Document Detail

Intercostal arteriovenous fistula associated with neurofibromatosis manifesting as congestive myelopathy: case report.
MedLine Citation:
PMID:  17881941     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Vascular abnormalities associated with neurofibromatosis Type 1 (NF-1) are well known, but arteriovenous fistulae (AVF) are rare and usually involve vertebral AVF. A case of intercostal AVF associated with NF-1 and manifesting as congestive myelopathy is described. CLINICAL PRESENTATION: A 62-year-old woman with a medical history of NF-1 experienced gradually worsening gait disturbance. Neurological examination at the time of admission found spastic paraparesis, decrease of sensation in the bilateral lower extremities, and vesicorectal disturbance. Magnetic resonance imaging scans revealed flow void sign and a congestive lesion of the thoracolumbar spinal cord, as well as a huge mass in the paravertebral region at T10-T12. Spinal angiography revealed an intercostal AVF with a large paravertebral varix, which drained to the spinal medullary vein and caused dilation of the intradural venous plexus of the spinal cord resulting in congestive myelopathy. INTERVENTION: Direct surgery was selected for the occlusion of the draining point of the medullary vein, located in the entry of the dura. The patient underwent hemilaminectomy at T10-T12, and the dural entry of the draining vein was occluded. Postoperative angiography revealed no dilated venous plexus of the spinal cord and reduced paravertebral varix. The symptoms were gradually relieved after the surgery. CONCLUSION: The present case of a very rare intercostal AVF with an unusual manifestation of congestive myelopathy occurred in a relatively rare association with NF-1. Accurate evaluation of the vascular anomaly allowed selection of the appropriate surgical method.
Atsushi Saito; Toshiyuki Takahashi; Masayuki Ezura; Teiji Tominaga
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  61     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-20     Completed Date:  2007-11-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E656-7; discussion E657     Citation Subset:  IM    
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
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MeSH Terms
Arteriovenous Fistula / complications,  pathology*
Diagnosis, Differential
Intercostal Muscles / pathology*
Middle Aged
Neurofibromatoses / complications,  pathology*
Spinal Cord Diseases / complications,  pathology*
Thoracic Vertebrae / pathology

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