Arteriovenous Fistula of the Filum Terminale: Diagnosis, Treatment, and Literature Review
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Correspondence
Arteriovenous Fistula of the Filum Terminale: Diagnosis, Treatment, and Literature Review S. Fischer · M. Aguilar Perez · H. Bassiouni · N. Hopf · H. Bäzner · H. Henkes
Received: 4 August 2012 / Accepted: 22 November 2012 © Springer-Verlag Berlin Heidelberg 2012
List of Abbreviations AFT Artery of the filum terminale ASA Anterior spinal artery AV Arteriovenous AVFFT Arteriovenous fistula of the filum terminale DAVF Dural arteriovenous fistula DSA Digital subtraction angiography ICG Indocyanine green videoangiography IMAVM Intramedullary arteriovenous malformation LSA Lateral sacral artery PMAVM Perimedullary arteriovenous malformation SDAVF Spinal dural arteriovenous fistula Introduction The Foix–Alajouanine syndrome is characterized by an ascending myelopathy with progressive paraparesis of both H. Henkes () · S. Fischer · M. Aguilar Perez Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174 Stuttgart, Germany e-mail: [email protected] H. Bassiouni Neurochirurgische Klinik, Westpfalz Klinikum Kaiserslautern, Kaiserslautern, Germany N. Hopf Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany H. Bäzner Neurologische Klinik, Klinikum Stuttgart, Stuttgart, Germany H. Henkes Medizinische Fakultät der Universität Duisburg-Essen, Essen, Germany
legs, progressive and mostly symmetrical sensory deficit, and sphincter dysfunction. Dilated and tortuous epidural veins on the surface of an edematous spinal cord are the key finding on magnetic resonance imaging (MRI) [1, 2]. Edema, swelling, and malfunction of the spinal cord are essentially due to a venous congestion caused by an acquired arteriovenous (AV) shunt, which is mostly located in the spinal dura mater. We report on a patient presenting with a Foix–Alajouanine syndrome related to a perimedullary arteriovenous fistula (AVF) of the filum terminale (AVFFT) with supply from the artery of the filum terminale (AFT), with main tributaries from the ninth thoracic segmental artery and with collateral supply from the left lateral sacral artery (LSA). Diagnostic issues of this disorder and the treatment strategies are discussed. Case Report In April 2010, a 69-year-old man was referred to our institution with a predominantly asymmetrical paraplegia, progressive numbness of both legs, and bladder dysfunction with urinary retention. These symptoms were first observed several years earlier. The patient reported a fluctuating but essentially progressive course. The medical history included a stent treatment of an aneurysm of the abdominal aorta, performed in 2009. The patient had undergone a neurological workup including a spinal angiography 1 month earlier in another hospital without the detection of the suspected spinal AV shunt, and from there he was discharged with a recommendation of physiotherapy. MRI in April 2010 showed an edema of the conus medullaris and the thoracic spinal cord as well as dilated and tortuous spinal perimedullary veins (Fig. 1a, b).
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Fig. 1 a T2-weighted image of the thoracic spine in a patie
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