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Pathomorphological description of the shunted portion of a filum terminale arteriovenous fistula.
Spine J. 2014 Feb 01; 14(2):e7-10.SJ

Abstract

BACKGROUND CONTEXT

The clinical morphology of a filum terminale arteriovenous fistula (f-AVF) is well known; however, pathological details of the fistulized portion are unknown. Herein, we report the pathological findings of the f-AVF.

STUDY DESIGN

Case report and literature review.

PURPOSE

To present a detailed pathological examination of the fistulized portion of the f-AVF.

METHODS

A 71-year-old man presented with gradually worsening bilateral foot paresthesias and anal dysesthesia. T2-weighted magnetic resonance imaging showed flow voids surrounding an edematous conus medullaris and cauda equina with spinal stenosis at L3-L4 and L4-L5. Spinal digital subtraction angiography demonstrated an f-AVF fed by the left T9 intercostal artery.

RESULTS

We performed laminotomies of L3 and L4 to open the dura mater and found a hypertrophic filum terminale. It was resected, leaving a length of 2 cm between the abnormal proximal end and normal distal end. The f-AVF completely disappeared after the surgery. On pathological examination, the filum terminale included two vessels at the proximal end and one at the distal end. At the proximal end, immunostaining showed one vessel that was definitively an artery with both an internal elastic membrane (IEM) and smooth muscle. The other was a vein and lacked an IEM. On the distal side, the collagen fibers gradually increased, the IEM partially disappeared from the arterial wall, and the vein became arterialized with a thin IEM. At the distal end the two vessels joined. Therefore, we speculated that the fistulized portion of the f-AVF was not a fistula point but had some lengths where the artery had characteristics of a vein and there was venous arterialization.

CONCLUSIONS

The filum arteriovenous shunting occurred at the portion where there was venous arterialization and the artery had the characteristics of a vein. Therefore, resecting the filum terminale requires more proximal from the normal distal end.

Authors+Show Affiliations

Department of Neurological Surgery, Aichi Medical University Hospital, Karimata, Yazako, Nagakute City, Aichi, Japan. Electronic address: take7106@aichi-med-u.ac.jp.Department of Neurological Surgery, Aichi Medical University Hospital, Karimata, Yazako, Nagakute City, Aichi, Japan.Department of Neurological Surgery, Aichi Medical University Hospital, Karimata, Yazako, Nagakute City, Aichi, Japan.Department of Neurological Surgery, Aichi Medical University Hospital, Karimata, Yazako, Nagakute City, Aichi, Japan.Department of Neurological Surgery, Aichi Medical University Hospital, Karimata, Yazako, Nagakute City, Aichi, Japan.Department of Neurological Surgery, Aichi Medical University Hospital, Karimata, Yazako, Nagakute City, Aichi, Japan.Department of Pathology, Aichi Medical University Hospital, Karimata, Yazako, Nagakute City, Aichi, Japan.Department of Neurological Surgery, Aichi Medical University Hospital, Karimata, Yazako, Nagakute City, Aichi, Japan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

24314764

Citation

Takeuchi, Mikinobu, et al. "Pathomorphological Description of the Shunted Portion of a Filum Terminale Arteriovenous Fistula." The Spine Journal : Official Journal of the North American Spine Society, vol. 14, no. 2, 2014, pp. e7-10.
Takeuchi M, Niwa A, Matsuo N, et al. Pathomorphological description of the shunted portion of a filum terminale arteriovenous fistula. Spine J. 2014;14(2):e7-10.
Takeuchi, M., Niwa, A., Matsuo, N., Joko, M., Nakura, T., Aoyama, M., Yokoi, T., & Takayasu, M. (2014). Pathomorphological description of the shunted portion of a filum terminale arteriovenous fistula. The Spine Journal : Official Journal of the North American Spine Society, 14(2), e7-10. https://doi.org/10.1016/j.spinee.2013.09.022
Takeuchi M, et al. Pathomorphological Description of the Shunted Portion of a Filum Terminale Arteriovenous Fistula. Spine J. 2014 Feb 1;14(2):e7-10. PubMed PMID: 24314764.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pathomorphological description of the shunted portion of a filum terminale arteriovenous fistula. AU - Takeuchi,Mikinobu, AU - Niwa,Aichi, AU - Matsuo,Naoki, AU - Joko,Masahiro, AU - Nakura,Takahiro, AU - Aoyama,Masahiro, AU - Yokoi,Toyoharu, AU - Takayasu,Masakazu, Y1 - 2013/10/12/ PY - 2013/06/06/received PY - 2013/08/26/revised PY - 2013/09/19/accepted PY - 2013/12/10/entrez PY - 2013/12/10/pubmed PY - 2014/10/14/medline KW - AVF KW - Arterialization KW - Artery with characteristics of a vein KW - Filum terminale arteriovenous fistula KW - Pathology KW - Shunt SP - e7 EP - 10 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 14 IS - 2 N2 - BACKGROUND CONTEXT: The clinical morphology of a filum terminale arteriovenous fistula (f-AVF) is well known; however, pathological details of the fistulized portion are unknown. Herein, we report the pathological findings of the f-AVF. STUDY DESIGN: Case report and literature review. PURPOSE: To present a detailed pathological examination of the fistulized portion of the f-AVF. METHODS: A 71-year-old man presented with gradually worsening bilateral foot paresthesias and anal dysesthesia. T2-weighted magnetic resonance imaging showed flow voids surrounding an edematous conus medullaris and cauda equina with spinal stenosis at L3-L4 and L4-L5. Spinal digital subtraction angiography demonstrated an f-AVF fed by the left T9 intercostal artery. RESULTS: We performed laminotomies of L3 and L4 to open the dura mater and found a hypertrophic filum terminale. It was resected, leaving a length of 2 cm between the abnormal proximal end and normal distal end. The f-AVF completely disappeared after the surgery. On pathological examination, the filum terminale included two vessels at the proximal end and one at the distal end. At the proximal end, immunostaining showed one vessel that was definitively an artery with both an internal elastic membrane (IEM) and smooth muscle. The other was a vein and lacked an IEM. On the distal side, the collagen fibers gradually increased, the IEM partially disappeared from the arterial wall, and the vein became arterialized with a thin IEM. At the distal end the two vessels joined. Therefore, we speculated that the fistulized portion of the f-AVF was not a fistula point but had some lengths where the artery had characteristics of a vein and there was venous arterialization. CONCLUSIONS: The filum arteriovenous shunting occurred at the portion where there was venous arterialization and the artery had the characteristics of a vein. Therefore, resecting the filum terminale requires more proximal from the normal distal end. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/24314764/Pathomorphological_description_of_the_shunted_portion_of_a_filum_terminale_arteriovenous_fistula_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(13)01562-3 DB - PRIME DP - Unbound Medicine ER -