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

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.

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

Surgical Neurology International ◽

10.25259/sni_80_2021 ◽

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

Interventional Neuroradiology ◽

10.1177/159101991101700213 ◽

2011 ◽

Vol 17 (2) ◽

pp. 217-223 ◽

Cited By ~ 4

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.

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Cyst of the Filum Terminale: Potpourri of 3 Prenatally Diagnosed Cases

Journal of Fetal Medicine ◽

10.1007/s40556-020-00269-0 ◽

2020 ◽

Author(s):

Debasmita Mandal ◽

Prasanna Roy ◽

Shankar Dey

Keyword(s):

Conus Medullaris ◽

Clinical Entity ◽

Advanced Technology ◽

Filum Terminale ◽

Fibrous Band ◽

Pia Mater

AbstractThe filum terminale (FT) is an extension of pia mater, a fibrous band that connects the conus medullaris and the posterior body of the coccyx. Current advanced technology in ultrasonography has enabled visualisation of the FT and small structures like a FT cyst can be diagnosed prenatally. Reports pf these cysts are rare. We report three cases of a FT cyst diagnosed prenatally. The objective of reporting these is to make clinicians aware of the importance of the relevance of this clinical entity.

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Filum Terminale Arteriovenous Fistula in Association with Degenerative Lumbosacral Spinal Canal Stenosis: Report of 3 Cases and Review of the Literature

World Neurosurgery ◽

10.1016/j.wneu.2020.03.011 ◽

2020 ◽

Vol 138 ◽

pp. 231-241

Author(s):

Prasert Iampreechakul ◽

Wuttipong Tirakotai ◽

Korrapakc Wangtanaphat ◽

Punjama Lertbutsayanukul ◽

Somkiet Siriwimonmas

Keyword(s):

Arteriovenous Fistula ◽

Spinal Canal ◽

Spinal Canal Stenosis ◽

Filum Terminale ◽

Review Of The Literature ◽

Canal Stenosis

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Sacral Extradural Angiolipoma Associated with Tight Filum Terminale and Spina Bifida Coexisting with Spinal Arteriovenous Fistula

World Neurosurgery ◽

10.1016/j.wneu.2020.04.239 ◽

2020 ◽

Vol 140 ◽

pp. 37-45

Author(s):

Prasert Iampreechakul ◽

Teera Tangviriyapaiboon ◽

Anusak Liengudom ◽

Punjama Lertbutsayanukul ◽

Samasuk Thammachantha ◽

...

Keyword(s):

Spina Bifida ◽

Arteriovenous Fistula ◽

Filum Terminale ◽

Spinal Arteriovenous Fistula ◽

Tight Filum Terminale

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

Journal of Neurosurgery Spine ◽

10.3171/2014.5.spine13670 ◽

2014 ◽

Vol 21 (3) ◽

pp. 489-493 ◽

Cited By ~ 9

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.

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Clipping of spinal arteriovenous fistula of the filum terminale under intraoperative angiography guidance

Formosan Journal of Surgery ◽

10.4103/fjs.fjs_36_19 ◽

2019 ◽

Vol 52 (4) ◽

pp. 151 ◽

Cited By ~ 1

Author(s):

Hsin-Yao Lin ◽

Yun-Ju Lee ◽

Kai-Chun Lin ◽

Cheng-Chia Tsai

Keyword(s):

Arteriovenous Fistula ◽

Filum Terminale ◽

Intraoperative Angiography ◽

Spinal Arteriovenous Fistula

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Perimedullary Arteriovenous Fistula of the Filum Terminale

Neurosurgery ◽

10.1227/01.neu.0000359529.40577.a1 ◽

2010 ◽

Vol 66 (1) ◽

pp. E219-E220 ◽

Cited By ~ 25

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.

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