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Arteriovenous Fistula of the Filum Terminale: A Case Report and Review of the Literature.
World Neurosurg. 2019 Oct; 130:42-49.WN

Abstract

BACKGROUND

Fistulas of the filum terminale are rare lesions that result from a fistulous connection between the artery and vein of the filum terminale. These lesions often present as progressive thoracic myelopathy secondary to venous hypertension that is transmitted to the coronal venous plexus of the spinal cord. Frequently, filum fistulas will be associated with lumbar stenosis and likely form as a result of chronic inflammation and compression. However, owing to the relative rarity of filum fistulas and the commonality of lumbar stenosis, the presence of a filum fistula could be overlooked or misdiagnosed.

CASE DESCRIPTION

We have presented the case of a 62-year-old man with severe lumbar stenosis who had presented with progressive thoracic myelopathy. The evaluation, including spinal angiography, identified a low-flow arteriovenous fistula within the filum terminale that was successfully treated with microsurgical obliteration. The patient tolerated the procedure well, with good functional recovery within 1 month.

CONCLUSION

Just as was the case with our patient, these lesions demonstrate a high association with lumbar stenosis and tethered or tight cord syndrome. We reviewed the clinical presentation, imaging findings, surgical management, and possible mechanisms of development for these rarely encountered fistulas.

Authors+Show Affiliations

Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA.Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA.Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA. Electronic address: tylerscullen@gmail.com.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

31254689

Citation

Scullen, Tyler, et al. "Arteriovenous Fistula of the Filum Terminale: a Case Report and Review of the Literature." World Neurosurgery, vol. 130, 2019, pp. 42-49.
Scullen T, Mathkour M, Amenta PS, et al. Arteriovenous Fistula of the Filum Terminale: A Case Report and Review of the Literature. World Neurosurg. 2019;130:42-49.
Scullen, T., Mathkour, M., Amenta, P. S., & Dallapiazza, R. F. (2019). Arteriovenous Fistula of the Filum Terminale: A Case Report and Review of the Literature. World Neurosurgery, 130, 42-49. https://doi.org/10.1016/j.wneu.2019.06.136
Scullen T, et al. Arteriovenous Fistula of the Filum Terminale: a Case Report and Review of the Literature. World Neurosurg. 2019;130:42-49. PubMed PMID: 31254689.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Arteriovenous Fistula of the Filum Terminale: A Case Report and Review of the Literature. AU - Scullen,Tyler, AU - Mathkour,Mansour, AU - Amenta,Peter S, AU - Dallapiazza,Robert F, Y1 - 2019/06/26/ PY - 2019/04/30/received PY - 2019/06/16/revised PY - 2019/06/17/accepted PY - 2019/6/30/pubmed PY - 2020/1/22/medline PY - 2019/6/30/entrez KW - Arteriovenous fistula KW - Endovascular KW - Microsurgery KW - Myelopathy KW - Spinal stenosis SP - 42 EP - 49 JF - World neurosurgery JO - World Neurosurg VL - 130 N2 - BACKGROUND: Fistulas of the filum terminale are rare lesions that result from a fistulous connection between the artery and vein of the filum terminale. These lesions often present as progressive thoracic myelopathy secondary to venous hypertension that is transmitted to the coronal venous plexus of the spinal cord. Frequently, filum fistulas will be associated with lumbar stenosis and likely form as a result of chronic inflammation and compression. However, owing to the relative rarity of filum fistulas and the commonality of lumbar stenosis, the presence of a filum fistula could be overlooked or misdiagnosed. CASE DESCRIPTION: We have presented the case of a 62-year-old man with severe lumbar stenosis who had presented with progressive thoracic myelopathy. The evaluation, including spinal angiography, identified a low-flow arteriovenous fistula within the filum terminale that was successfully treated with microsurgical obliteration. The patient tolerated the procedure well, with good functional recovery within 1 month. CONCLUSION: Just as was the case with our patient, these lesions demonstrate a high association with lumbar stenosis and tethered or tight cord syndrome. We reviewed the clinical presentation, imaging findings, surgical management, and possible mechanisms of development for these rarely encountered fistulas. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31254689/Arteriovenous_Fistula_of_the_Filum_Terminale:_A_Case_Report_and_Review_of_the_Literature_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)31688-2 DB - PRIME DP - Unbound Medicine ER -