Acute thrombosis of a giant perimedullary arteriovenous fistula in a pediatric HHT patient

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant hereditary disorder that results in arteriovenous malformations (AVMs) in the nose, mucocutaneous surfaces and visceral organs, including lung, brain, liver, bowel and rarely spinal cord. We describe a case of a young child with HHT who presented with acute paraparesis due to acute thrombosis of a spinal perimedullary arteriovenous fistula. Patient underwent coil embolization of spinal arteriovenous shunt with resolution of clinical symptoms. This case highlights the possibility of catastrophic complications in young children with HHT, the potential preventive role of screening for spinal AVMs in HHT and the importance of timely intervention.

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Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula

Journal of Neurosurgery ◽

10.3171/jns.1983.59.6.1019 ◽

1983 ◽

Vol 59 (6) ◽

pp. 1019-1030 ◽

Cited By ~ 152

Author(s):

Edward H. Oldfield ◽

Giovanni Di Chiro ◽

Eugene A. Quindlen ◽

Kenneth G. Rieth ◽

John L. Doppman

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Arteriovenous Malformations ◽

Venous Hypertension ◽

Current Therapy ◽

Type I ◽

Content Type ◽

Symptoms And Signs ◽

Extensive Surgery ◽

Fine Print

✓ As demonstrated by selective spinal cord arteriography, over 80% of spinal cord arteriovenous malformations (AVM's) occupy a predominantly extramedullary position. Current therapy frequently requires surgical stripping of the long dorsal intradural vessel(s) from the underlying spinal cord over many cord segments. The authors report six patients with a dural arteriovenous fistula fed by a cluster of abnormal epidural arteries. These vessels, which surrounded and were embedded into the dural covering of a thoracic nerve root, drained into a long sinuous intrathecal paramedullary vein(s). The angiographic and surgical appearance of the intradural component of these lesions was identical to that of lesions previously classified as Type I AVM's of the spinal cord. All patients had symptoms and signs of myelopathy. In five patients, surgery was limited to coagulation and excision of the extradural vessels and division of the intradural arterialized vein. Progressive improvement began within days following surgery. No residual abnormality was demonstrated by postoperative selective spinal cord arteriography, which was performed in all five patients. The findings support those of Kendall and Logue, that surgery restricted to elimination of the arteriovenous fistula at the intervertebral foramen is curative, and that more extensive surgery is unnecessary for this subgroup of AVM's of the spinal cord. These lesions comprise a sizable percent of all spinal AVM's. Resolution of myelopathy in these patients supports the hypothesis that venous hypertension causes chronic progressive myelopathy.

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Metachronous Multiplicity of Spinal Cord Arteriovenous Fistula and Spinal Dural AVF in a Patient with Hereditary Haemorrhagic Telangiectasia

Interventional Neuroradiology ◽

10.1177/159101990501100113 ◽

2005 ◽

Vol 11 (1) ◽

pp. 79-82 ◽

Cited By ~ 16

Author(s):

J.C.M. Ling ◽

R. Agid ◽

S. Nakano ◽

M.P.S. Souza ◽

G. Reintamm ◽

...

Keyword(s):

Spinal Cord ◽

Mr Imaging ◽

Arteriovenous Fistula ◽

Autosomal Dominant ◽

Clinical Presentation ◽

Hereditary Haemorrhagic Telangiectasia ◽

Spinal Angiography ◽

Spinal Dural Avf ◽

Spinal Avm

HHT (Hereditary Haemorrhagic Telangiectasia or Rendu Osler Weber disease) is a known autosomal dominant dysplasia. The first clinical presentation of HHT in a child may be a cerebral or spinal AVM. We present the case of a young boy with HHT who had a previous spinal cord AVF treated by surgical obliteration and then presented with a spinal dural AVF nine months later. This patient had surgical obliteration of a spinal cord perimedullary AVF and subsequently developed a new spinal dural AVF at a different level. The diagnosis was made by spinal MR imaging and spinal angiography

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Vascular Anatomy of the Spinal Cord and Classification of Spinal Arteriovenous Malformations

Interventional Neuroradiology ◽

10.1177/15910199000060s131 ◽

2000 ◽

Vol 6 (1_suppl) ◽

pp. 195-198 ◽

Cited By ~ 25

Author(s):

K. Miyasaka ◽

T. Asano ◽

S. Ushikoshi ◽

K. Hida ◽

I. Koyanagi

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Arteriovenous Malformations ◽

Vascular Anatomy ◽

Arteriovenous Shunt ◽

Anatomical Location ◽

Venous Anatomy ◽

Spinal Arteriovenous Malformations ◽

Surgical Treatments

The arterial and venous anatomy of the spinal cord was described in terms of extrinsic and intrinsic contribution to the cord substance. Based upon anatomical location of an arteriovenous shunt, spinal arteriovenous malformations (AVMs) were classified into intramedullary AVM, perimedullary arteriovenous fistula (AVF) and dural AVF. This simple classification seems practical from the standpoint of endovascular and surgical treatments since it reflects anatomical differences in the shunt location, which is the target in either approach.

