Multiple arteriovenous malformations of the spinal cord in an adolescent: case report

We report long-term follow-up of a rare multiple arteriovenous malformation of the spinal cord in a 15-year-old patient. A significant reduction in the size of the lesion was achieved by microsurgical resection of the dorsal and lateral portions. This eliminated the initial source of subarachnoid haemorrhage, and the patient's condition remained stable for 10 years. Renewed angiography of the residual ventrolateral malformation became necessary after recurrent subarachnoid haemorrhage, and the centre of the malformation was embolised selectively with bucrylate. Following embolisation, prophylactic treatment with steroids and heparin led to rapid improvement of the pre-embolisation symptoms. Our observations indicate that venous flow in the spinal cord is highly sensitive to haemodynamic changes. The angioarchitecture was indicative of multifocal arteriovenous shunts, an extremely rare condition, and the question arises whether these shunts were acquired or congenital.