returning cranially along the filum terminale, diagnostic of an intradural arteriovenous fistula. An L4 laminectomy and transection of the filum terminale rostral to the lesion were performed to disrupt the medullary arterial supply to the intradural fistula and outflow to the medullary venous plexus of the spinal cord. At 10-month clinical follow, up the patient had regained bowel and bladder continence, was able to ambulate with a cane, and reported subjective improvement of lower extremity paresthesias. Selective spinal angiography at 1 year demonstrated no residual arteriovenous shunt.

CONCLUSION

Pathological venous hypertension of a type A intradural arteriovenous fistula of the sacral filum terminale can be treated by transection of the filum terminale at L4. This avoids posterior partial sacrectomy required for direct resection; however, subsequent clinical follow-up is necessary to monitor for reconstitution.

Authors+Show Affiliations

School of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

21499152

Citation

Witiw, Christopher D., et al. "Sacral Intradural Arteriovenous Fistula Treated Indirectly By Transection of the Filum Terminale: Technical Case Report." Neurosurgery, vol. 69, no. 3, 2011, pp. E780-4; discussion E784.
Witiw CD, Fallah A, Radovanovic I, et al. Sacral intradural arteriovenous fistula treated indirectly by transection of the filum terminale: technical case report. Neurosurgery. 2011;69(3):E780-4; discussion E784.
Witiw, C. D., Fallah, A., Radovanovic, I., & Wallace, M. C. (2011). Sacral intradural arteriovenous fistula treated indirectly by transection of the filum terminale: technical case report. Neurosurgery, 69(3), E780-4; discussion E784. https://doi.org/10.1227/NEU.0b013e31821bc64c
Witiw CD, et al. Sacral Intradural Arteriovenous Fistula Treated Indirectly By Transection of the Filum Terminale: Technical Case Report. Neurosurgery. 2011;69(3):E780-4; discussion E784. PubMed PMID: 21499152.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sacral intradural arteriovenous fistula treated indirectly by transection of the filum terminale: technical case report. AU - Witiw,Christopher D, AU - Fallah,Aria, AU - Radovanovic,Ivan, AU - Wallace,M Christopher, PY - 2011/4/19/entrez PY - 2011/4/19/pubmed PY - 2011/12/13/medline SP - E780-4; discussion E784 JF - Neurosurgery JO - Neurosurgery VL - 69 IS - 3 N2 - BACKGROUND AND IMPORTANCE: Type A intradural arteriovenous fistulae of the sacral filum terminale are rare lesions fed primarily by the distal anterior spinal artery. The artery is frequently too narrow or tortuous for endovascular obliteration, and direct surgical resection of the fistula requires an invasive sacrectomy. We present a less invasive indirect surgical approach through an L4 laminectomy and transection of the filum terminale rostral to the fistula. CLINICAL PRESENTATION: A 62-year-old man presented with a 6-month history of progressive bilateral lower extremity paresthesias and weakness and associated incontinence and impotence. Spinal magnetic resonance imaging demonstrated perimedullary flow voids. Selective spinal angiography revealed a fistula at S2-3 between the distal anterior spinal artery and an early draining vein returning cranially along the filum terminale, diagnostic of an intradural arteriovenous fistula. An L4 laminectomy and transection of the filum terminale rostral to the lesion were performed to disrupt the medullary arterial supply to the intradural fistula and outflow to the medullary venous plexus of the spinal cord. At 10-month clinical follow, up the patient had regained bowel and bladder continence, was able to ambulate with a cane, and reported subjective improvement of lower extremity paresthesias. Selective spinal angiography at 1 year demonstrated no residual arteriovenous shunt. CONCLUSION: Pathological venous hypertension of a type A intradural arteriovenous fistula of the sacral filum terminale can be treated by transection of the filum terminale at L4. This avoids posterior partial sacrectomy required for direct resection; however, subsequent clinical follow-up is necessary to monitor for reconstitution. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/21499152/Sacral_intradural_arteriovenous_fistula_treated_indirectly_by_transection_of_the_filum_terminale:_technical_case_report_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/NEU.0b013e31821bc64c DB - PRIME DP - Unbound Medicine ER -