Metachronous spinal pial arteriovenous fistulas: case report

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  • 1 Departments of Radiology,
  • 4 Neurological Surgery, and
  • 5 Neurology, Northwestern University, Chicago, Illinois;
  • 2 Department of Radiology, Ain Shams University, Cairo, Egypt;
  • 3 Department of Neurology, Loyola University, Chicago, Illinois; and
  • 6 Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
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Spinal pial arteriovenous fistulas (spAVFs) are believed to be congenital lesions, and the development of a de novo spAVF has not been previously described. A 49-year-old female with a childhood history of vascular malformation–induced right lower-extremity hypertrophy presented in 2004 with progressive pain in her right posterior thigh and outer foot. Workup revealed 3 separate type IV spAVFs, which were treated by combined embolization and resection, with final conventional angiography showing no residual spinal vascular lesion in 2005. Ten years later, the patient returned with new right lower-extremity weakness, perineal pain, and left plantar foot numbness. Repeat spinal angiography demonstrated 2 de novo intertwined conus medullaris spAVFs.

ABBREVIATIONS ASA = anterior spinal artery; AVF = arteriovenous fistula; AVM = arteriovenous malformation; HHT = hemorrhagic telangiectasia; NBCA = N-butyl cyanoacrylate; PSA = posterior spinal artery; spAVF = spinal pial AVF; VEGF = vascular endothelial growth factor.

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Contributor Notes

Correspondence Ali Shaibani: Northwestern University, Chicago, IL. ali.shaibani@nm.org; ashaibani@luriechildrens.org.

INCLUDE WHEN CITING Published online November 6, 2020; DOI: 10.3171/2020.6.SPINE20600.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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