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Percutaneous embolization of renal arteriovenous fistula

VASA ◽

10.1024/0301-1526.34.3.207 ◽

2005 ◽

Vol 34 (3) ◽

pp. 207-210 ◽

Cited By ~ 2

Author(s):

Sendi ◽

Toia ◽

Nussbaumer

Keyword(s):

Heart Failure ◽

Arteriovenous Fistula ◽

Clinical Symptoms ◽

Rare Complication ◽

Abdominal Discomfort ◽

Renal Arteriovenous Fistula ◽

Percutaneous Embolization ◽

Arterial Access ◽

Number Of Publications ◽

Occluding Balloon

Acquired renal arteriovenous fistula is a rare complication following a nephrectomy and its diagnosis may be made many years after the intervention. The closure of the fistula is advisable in most cases, since it represents a risk for heart failure and rupture of the vessel. There are an increasing number of publications describing different techniques of occlusion. The case of a 70-year-old woman with abdominal discomfort due to a large renal arteriovenous fistula, 45 years after nephrectomy, is presented and current literature is reviewed. Percutaneous embolization was performed by placing an occluding balloon through the draining vein followed by the release of nine coils through arterial access. One day after successful occlusion of the fistula, clinical symptoms disappeared.

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Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.75 ◽

2018 ◽

Vol 1 (2) ◽

Author(s):

Nur Setiawan Suroto

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Vascular Malformation ◽

Dural Arteriovenous Fistula ◽

Motor Symptoms ◽

Elderly Men ◽

Spinal Dural Arteriovenous Fistula ◽

Sensory Disturbances ◽

Av Fistulas ◽

Low Rate

Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region.Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances.

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Potential Role of Cytokines in Children with Acute Appendicitis and Acute Mesenteric Lymphadenitis

Acta Chirurgica Latviensis ◽

10.2478/v10163-012-0025-5 ◽

2011 ◽

Vol 11 (1) ◽

pp. 130-133

Author(s):

Astra Zviedre ◽

Arnis Engelis ◽

Mohit Kakar ◽

Aigars Pētersons

Keyword(s):

Early Detection ◽

Acute Appendicitis ◽

Inflammatory Mediators ◽

Potential Role ◽

Clinical Symptoms ◽

Future Research ◽

Mesenteric Lymphadenitis ◽

Proper Diagnosis ◽

Near Future

Potential Role of Cytokines in Children with Acute Appendicitis and Acute Mesenteric Lymphadenitis Although, AAP and AML have different etiological factors, clinical symptoms are very much similar but treatment tactics in both the disease differ a lot. In case of AML, treatment is more conservative and does not require hospitalization while in case of AAP immediate hospitalization and maybe further surgery can be mandatory. With the identification of group of cytokines serum inflammatory mediators IL-8, IL-10, IL-12[p70], IL-17, TNF-a and MCP-1, it is believed early and proper diagnosis of AAP in the near future. Research of cytokines-serum inflammatory mediators has opened new opportunities for an early detection and differentiation of these two diseases in children.

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Clipping of an anterior spinal artery aneurysm using an endoscopic fluorescence imaging system for craniocervical junction epidural arteriovenous fistula: technical note

Journal of Neurosurgery Spine ◽

10.3171/2019.1.spine18983 ◽

2019 ◽

Vol 31 (2) ◽

pp. 279-284 ◽

Cited By ~ 2

Author(s):

Ahmed Mansour ◽

Toshiki Endo ◽

Tomoo Inoue ◽

Kenichi Sato ◽

Hidenori Endo ◽

...

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Fluorescence Imaging ◽

Imaging System ◽

Artery Aneurysm ◽

Craniocervical Junction ◽

Anterior Spinal Artery ◽

Posterolateral Approach ◽

Fluorescence Imaging System ◽

Ventral Spinal Cord

The authors report the case of a 78-year-old man with a craniocervical junction epidural arteriovenous fistula who presented with subarachnoid hemorrhage from a ruptured anterior spinal artery (ASA) aneurysm. Because endovascular embolization was difficult, a posterolateral approach was chosen and a novel endoscopic fluorescence imaging system was utilized to clip the aneurysm. The fluorescence imaging system provided clear and magnified views of the ventral spinal cord simultaneously with the endoscope-integrated indocyanine green videoangiography, which helped safely obliterate the ASA aneurysm. With the aid of this novel imaging system, surgeons can appreciate and manipulate complex vascular pathologies of the ventral spinal cord through a posterolateral approach, even when the lesion is closely related to the ASA.

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