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KMID : 1099620100070020107
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Korean Journal of Spine
2010 Volume.7 No. 2 p.107 ~ p.110
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Spinal Intradural Ventral Arteriovenous Fistula Mimicking an Intramedullary Ependymoma - A Case Report -
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오선규:Oh Sun-Kyu
:Bae Chae-Wan/:Ahn Jae-Sung/:Rhim Seung-Chul
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Abstract
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We present a rare case of an intradural ventral arteriovenous fistula(AVF) mimicking an intramedullary ependymoma. A 46-year-old woman presented with sudden onset of right leg weakness, which she had been experiencing for two weeks. Whole-spine magnetic resonance imaging(MRI) scan revealed a 0.5-cm-sized intramedullary lesion of high signal with a dark signal rim on a T2-weighted image at the T9 level. The T1-weighted MRI after contrast enhancement revealed a nodular and rim-like enhancement. However, a signal void, likely to be seen in the case of an engorged vein, was not obvious, thus giving the impression of an intramedullary ependymoma. Surgery was planned, but was aborted due to the observation of a large engorged vein as soon as the dura was opened. Spinal angiogram demonstrated a small intradural ventral AVF with a single feeding artery from the upper limb of the radiculomedullary artery at the T9 level on the left side. Endovascular embolization was performed but failed due to unex- pected vasospasm resulting in paraplegia. Finally, the patient underwent re-exploration and surgical ligation of the AVF. The postoperative angiogram demonstrated complete obliteration of the fistula. Most spinal AVFs are found in elderly patients, as spinal degenerative diseases or neoplasms. Although it is a rare disease, clinicians should be aware of the occurrence of spinal AVFs, because their misdiagnoses can result in progressively disabling neurologic conditions. Thus, clinicians must attempt to correctly diagnose spinal AVFs at the first examination.
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KEYWORD
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Intradural arteriovenous fistula, Intramedullary ependymoma, Indocyanine green fluorography
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