Spinal arteriovenous malformation in a pediatric patient with a history of congenital syphilis: a case report

Abstract

Background Spinal arteriovenous malformations in children are extremely rare and pose great risk for intraoperative hemorrhage. Congenital syphilis sometimes presents with vascular symptoms, however, there is little published on patients with a history of congenital syphilis presenting with spinal arteriovenous malformations. Case presentation A 15-month-old female with a history of congenital syphilis presented with urinary retention, fever, and subacute onset of paraplegia. MRI showed a lesion at T8-L1, angiogram was performed which confirmed the presence of a complex type IVc arteriovenous malformation and fistula from Artery of Adamkiewicz at L1-L2. It also showed peri medullary dilated veins and a pseudoaneurysm that compressed the spinal cord at T8-T10. Somatosensory evoked potentials and motor-evoked potentials were not recordable on the bilateral lower extremities prior to surgery. Once the patient was optimized for surgery, osteoplastic laminotomies from T6-T12 were performed. The dura was opened and the intradural, intramesenchymal hematoma was evacuated. There were two episodes of brisk arterial bleeding with hypotension during resection of the hematoma. The patient was taken to the angiography suite from the OR to successfully coil the large aneurysm. Intraoperative spinal cord monitoring remained undetectable in the bilateral lower extremities. The patient’s paraplegia remained unchanged from preoperative presentation. Conclusion Congenital syphilis may present with vascular changes that might impact surgical approaches and treatment outcomes in patients with spinal arteriovenous malformations. Preparation for massive transfusion and intraoperative monitoring are imperative in ensuring a safe perioperative experience.

Salvageable Intra-stent Coil Embolization Treatment for Spinal Dural Arteriovenous Fistula in a Child

“…Complications of endovascular interventions include hemorrhage, dissection of vessels, spasm, or, in more severe cases, the occlusion of vessels and ischemia [8,14]. This sheds light on the importance of preoperative planning and the presence of a multidisciplinary team to minimize the risk of complications.…”

“…However, this may be related to the fact that patients who undergo open vascular interventions are often more complex and have already attempted endovascular interventions. Complications of endovascular interventions include hemorrhage, dissection of vessels, spasm, or, in more severe cases, the occlusion of vessels and ischemia [ 8 , 14 ]. This sheds light on the importance of preoperative planning and the presence of a multidisciplinary team to minimize the risk of complications.…”

“…Moreover, the presentation of such patients poses a diagnostic challenge to treating physicians. The symptoms include neurological deficits such as impaired sensation, paralysis, disturbed micturition, and defecation [ 4 , 7 , 8 ]. Moreover, patients may present with back pain due to subarachnoid hemorrhage [ 7 , 8 ].…”

“…The symptoms include neurological deficits such as impaired sensation, paralysis, disturbed micturition, and defecation [ 4 , 7 , 8 ]. Moreover, patients may present with back pain due to subarachnoid hemorrhage [ 7 , 8 ].…”

“…There are four reported types of spinal arteriovenous malformations (AVMs) i.e., type I spinal dural AVMs, which are slow-flow lesions that mostly occur in adulthood; type II spinal glomus AVMs, which are congenital and considered high-flow lesions; type III spinal juvenile AVMs, which form prenatally and are high-flow lesions; and type IV intradural perimedullary AVMs, which are pia-based lesions [ 8 , 11 , 12 ]. We report a rare case of type IV SDAVF in a child who was treated with endovascular embolization.…”