A Case of Radicular Arteriovenous Fistula in the Cervical Spine

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  • Yonenaga Masanori
    Department of Neurosurgery, Kagoshima Prefectural Oshima Hospital Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Yamahata Hitoshi
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Tanaka Shunichi
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Yoshimoto Koji
    Department of Neurosurgery, Graduate School of Medical Sciences. Kyushu University
  • Kawahara Dan
    Somuta Neurosurgery Clinic
  • Hanaya Ryosuke
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University

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Other Title
  • 頚椎radicular arteriovenous fistulaの1例

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<p>  We report a case of spinal radicular arteriovenous fistula (SRAVF) at the lower cervical region in an 80-year-old woman who presented with a sudden onset of headache and nausea due to subarachnoid hemorrhage (SAH). Initial computed tomography (CT) showed an SAH mainly in the posterior cranial fossa. 3D-CT angiography (CTA) showed no intracranial aneurysm or dissection. The angiogram showed that the left C7 radiculomedullary artery (RMA) joined the anterior spinal artery (ASA), which supplied a feeding artery toward the AV shunt point at the left C8 level and a draining vein toward the cranial side from the shunt point. The feeding artery had an aneurysm, and there was no left C8 RMA. The preoperative diagnosis was SAH due to spinal perimedullary AVF, prompting a direct anterior approach on day 29. </p><p>  Intraoperative findings showed that the feeding artery from the ASA ran to the left side. An aneurysm was located in front of the spinal cord, and the AV shunt was found on the C8 nerve root, leading to the diagnosis of renal arteriovenous fistula (RAVF). To preserve the function of the left C8 nerve root, we did not cauterize the shunt on the nerve root but performed trapping of the aneurysm as proximal occlusion of the AVF. Intraoperative angiography confirmed the disappearance of the AV shunt. The postoperative course was uneventful; CTA one year after surgery showed no recurrence of the AVF.</p><p>  RAVF of the mid or lower cervical spine is rare, and its standard treatment has not been established. Detailed preoperative examination, including cone-beam CT and selective angiography, is useful for accurate diagnosis and appropriate treatment.</p>

Journal

  • Spinal Surgery

    Spinal Surgery 37 (3), 278-283, 2023

    The Japanese Society of Spinal Surgery

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