scholarly journals Arteriovenous Fistula in a Nerve Root of the Cauda Equina Fed by a Proximal Radiculo-Medullary Artery

2011 ◽  
Vol 17 (2) ◽  
pp. 217-223 ◽  
Author(s):  
T. Ohtonari ◽  
S. Ota ◽  
N. Nishihara ◽  
K. Suwa ◽  
T. Ota ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Nerve Root ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Magnetic Resonance Images ◽  
Digital Subtraction ◽  
Feeding Artery ◽  
Spinal Arteriovenous Fistula ◽  
First Case ◽  
Flow Void

While there have been a few reports on cases of intradural spinal arteriovenous fistula located on the filum terminale, no cases of its location in a nerve root of the cauda equina have been reported to date. We describe two such cases and describe the intraoperative findings. A 40-year-old man presented weakness of his left leg. Another 62-year-old man presented paraparesis dominantly in his left leg with urinary hesitation. In both cases, spinal T2-weighted magnetic resonance images showed edema of the spinal cord, indicating a flow void around it. Digital subtraction angiography disclosed an anterior radicular artery branching from the anterior spinal artery on the surface of the conus medullaris and a turnaround vein running in the opposite direction within the cauda equina. In the first patient, while the feeding artery running along a nerve root was detected, the draining vein and the fistula were not identified at first sight. An incision into the respective nerve root exposed their location within it. In the second patient, unlike the first case, the feeding artery and the fistula were buried in a nerve root, while the draining vein was running along the nerve's surface. In both cases, permanent clips were applied to the draining vein closest to the fistula. The recognition of a hidden fistulous point in a nerve root of the cauda equina is essential for successful obliteration of the fistula.

Spinal arteriovenous fistula located in the filum terminale externa: A case report and review of the literature

2020 ◽  
pp. 159101992096836
Author(s):  
Bikei Ryu ◽  
Shinsuke Sato ◽  
Tatsuki Mochizuki ◽  
Yasunari Niimi
Keyword(s):  
Arteriovenous Fistula ◽  
Clinical Characteristics ◽  
Significant Contribution ◽  
Conus Medullaris ◽  
Magnetic Resonance Images ◽  
Filum Terminale ◽  
Review Of The Literature ◽  
Pia Mater ◽  
Progressive Myelopathy ◽  
Spinal Arteriovenous Fistula

A filum terminale arteriovenous fistula (FTAVF) is an extremely rare spinal arteriovenous fistula (AVF) and typically presents with myelopathy and conus medullaris syndrome caused by venous congestion in the spinal cord. Most reported FTAVFs are intradural pial AVFs with perimedullary drainage in the filum terminale interna. However, there are no reports of AVFs in the filum terminale externa (FTE). We describe a case involving a 68-year-old man with an AVF in the FTE who presented with progressive myelopathy and underwent successful endovascular treatment. We identified the specific shunt point by fusing postoperative computed tomography and magnetic resonance images. The features of the extradural sac AVF developed in the FTE may mimic those of a dural AVF with dural supply to the FTE covered by the dural component, unlike typical FTAVFs where the shunt develops at the pia mater. This case makes a significant contribution to the field by increasing the understanding of the clinical characteristics of an AVF that develops in the FTE and its angioarchitecture.

Extramedullary Ependymoma Near the Conus Medullaris With Lumbar Nerve Root Attachment: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. E831-E834 ◽  
Author(s):  
Christopher M Bonfield ◽  
Devin Amin ◽  
Ronald L Hamilton ◽  
Peter C Gerszten
Keyword(s):  
Nerve Root ◽  
Spinal Cord Tumor ◽  
Cauda Equina ◽  
Compression Fracture ◽  
Conus Medullaris ◽  
Magnetic Resonance Images ◽  
World Health ◽  
Low Grade ◽  
Lumbar Nerve Root ◽  
Intradural Extramedullary

