Epidural Arteriovenous Fistula After Endoscopic Lumbar Laminectomy: A Rare Postoperative Presentation

Spinal dural and epidural arteriovenous fistulas (AVFs) are rare. However, the presentation of epidural AVFs after endoscopic surgery has rarely been described. This article reports a rare case of an epidural AVF that presented after an endoscopic lumbar laminectomy. A 58-year-old man underwent endoscopic lumbar laminectomy at the L2-L4 level with 50 ml of intraoperative blood loss and no intraoperative complications, including bleeding, dural injury, or cerebrospinal fluid (CSF) leakage. He presented with recurrent motor and sensory disturbances in the right lower extremity. Follow-up magnetic resonance imaging (MRI) examination four months after endoscopic surgery revealed a hyperintense lesion in the lower thoracic spinal cord. Steroid pulse therapy and plasma exchange for possible myelitis failed to improve neurological deficits. During this period, motor and sensory disturbances in the left lower extremity and dysuria appeared. Repeated MRI revealed multiple flow voids ventral and dorsal to the thoracic spinal cord. Selective angiography of the right segmental L2 artery revealed an epidural AVF fed by a dorsal somatic branch. The epidural AVF drained retrogradely into the perimedullary vein. Direct obliteration of the epidural AVF was planned. The epidural AVF was successfully treated surgically. Postoperatively, the motor weakness in the lower extremities and dysuria resolved. No recurrence occurred after seven months. Epidural AVFs can present following endoscopic lumbar laminectomy. This condition should be considered a rare postoperative manifestation.