gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Pelvic arteriovenous malformation concealing a spinal dural arteriovenous fistula

Meeting Abstract

  • Ehab Shiban - Department of Neurosurgery, Technical University of Munich, Germany
  • Jens Lehmberg - Department of Neurosurgery, Technical University of Munich, Germany
  • Florian Ringel - Department of Neurosurgery, Technical University of Munich, Germany
  • H. Eckstein - Department of Vascular Surgery, Technical University of Munich, Germany
  • T. Liebig - Department of Neuroradiology, Technical University of Munich, Germany
  • Bernhard Meyer - Department of Neurosurgery, Technical University of Munich, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1854

DOI: 10.3205/10dgnc325, URN: urn:nbn:de:0183-10dgnc3258

Published: September 16, 2010

© 2010 Shiban et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Spinal dural arteriovenous fistula (SDAVF) is a disease that is not efficiently diagnosed. Due to nonspecific and manifold clinical symptoms, there is a long delay between onset of first symptoms and definitive diagnosis. We report the case of a patient with progressive myelopathy believed to be caused by a large pelvic arteriovenous malformation which concealed a thoracic SDAVF.

Case illustration: A 62-year-old man presented with symptoms of progressive partial spinal paralyses. MRI showed edema of the thoracic cord and regional dilated perimedullary vessels. Repeated spinal angiograms failed to demonstrate a spinal d-AVF, however a large pelvic arteriovenous malformation was incidentally found. The pelvic AVM was repeatedly partially embolizes but failed to to yield any relief to the patient’s symptoms, the problems remained progressive. We performed a complete embolisation followed by AVM shunt disconnection. Thereafter his symptoms were regressive. Two months later the patients was readmitted because of renewed progressive symptoms. MRI showed a progressive congestive myelopathy. Pelvic angiogram showed no revascularization of the pelvic AVM. A spinal dural fistula was not detected by a renewed spinal angiogram. A multidetector computed tomographic angiography revealed a Th3 arteriovenous fistula. This was then clipped and the patient’s symptoms were regressive.

Conclusions: Spinal dural AVF is often misdiagnosed. In middle aged patients especially men with ascending motor or sensory deficits in the legs, spinal d-AVF should be considered. Multidetector computed tomographic angiography is a very useful diagnostic tool for its detection.