Abstract BACKGROUND AND IMPORTANCE: Ependymomas are the most common primary spinal cord tumor, most frequently located near the cauda equina and conus medullaris. We believe that this is the first reported case of a low-grade, nonmyxopapillary (World Health Organization grade 2), intradural, extramedullary ependymoma involving a spinal nerve root. CLINICAL PRESENTATION: An 87-year-old woman presented with a chief complaint of acute onset of severe right hip and lateral thigh pain without midline back pain. She had baseline chronic bladder dysfunction, which remained unchanged. Her physical examination was significant for 4/5 strength in her right hip flexion (possibly related to pain), and 5 beats of clonus bilaterally. She had no point tenderness at the level of her compression fracture. Computed tomography of the patient's lumbar spine revealed a well-corticated, chronic compression fracture of the L3 vertebral body. Magnetic resonance images demonstrated an ovoid-shaped, 1.5 × 1-cm, well-circumscribed, intradural, extramedullary lesion at the conus medullaris. The patient underwent an L1-3 laminectomy with intradural resection of the mass, which was found to be intricately involved with a single nerve root. The nerve root was coagulated and sectioned, and a gross total resection of the tumor was achieved. CONCLUSION: The patient tolerated the procedure well, with no complications or any postoperative neurological deficit. Her right-sided pain immediately resolved after surgery. Her strength and ambulation were normal after surgery. No adjuvant radiotherapy was offered to the patient. This case illustrates a unique tumor presentation and the successful surgical treatment of the condition.

Postoperative cauda equina syndrome in patients undergoing single-level lumbar microdiscectomy

2005 ◽  
Vol 19 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Vassilios Dimopoulos ◽  
Kostas N. Fountas ◽  
Theofilos G. Machinis ◽  
Carlos Feltes ◽  
Induk Chung ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
De Novo ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Clinical Findings ◽  
Magnetic Resonance Images ◽  
Single Level ◽  
Lumbar Microdiscectomy ◽  
First Case ◽  
Intraoperative Electrophysiological Monitoring

Cauda equina syndrome is a well-documented complication of uneventful lumbar microdiscectomy. In the vast majority of cases, no radiological explanation can be obtained. In this paper, the authors report two cases of postoperative cauda equina syndrome in patients undergoing single-level de novo lumbar microdiscectomy in which intraoperative electrophysiological monitoring was used. In both patients, the amplitudes of cortical and subcortical intraoperative somatosensory evoked potentials (SSEPs) abruptly decreased during discectomy and foraminotomy. In the first patient, a slow, partial improvement of SSEPs was observed before the end of the operation, whereas no improvement was observed in the second patient. In the first case, clinical findings consistent with cauda equina syndrome were seen immediately postoperatively, whereas in the second one the symptoms developed within 1.5 hours after the procedure. Postoperative magnetic resonance images obtained in both patients, and a lumbar myelogram obtained in the second one revealed no signs of conus medullaris or nerve root compression. Both patients showed marked improvement after an intense course of rehabilitation. The authors' findings support the proposition that intraoperative SSEP monitoring may be useful in predicting the development of cauda equina syndrome in patients undergoing lumbar microdiscectomy. Nevertheless, further prospective clinical studies are necessary for validation of these findings.

scholarly journals Anaplastic pilocytic astrocytoma of the cerebellum presenting with conus medullaris drop metastasis

2021 ◽  
Vol 8 (1) ◽  
pp. 10
Author(s):  
Jared F. Sweeney ◽  
Vaibhav Chumbalkar ◽  
Michael D. Staudt ◽  
Pouya Entezami ◽  
Jiang Qian ◽  
...  
Keyword(s):  
Pilocytic Astrocytoma ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Complete Understanding ◽  
First Case ◽  
Spine Imaging ◽  
Drop Metastasis ◽  
Cerebellar Mass ◽  
Definition Of ◽  
Staged Operations

Due to its rarity, a complete understanding of the clinical behavior, pathogenesis, and diagnostic definition of anaplastic pilocytic astrocytoma (APA) is currently lacking. The optimal clinical management and use of adjuvant therapies has yet to be defined. We present a 64 year-old-female with progressive headaches, dysarthria, and ataxia, who was found to have right cerebellar mass. A gross total resection was achieved through two staged operations. Pathology demonstrated focal areas of necrosis, tumor infiltration, and increased mitotic activity most consistent with APA. Adjuvant chemotherapy and stereotactic radiosurgery were administered. Approximately two years later, the patient presented with symptoms of cauda equina syndrome, and lumbar spine imaging demonstrated a large intradural mass at the conus medullaris with diffuse leptomeningeal enhancement. A biopsy was performed and was consistent with metastatic APA. APA may rarely progress to metastatic disease, most frequently involving the leptomeninges of the posterior fossa and cervical spine. This report represents the first case of metastases distal to the cervicomedullary junction.

