Spinal epidural arteriovenous fistula with late onset perimedullary venous hypertension after lumbar surgery: case report and discussion of the pathophysiology

Spine
Ahmad KhaldiThomas C Origitano

Abstract

Case report and literature review. Spinal epidural arteriovenous fistulas with secondary reflux into the perimedullary veins are rare. We report a patient who presented with delayed progressive congestive myelopathy after lumbar surgery. The pathophysiology and the anatomic basis for the responsible arteriovenous fistula are discussed. Delayed neurological deterioration after spinal surgery is uncommon. Epidural fistulae uncommonly may become symptomatic from an epidural hematoma, mass effect from distended veins, and rarely from a spinal dural arteriovenous fistula. We report on a patient with delayed progressive congestive myelopathy after lumbar surgery, and discuss the pathophysiology and the anatomical basis for the causative fistula. A 68-year-old man presented with progressive lower extremity weakness and sensory decrease, and loss of sphincter control 2 years after unilateral lumbar laminectomy and fusion for a disc herniation. MRI showed diffuse new cord edema and intradural perimedullary dilated vessels. Spinal angiography revealed an epidural arteriovenous fistula at the site of the previous laminectomy, with intradural perimedullary venous drainage. The fistula was successfully treated surgically and the patient exp...Continue Reading

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Citations

Sep 17, 2013·Journal of Neurosurgery. Spine·Wendy HuangRose Du
Mar 28, 2013·Journal of Neurointerventional Surgery·Dinesh RamanathanBasavaraj V Ghodke
Jan 23, 2016·Journal of Neurointerventional Surgery·Waleed BrinjikjiGiuseppe Lanzino
May 8, 2015·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·Toshiharu MurakamiHiroyuki Nakase
Jul 5, 2017·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·Giacomo TalentiFrancesco Causin
Oct 19, 2011·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·G DabusE J Russell

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