A Radicular Arteriovenous Fistula in a Patient presenting with Subarachnoid Hemorrhage

Abstract

  A 55-year-old woman presented with subarachnoid hemorrhage. Digital subtraction angiography (DSA) showed AVF with a varix fed by cervical spine (C) 5 radicular arteries. We performed urgent TAE for the C5 radicular artery with coils followed by direct surgery. The small vessels were intricately wrapped around the C5 nerve root and drained into the varix, which existed between the right C5 ventral and dorsal nerve root. From these operative findings, we diagnosed this lesion as C5 radicular AVF. The varix and surrounding small vessels were coagulated step-by-step, and postoperative DSA showed that the AVF had completely disappeared. Although our initial diagnosis for this patient was spinal dural AVF presented with subarachnoid hemorrhage, we finally diagnosed this lesion as radicular AVF using the intraoperative findings. Radicular AVF looks like spinal dAVF, but is different in anatomical features and symptoms. We can recognize radicular AVF as a differential diagnosis from dAVF by the fistulous point.