Tethered cord due to caudal lipomeningocele associated with a lumbar dural arteriovenous fistula

2014 ◽  
Vol 21 (3) ◽  
pp. 489-493 ◽  
Author(s):  
Sandip B. Mavani ◽  
Trimurti D. Nadkarni
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Present Report ◽  
Tethered Cord ◽  
Conus Medullaris ◽  
Magnetic Resonance Images ◽  
Lower Limbs ◽  
Lumbosacral Spine ◽  
Gradual Improvement

A 29-year-old man presented with progressive paraparesis associated with sensory impairment in both lower limbs for the past 2 years. He was experiencing the sensation of incomplete urinary evacuation. The patient had undergone an earlier operation for a lumbar lipomeningocele at birth. Magnetic resonance images of the lumbosacral spine showed a low-lying conus medullaris adherent to a caudal lipoma. There was a leash of abnormal vascular channels in the adjacent subarachnoid space. The patient underwent spinal angiography that revealed a dural arteriovenous fistula (AVF) principally fed by the left fourth lumbar (L-4) radicular branch. At surgery the cord was detethered by disconnection of the sacral lipoma. The dural fistula was obliterated by occlusion of the L-4 radicular feeder close to the nidus of the fistula. Postoperatively, the patient experienced an immediate relief of sensation of tightness in both lower limbs. There was a gradual improvement of power and sensation at the 6-month follow-up examination. According to the authors' literature search, the present case is a unique report of a rare association of spinal cord tethering due to a caudal lipoma associated with a lumbar dural AVF. The present report discusses the etiopathology, presentation, and management of this case.

Conus medulla—cauda compression from nerve root hypertrophy in a child with Dejerine—Sottas syndrome: improvement with laminectomy and duraplasty

2002 ◽  
Vol 97 (2) ◽  
pp. 244-247 ◽  
Author(s):  
Kleopas A. Kleopa ◽  
Leslie N. Sutton ◽  
Joseph Ong ◽  
Gihan Tennekoon ◽  
Albert E. Telfeian
Keyword(s):  
Magnetic Resonance Imaging ◽  
Nerve Root ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Myelin Protein Zero ◽  
Resonance Imaging ◽  
Content Type ◽  
Leg Weakness ◽  
Protein Zero ◽  
Fine Print

✓ This 7-year-old boy with Dejerine—Sottas syndrome caused by a mutation in the myelin protein zero gene began to suffer rapid deterioration with increasing leg weakness, loss of the ability to ambulate, and bowel and bladder incontinence. Magnetic resonance imaging of the spine revealed nerve root hypertrophy resulting in compression of the conus medullaris and cauda equina. Decompressive surgery was successful in reversing some of his deficits.

Perimedullary Arteriovenous Fistula of the Filum Terminale

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. E219-E220 ◽  
Author(s):  
Yong Jun Jin ◽  
Ki-Jeong Kim ◽  
O Ki Kwon ◽  
Sang Ki Chung
Keyword(s):  
Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Conus Medullaris ◽  
Leg Pain ◽  
Anterior Spinal Artery ◽  
Filum Terminale ◽  
Segmental Artery ◽  
First Case ◽  
History Of ◽  
The Right

Abstract OBJECTIVE Although a dural or intramedullary arteriovenous fistula involving the conus medullaris and fed by the lateral sacral artery has been reported, a case of perimedullary fistula arising from an artery in the filum terminale has not been described in the literature. The authors report the first case of perimedullary arteriovenous fistula located in the filum terminale. CLINICAL PRESENTATION A 61-year-old man presented with a 10-year history of leg pain. Thoracolumbar magnetic resonance imaging scans revealed multiple perimedullary signal voids from T10 to L3. Angiography showed engorged perimedullary veins and a fistula fed by the anterior spinal artery from the right ninth segmental artery and by 2 branches of the left lateral sacral artery. The anterior spinal artery was also regarded as the artery of the filum terminale. INTERVENTION Transarterial embolization was performed to occlude the feeders from the left lateral sacral artery, and an L5 total laminectomy was subsequently performed to obliterate residual fistulous material from the artery of the filum terminale. The thickened, yellowish filum, surrounded by tortuous, engorged veins, was coagulated and resected. Postoperatively, the patient's symptoms gradually resolved and were not aggravated during long periods of walking. CONCLUSION It must be noted that a fistula can be located in the filum terminale and can be successfully treated using multidisciplinary approaches.

