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Exclusively epidural spinal metameric arteriovenous shunts: case report and literature review
Alaa Elkordy1, Toshiki Endo2, Kenichi Sato3
1Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan; Department of Neuroendovascular Therapy, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan; Neuroendovascular Section, Department of Neurology, Tanta University, 45 El-Geish St., Tanta 31111, Egypt.
Background Context:
Spinal arteriovenous metameric syndrome (SAMS) is a subgroup of spinal arteriovenous malformations (AVMs). Most SAMS cases have intra- and extradural AVMs and suffer from hematomyelia, subarachnoid hemorrhage, or venous congestive myelopathy.
Purpose:
To present a rare case of SAMS in which spinal AVMs were exclusively epidural. We reviewed previous literature and evaluated the feasibility of a treatment strategy using endovascular interventions, followed by surgical obliteration.
Study Design:
A case report and literature review of SAMS.
Methods:
We report a case of a 15-year-old boy suffering from SAMS in which epidural venous ectasia because of extradural AVMs caused spinal cord compression.
Results:
The patient was successfully treated with multiple sessions of transarterial embolization followed by open surgery. After the treatment, his neurologic deficits resolved. Postoperative angiography confirmed complete obliteration of extradural AVMs.
Conclusions:
Although exclusively epidural spinal AVM is an uncommon type of SAMS, combined endovascular and surgical interventions can be an effective treatment for AVMs to achieve better radiologic outcomes and complete resolution of patient symptoms.
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