Pediatric high-flow, cervical spinal, macro-arteriovenous fistula, treated with the endovascular cotton candy glue injection technique

Case report A 3-year-old boy presented to our hospital with progressive neurological deficits. Spinal magnetic resonance imaging (MRI) revealed a perimedullary macro-arteriovenous fistula (PMAVF) resulting in a large venous pouch within the parenchyma of the lower cervical spinal cord. Transarterial...

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Bibliographic Details
Published in:Child's nervous system 2010-11, Vol.26 (11), p.1633-1638
Main Authors: Iizuka, Yuo, Kohda, Ehiichi, Tsutsumi, Yoshiyuki, Masaki, Hidekazu, Nosaka, Shunsuke, Morota, Nobuhito, Kobayashi, Shigeki, Konishi, Yoshifumi
Format: Article
Language:English
Subjects:
Angiography
Arteriovenous Malformations - diagnosis
Arteriovenous Malformations - therapy
Case Report
Cerebellum - blood supply
Cervical Vertebrae - blood supply
Child
Embolization, Therapeutic - methods
Enbucrilate - administration & dosage
Endovascular intervention
Follow-Up Studies
Humans
Magnetic Resonance Angiography
Male
Medicine
Medicine & Public Health
N-Butyl cyanoacrylate
Neurologic Examination
Neurosciences
Neurosurgery
Pediatric
Powders
Spinal arteriovenous fistulae
Spinal Cord - blood supply
Tantalum - administration & dosage
Tissue Adhesives - administration & dosage
Tomography, Spiral Computed
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Summary:Case report A 3-year-old boy presented to our hospital with progressive neurological deficits. Spinal magnetic resonance imaging (MRI) revealed a perimedullary macro-arteriovenous fistula (PMAVF) resulting in a large venous pouch within the parenchyma of the lower cervical spinal cord. Transarterial varix embolization of the fistula from the venous side was performed using N-butyl cyanoacrylate with tantalum powder. Postembolization angiography confirmed obliteration of the fistula, and MRI revealed thrombosis and reduction in size of the venous component. The patient's clinical symptoms were reduced dramatically following the intervention, and no neurological complications occurred due to the treatment. The prognosis of spinal PMAVF depends primarily on the presence of medullar signs and symptoms and on time to treatment. The volume of the venous pouch after the intervention was markedly reduced, and complete clinical recovery was obtained. Urgent endovascular intervention, as seen in this case, is considered first-line therapy and aims to decrease the risk of neurological sequela.
ISSN:0256-7040
1433-0350
DOI:10.1007/s00381-010-1181-3