gms | German Medical Science

Objective: Among the entity of spinal cord vascular malformations we distinguish between cavernomas, arteriovenous malformations (AVMs) and the presumably acquired dural arteriovenous fistulae. Since clinical symptomatology might be similar, differentiation between these lesions is only possible with angiographic criteria. The coincidence of two of these scarce entities is extremely rare, the concurrence of a spinal glomerular and perimedullary AVM has until now not been described.

Methods: We report on a 36-years-old patient who harboured both a glomerular AVM and an AVM of the perimedullary fistulous type that were fed by the same dorsolateral radiculomedullary artery. The patient endured a five year history with unspecific slowly developing sensorimotor deficits as paraparesis and hypoaesthesia of both legs. MRI demonstrated cord edema, and a conglomerate of intramedullary located vessels and dilated perimedullary veins. The intramedullary nidus was located lateral to the spinal cord at Th12. On selective spinal angiography, the glomerular AVM at TH12 could be identified as being fed by the anterior spinal artery that arose from Th9 and from a dorsolateral artery arising from L2. In addition, from the same dorsolateral artery, a delayed filling of a perimedullary fistula (Type 1) that was located at L1 with the fistulous zone clearly separated from the glomerular AVM could be visualized. These findings altered the therapeutic strategy and the patient underwent endovascular therapy via the L2 segmental artery employing particles resulting in complete obliteration of the perimedullary fistula and of those nidus parts of the glomerular AVM that were fed from the dorsolateral artery. At discharge the patient´s neurological status had improved.

Results: This case report underlines, that using MRI alone, the type of AVM can not be differentiated, instead, selective arterial angiography is necessary to plan the therapeutic approach that was chosen to be endovascular in this case, since it was felt that both AVMs could be treated least invasively via the same feeding segmental artery.

Conclusions: The concurrence of two spinal arteriovenous malformations is a rare finding but might alter the therapeutic strategy and should therefore be kept in mind.