Traumatic spinal perimedullary arteriovenous fistula due to knife stabbing and subsequent kyphosis

Case report

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Perimedullary arteriovenous fistula (AVF) is a relatively rare spinal vascular malformation. Although it has traditionally been considered to be a congenital lesion, some cases identified in adults have suggested that the lesion may be acquired. The etiology and exact mechanism of these lesions are unknown. The authors present a case of a perimedullary AVF caused by a direct stabbing injury of the spinal cord and induced by subsequent kyphosis, and they discuss the pathogenesis and treatment strategy.

Abbreviation used in this paper:AVF = arteriovenous fistula.

Article Information

Address correspondence to: Feng Ling, M.D., Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, No. 45 Changchun St., Xicheng District, Beijing, People's Republic of China. email: Byh.MD@hotmail.com.

Please include this information when citing this paper: published online May 31, 2013; DOI: 10.3171/2013.5.SPINE121112.

© AANS, except where prohibited by US copyright law.

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Figures

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    A and B: Initial MR images obtained immediately after the stabbing. The sagittal image (A) demonstrates the knife injury between the T-12 and L-1 levels. The axial images (B) demonstrate scattered hyperintensity in the cord, indicating hemorrhage, and absence of retroperitoneal hematoma. C and D: Discharge MR images obtained 50 days after injury showing no evidence of a spinal AVF. The axial images (D) show the hematoma in the right side of the spinal cord.

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    A: Sagittal T2-weighted MR image obtained 4 years and 4 months after injury revealing perimedullary flow-void signal above the L-1 level and kyphosis with disc herniation. B: Anteroposterior angiogram confirming the perimedullary AVF. The angiogram was obtained by selective injection of the right T-8 intercostal artery, which was supplied by the anterior spinal artery and drained into the dilated and tortuous perimedullary veins rostrally. C: Postembolization angiogram demonstrating complete obliteration of the fistula.

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    A and B: Preoperative sagittal (A) and coronal (B) CT scans showing significant thoracolumbar kyphosis and slight lumbar scoliosis. C and D: Postoperative lateral (C) and anteroposterior (D) radiographs obtained 4 days after surgery showing instrumentation from T-11 to L-2 and absence of kyphosis.

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