Cervical Epidural Arteriovenous Malformation Occurring with a Spinal Neurofibroma

Abstract

ASCULAR lesions of the spinal cord are a well-recognized entity, having been comprehensively reviewed by Elsberg, 3 Wyburn-Mason, 6 and more recently by Odom. 4 Epidural vascular lesions are commonly hematomas or hemangiomas. Arteriovenous fistulas involving the vertebral vessels in the neck have occasionally been reported? ,2 .~ Nearly all of these fistulas have resulted from penetrating neck injuries, and the venous component has not primarily involved the epidural space. To our knowledge, only a single case of congenital arteriovenous malformation of the vertebral vessels has been reported2 The purpose of this report is to present an unusual case having this rare epidural vascular anomaly in addition to a spinal neurofibroma. We also wish to emphasize the method of angiographic study using selective arterial catheterization with subtraction. Case Report History. The patient, a 17-year-old righthanded Negro male, was admitted on December 17, 1965, with complaints of weakness of the right arm and pain in the neck and right shoulder. While lifting a heavy object in August, 1965, he turned his head from right to left and immediately felt pain in the neck. This later radiated to the right shoulder. The pain was intermittent, occurring 3 to 4 times per day and at night. Cervical motion and coughing increased the pain, which was worse nocturnally. In November, 1965, his neck was stiff and he had a limited range of cervical motion. Numbness began in the right index finger and then involved the remaining fingers of that hand. A progressive weakness of the right arm and

Spinal extradural arteriovenous fistulas

“…Each report documented 1 [3][4][5]7,8,12,14,15,20,23,24,27,[29][30][31][32][33]35,37,[39][40][41][42][43][45][46][47][48][50][51][52][55][56][57][58][59]64,[67][68][69][70][71][72][73] or 2 1,9,11,13,16,19,28,38,49,62,…”

Spinal extradural arteriovenous malformations with parenchymal drainage: venous drainage variability and implications in clinical manifestations

“…5,13 It is possible that these extradural AVM/ AVFs arise as congenital or acquired lesions; interestingly, the patient in Case 4 developed a fistula 30 years following laminectomy, supporting the possibility that these lesions are acquired. Purely extradural AVFs have been associated with penetrating and nonpenetrating trauma, neurofibromatosis, 7 and other more extensive vascular malformations.…”

Exclusively Epidural Spinal Arteriovenous Malformation: A Short Review

“…In 1966, Hoffman was the first to report EESAVM confirmed by angiography [18]. The so called modern era in the treatment of spinal vascular malformation began in 1969 with Krayenbuhl and Yasargil and the publication of their microsurgical techniques, based heavily on the use of the operating microscope and bipolar cautery [19][20][21].…”

“…Most reported cases (62.5%) treated by surgical operation or combined with embolization have no residual neurological symptoms (Table 1). Harry reported a seventeen years old male with EESAVM in 1967, he was died of introduction of anaesthesia rather than the EESAVM itself [18], except this case all cases postoperative neurological syndromes had improvement. After 1990, all the reported cases treated by surgical operation can walk post-operation with or without support; no patient neurological symptoms get worse than pre-operation.…”

“…Unruptured EESAVM may symptomless, or present as protracted, progressive neurological decline [18,23,33,34]. Ruptured EESAVM may present acute back or thoracic pain subsequently with paraplegia [17,[24][25][26][27][28][29]31,32,36].…”