2020 Volume 34 Issue 3 Pages 297-301
A spinal epidural arteriovenous fistula (AVF) is classified as a spinal arteriovenous malformation (AVM), and is much rarer than other types of AVMs. Spinal epidural AVF often presents with compressive myelopathy or radiculopathy due to the compression of the spinal cord outside the dura mater or root sleeves by an enlarged venous plexus. It is also accompanied by venous congestive myelopathy due to intradural venous reflux. The treatment of a spinal epidural AVF is occlusion of the shunt points or exclusion of an enlarged venous plexus if it compresses the spinal cord or root nerve. We report a rare case of spinal epidural hematoma caused by a spinal epidural AVF.
A 62-year-old man developed sudden neck pain, followed by quadriplegia and urinary disturbance over several hours ; the patient was transported to the hospital on that day. Cervical computed tomography showed that the ventral epidural hematoma extending between the C1 and C6 levels resulted in compression of the spinal sac. The patient did not have a traffic accident, or abnormalities in coagulation. Magnetic resonance T2-weighted images showed a T2-flow void along the C2 root sleeve ; therefore, we diagnosed the patient as a spinal epidural AVF with some dilated venous plexus by angiography. The main cause of the neurological deterioration was the compression of the spinal sac by the epidural hematoma, and there were no findings that the venous plexus compressed the root nerve. We performed endovascular embolization of the right vertebral artery and ascending pharyngeal artery using coils to reduce the flow of the spinal epidural AVF, and thereafter, C2-C6 decompressive laminectomy was performed. The patient's symptoms improved after the treatment. Spinal epidural hematoma caused by a spinal epidural AVF is rare, with only two cases reported to date of spinal epidural AVFs with a dilated venous plexus without intradural venous reflux. We report a case of a spinal epidural AVF with spinal epidural hematoma that was treated with neuro-intervention and microsurgery, with a good clinical course.
