2012 Volume 6 Issue 1 Pages 32-39
Objective: We report a case of giant cervical paravertebral arteriovenous shunt (AVS) with multiple dural arteriovenous fistulas (dAVFs) at the C1-2 cervical level successfully managed with embolization.
Case presentation: A 47-year-old male presented with progressive myelopathy and mild heart failure. Workup imaging studies indicated a giant cervical paravertebral arteriovenous shunt with soft tissue arteriovenous malformation (AVM) suggesting a diagnosis of spinal arteriovenous metameric syndrome (SAMS). Numerous feeding arteries contributed to these lesions and the shunt volume was extremely large. Transarterial and transvenous embolization of this huge paraspinal AVS did not improve his symptoms. The finding of multiple dAVFs located at the C1-2 cervical space on follow-up angiography after the 11th session led to the suspicion that these dAVFs were responsible for his myelopathy. His symptoms improved after the treatment of these dAVFs.
Conclusion: Precise diagnosis of the lesion responsible for the main symptom is mandatory in the treatment of complex spinal AVS, such as occurs in SAMS.
