CASE REPORTS   

Journal of Neurosurgical Sciences 2009 September;53(3):119-23

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English

Total occlusion of a conus medullaris pial arteriovenous malformation obtained with one session of superselective embolization

Carangelo B., Casasco A. E., Vallone I., Peri G., Cerase A., Venturi C., Palma L.

¹ Department of Neurosurgery, University of Siena, Siena, Italy; ² Department of Endovascular and Percutaneous Therapy, Clinica Nuestra Señora del Rosario, Madrid, Spain; ³ Unit of Diagnostic and Therapeutic Neuroradiology, Siena University Hospital, “Santa Maria alle Scotte” Polyclinic, Siena, Italy

The authors report about a case of the endovascular treatment of a pial arteriovenous malformation (AVM). The lesion was located on the conus medullaris. This injury is a rare spinal AVM. The diagnostic management and surgical treatment was chosen with a collaboration between neurosurgeons and neuroradiologists. The diagnostic management was based on clinical validation and magnetic resonance with angiographic technique as a gold standard. With regard to the surgical treatment of spinal AVM, endovascular and radiotherapy is a decision which should be taken multidisciplinarily. The treatment is crucial in resolving this lesion. The authors describe the case of a 38-year-old girl with clinical findings of progressive radiculomedullary ischemic process caused by the presence of spinal AVM. The angiographic images showed a pial AVM of the conus medullaris fed by an anterior radiculomedullary artery (Adamckiewiz artery) originated from a left T11 dorsospinal artery and by a posterior radiculopial artery originated from the left L1 artery. The draining veins were posterior pial veins, and accessory anterior subpial veins. Even if the first treatment of a pial arteriovenous malformation (AVM) of conus medullaris can be the surgical treatment for posterior localization, a neurointerventional angiographic and modern materials make it possible to reach pial AVMS of conus medullaris avoiding surgery. The authors describe a successful treatment of conus medullaris arteriovenous malformation with a one session of superselective embolization.