Dural arteriovenous fistula and progressive conus medullaris syndrome as complications of lumbar discectomy

2002 ◽  
Vol 97 (3) ◽  
pp. 375-379 ◽  
Author(s):  
Keizoh Asakuno ◽  
Phyo Kim ◽  
Toshiki Kawamoto ◽  
Masahiro Ogino
Keyword(s):  
Mr Imaging ◽  
Arteriovenous Fistula ◽  
Nerve Root ◽  
Dural Arteriovenous Fistula ◽  
Lumbar Disc ◽  
Conus Medullaris ◽  
Lumbar Discectomy ◽  
Content Type ◽  
Initial Surgery ◽  
Gastrocnemius Muscles

✓ A case of a dural arteriovenous fistula (DAVF) that developed at the site of nerve root sleeve damage as a result of lumbar disc extrusion is reported. A 60-year-old man who had undergone lumbar discectomy 3 years previously for severe left-sided sciatica and L5—S1 disc herniation presented with progressive gait disturbance. After the initial surgery, the symptoms resolved. Fourteen months after the operation, however, he started to experience dysesthesias in both legs and progressive gait and urinary disturbances. Physical examination revealed a weakness of the anterior tibialis and the gastrocnemius muscles, as well as decreased contractility of the anal sphincter and marked sacral hypesthesia. Magnetic resonance (MR) imaging revealed swelling and a T2 signal elongation in the conus medullaris; angiography demonstrated arteriovenous dural shunting between the left lateral sacral artery and the left S-1 radicular vein at the site of the previous operation. Surgery was conducted to excise the DAVF on the S-1 nerve root sleeve and an arterialized intradural vein on the root. The procedure resulted in resolution of the symptoms and disappearance of the abnormal angiographically and MR imaging—documented anomalies. This is the first report of a DAVF in which progressive conus myelopathy developed after a lumbar discectomy.

scholarly journals Spinal arteriovenous fistula in the lipoma of the filum terminale: A report of two cases and literature review

2021 ◽  
Vol 12 ◽  
pp. 103
Author(s):  
Kiyoharu Shimizu ◽  
Takafumi Mitsuhara ◽  
Masaaki Takeda ◽  
Satoshi Yamaguchi
Keyword(s):  
Literature Review ◽  
Arteriovenous Fistula ◽  
Magnetic Resonance Images ◽  
Partial Resection ◽  
Anterior Spinal Artery ◽  
Intercostal Artery ◽  
Histological Evaluation ◽  
Filum Terminale ◽  
Arteriovenous Fistulas ◽  
Spinal Arteriovenous Fistula

Background: Filum terminale arteriovenous fistulas (FTAVFs) are rare and their pathogenesis remains unknown. The authors report two cases of FTAVF that arose in the lipoma of the filum terminale. Case Description: The two patients were 72 and 76 years of age, and both presented with a progressive paraparesis. The first patient had an arteriovenous fistula (AVF) located at L5 that was supplied by the anterior spinal artery originating from the left T10 intercostal artery. The second patient’s AVF at L3-4 was fed by the anterior spinal artery originating from the left T8 intercostal artery. Both patients underwent partial resection of the filum terminale at the location of the shunts. The pathological examinations revealed that both the AVFs were embedded in the adipose tissue of the filum terminale, revealing the fatty fila that were not visible in preoperative magnetic resonance images. Conclusion: Two cases of FTAVF were successfully treated by obliterating the fistulas through partial resection of the affected fatty filum terminale. The literature review revealed 13 cases of FTAVF concomitant with the lipomas of the filum terminale. Resection and histological evaluation of the filum terminale should be performed to treat and elucidate the pathogenesis of FTAVF.

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