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Updated: Jun 12, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Pediatric high-flow, cervical spinal, macro-arteriovenous fistula, treated with the endovascular cotton candy glue
Yuo Iizuka1, Ehiichi Kohda, Yoshiyuki Tsutsumi
1Department of Radiology, Stroke Center Toho University Ohashi Medical Center, Ohashi 2-17-6, Meguro-ku, Tokyo, 153-8515, Japan. yuoii@med.toho-u.ac.jp
Case Report:
A 3-year-old boy presented to our hospital with progressive neurological deficits. Spinal magnetic resonance imaging (MRI) revealed a perimedullary macro-arteriovenous fistula (PMAVF) resulting in a large venous pouch within the parenchyma of the lower cervical spinal cord. Transarterial varix embolization of the fistula from the venous side was performed using N-butyl cyanoacrylate with tantalum powder. Postembolization angiography confirmed obliteration of the fistula, and MRI revealed thrombosis and reduction in size of the venous component. The patient's clinical symptoms were reduced dramatically following the intervention, and no neurological complications occurred due to the treatment. The prognosis of spinal PMAVF depends primarily on the presence of medullar signs and symptoms and on time to treatment. The volume of the venous pouch after the intervention was markedly reduced, and complete clinical recovery was obtained. Urgent endovascular intervention, as seen in this case, is considered first-line therapy and aims to decrease the risk of neurological sequela.
Insights
A pediatric case of spinal perimedullary macro-arteriovenous fistula (PMAVF) was successfully treated with endovascular embolization. This urgent intervention led to significant symptom reduction and complete clinical recovery in a young patient.
Area of Science:
- Neurology
- Interventional Radiology
- Pediatric Neurosurgery
Background:
- Spinal perimedullary macro-arteriovenous fistulas (PMAVFs) are rare vascular malformations presenting with progressive neurological deficits.
- Early diagnosis and treatment are crucial for preventing irreversible neurological damage.
Observation:
- A 3-year-old boy presented with progressive neurological deficits.
- Spinal MRI revealed a perimedullary macro-arteriovenous fistula with a large venous pouch in the lower cervical spinal cord.
Findings:
- Transarterial embolization using N-butyl cyanoacrylate achieved fistula obliteration.
- Post-embolization imaging confirmed thrombosis and reduced venous pouch size.
- The patient experienced dramatic symptom reduction and complete clinical recovery without neurological complications.
Implications:
- Urgent endovascular intervention is the first-line therapy for spinal PMAVF.
- Prompt treatment significantly reduces the risk of neurological sequelae.
- Successful embolization can lead to complete recovery in pediatric patients with spinal PMAVF.
