Document Detail

A transmedullary approach to occlusion of a ventral perimedullary arteriovenous fistula of the thoracic spinal cord.
MedLine Citation:
PMID:  20173556     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: A spinal perimedullary arteriovenous fistula (PMAVF) is a direct fistula of one or more spinal arteries into the perimedullary venous network with reversed venous flow and subsequent venous congestion of the spinal cord. The therapeutic goal of surgery is to normalize the venous drainage by obliterating the fistula. Strictly ventral lesions typically require an anterior approach to ensure adequate exposure of the fistula as well and the preservation of the physiological blood supply to the spinal cord. CLINICAL PRESENTATION: We present a case of a ventral PMAVF at the level of T10 with feeders from the anterior spinal artery, caudally draining veins on the ventral spinal cord, and a dilated transmedullary vein filling cranially draining veins on the dorsal aspect of the spinal cord. TECHNIQUE: The dilated transmedullary vein was approached by a laminectomy. The vein was coagulated, and the gliotic channel was used to approach the ventral fistula site from the dorsal surface of the spinal cord. Complete obliteration of the fistula was achieved, and the preoperative neurological deficit improved. CONCLUSION: We conclude that transmedullarly draining veins offers a possible dorsal approach for the occlusion of some ventral PMAVFs, thus avoiding more complex anterior approaches to the ventral spinal cord.
Alf Giese; Peter A Winkler; Christian Schichor; Sven Rainer Kantelhardt; Tobias Boeckh-Behrens; Joerg C Tonn; Veit Rohde
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  66     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-22     Completed Date:  2010-05-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  611-5; discussion 615     Citation Subset:  IM    
Department of Neurosurgery, Georg-August-University, G?ttingen, Germany.
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MeSH Terms
Central Nervous System Vascular Malformations
Laminectomy / methods*
Magnetic Resonance Imaging
Spinal Cord / surgery
Thoracic Vertebrae / surgery
Treatment Outcome
Vascular Surgical Procedures / methods*

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