Spinal Sparganosis Coexisting with Acquired Arteriovenous Fistula of the Filum Terminale

Iampreechakul, Prasert; Tirakotai, Wuttipong; Lertbutsayanukul, Punjama; Khunvutthidee, Sirirat; Thammachantha, Samasuk; Siriwimonmas, Somkiet

doi:10.1016/j.wneu.2020.01.132

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…Based on intraoperative findings, few studies showed the evidence of thickened and opaque arachnoid membrane, adhesions between the nerve roots, and/or chronic inflammation, probably being the precipitating factors involving in the formation of FTAVF. [ 13 , 15 ] In our case, we found the evidence of thickened and opaque arachnoid membrane and adhesions between the cauda equina roots during surgery.…”

Section: Discussionsupporting

confidence: 48%

Sacral dural arteriovenous fistula of the filum terminale coexisting with partially thrombosed filum vein: A case report and literature review

Iampreechakul

Wangtanaphat

Angsusing

et al. 2022

Surgical Neurology International

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Background: Filum terminale arteriovenous fistulas (FTAVFs) are rare and usually classified as intradural ventral AVFs or Type IVa perimedullary fistulas, located on the pia surface along the course of filum terminale internum (FTI). We report an extremely rare case of sacral dural arteriovenous fistula of the FT. We also review the occurrence of FTAVFs in the sacral region. Case Description: A 64-year-old man presented with progressive weakness of the lower extremities for 3 months and bowel/bladder dysfunction following long history of back pain radiating to both legs. Magnetic resonance imaging of the lumbosacral and thoracic spine showed spinal cord congestion, extending from the conus medullaris to the level of T3, and partial thrombosis within the abnormal tortuous and dilated flow void, running from the sacral area to conus medullaris. Further findings were compression fracture of L2 vertebra, Grade I degenerative spondylolisthesis at the level of L2-3, and L3-4, and spinal stenosis at L2-3, L3-4, and L4-5. Spinal angiography, maximum intensity projection reformatted image of angiographic computerized tomography, and three-dimensional reconstructed image clearly demonstrated dural AVF of the FT at the level of S2 supplied by bilateral lateral sacral and middle sacral arteries with cranial drainage to perimedullary vein through the enlarged vein of the filum. The patient was indirectly treated by transection of the filum terminale and the draining vein at the level of L5 rostral to the fistula. Conclusion: Sacral DAVFs of the FT are extremely rare. In our case, the formation of fistula may cause by venous hypertension secondary to partial thrombosis within the filum vein, probably resulting from long-standing spinal canal stenosis. Sacral FTAVFs may be found on the pia surface of the terminal FTI, dural component at the area of dural sac termination, or dural extension covering the filum terminale externum.

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Section: Discussionsupporting

confidence: 48%

Sacral dural arteriovenous fistula of the filum terminale coexisting with partially thrombosed filum vein: A case report and literature review

Iampreechakul

Wangtanaphat

Angsusing

et al. 2022

Surgical Neurology International

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“…However, our review showed that the median age of patients at the time of FT PAVF diagnosis was 58.9 ± 12.9 years, which argues against a purely congenital origin. 4,25 Therefore, both congenital and acquired factors may be involved in the origins of FT PAVFs.…”

Section: Discussionmentioning

confidence: 99%

Treatment of filum terminale pial arteriovenous fistulas in the sacral region: A case report and systematic review

Guo

2022

Neuroradiol J

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Spinal filum terminale pial arteriovenous fistulas (FT PAVFs) are uncommon. Most FT PAVFs are located in the lumbar region; far fewer are located in the sacral region. Due to the rarity of sacral FT PAVFs, the precise surgical dissection and removal of these lesions are challenging. Here, we report an FT PAVF in the sacral region. The patient was a 45-year-old male who suffered from progressive weakness and numbness of the bilateral lower limbs; his symptoms gradually worsened. Digital subtraction angiography (DSA) showed an AVF at the sacral canal at the S3-4 level. Microsurgical treatment with intraoperative DSA was performed, and the FT PAVF was resected. After the operation, the patient gradually recovered. Follow-up magnetic resonance imaging revealed a recession in the dilation of the spinal cord venous plexuses. A literature review was also performed, and a total of 14 FT PAVFs of the sacral region were identified. The patients identified in the literature review had an average age of 58.9 ± 12.9 years, and 92.9% of the patients were male. Spinal cord edema was present in 85.7% of the FT PAVF patients. Regarding treatment, 64.3% of the FT PAVF patients underwent microsurgical resection, 28.6% patients underwent endovascular treatment, and 7.1% patients underwent a hybrid operation; good outcomes were achieved with all three methods. Therefore, FT PAVF of the sacral region is a unique lesion whose angioarchitecture needs to be identified carefully; prompt treatment is necessary, and microsurgery can yield good outcomes.

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“…The patient underwent surgical removal of the granulation tissues with lysis adhesions and obliteration of the FTAVF simultaneously in the same surgical session with good recovery. [ 17 ] Subsequently, we reported another three cases with acquired FTAVFs, probably secondary to the severe spinal canal stenosis, and reviewed the literature about this condition in another 17 patients. [ 18 ] We found that the level of the fistulas in most patients is correlated with the level of spinal canal stenosis that may induce local injury or inflammation of the filum terminale and produce fistula formation.…”

Section: Discussionmentioning

confidence: 99%

Filum terminale arteriovenous fistula coexisting with a large L2–L3 disc sequestration and associated diffuse lumbar arachnoiditis

et al. 2021

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The authors describe a case of filum terminale arteriovenous fistula (FTAVF) in association with a large L2–L3 disc sequestration and diffuse lumbar arachnoiditis. A 64-year-old male manifested with chronic back pain and gait difficulty. Magnetic resonance imaging (MRI) of the thoracic and lumbosacral spine revealed spinal cord congestion extending from the conus medullaris to the level of T9. There was a large disc sequestration came from L2–L3 disc herniation. In addition, thickening, clumping, and enhancement of the entire cauda equina were noted, probably representing arachnoiditis. MR angiography (MRA) and spinal angiography confirmed FTAVF at the level of L5. The patient underwent laminectomy with lysis adhesions and obliteration of the fistula. His postoperative course was uneventful. MRI and MRA of the thoracolumbar spine obtained 4 months after surgery revealed complete obliteration of the fistula and significant resolution of spinal cord congestion. Enhancement of the cauda equina roots was no longer visible. Interestingly, the significant resorption of the sequestrated disc was documented on MRI. The formation of the FTAVF in the present study may result from severe spinal canal stenosis caused by a large disc sequestration blocking the rostral venous drainage of the fistula, or chronic inflammation, and adhesions of the caudal nerve roots from lumbar arachnoiditis. It seems that FTAVF may be of acquired origin by this evidence.

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Spinal Sparganosis Coexisting with Acquired Arteriovenous Fistula of the Filum Terminale

Cited by 8 publications

References 15 publications

Sacral dural arteriovenous fistula of the filum terminale coexisting with partially thrombosed filum vein: A case report and literature review

Sacral dural arteriovenous fistula of the filum terminale coexisting with partially thrombosed filum vein: A case report and literature review

Treatment of filum terminale pial arteriovenous fistulas in the sacral region: A case report and systematic review

Filum terminale arteriovenous fistula coexisting with a large L2–L3 disc sequestration and associated diffuse lumbar arachnoiditis

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