Skip to main content
SpringerLink
Log in

A case of arteriovenous fistula of the cauda equina fed by the proximal radicular artery: anatomical features and treatment precautions

  • Case Report
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Arteriovenous fistula (AVF) of the cauda equina (CE) fed by the proximal radicular artery (PRA) is very rare, and the differentiation from that of the filum terminale (FT) is important to avoid treatment-related injury to the CE when endovascular treatment is selected. The authors describe a case of AVF of the CE fed by the PRA, demonstrate the anatomical features and discuss the treatment precautions.

Methods

A 69-year-old man presented with a transient weakness of lower limbs. Spinal angiography and magnetic resonance (MR) imaging revealed AVF, of which the feeding artery arose from the anterior spinal artery (ASA), forming the fistula at L2 level to be drained into the longitudinal venous trunk. Under a tentative diagnosis of AVF of the FT, endovascular treatment was attempted but failed due to impossible catheterization into the ASA. Therefore, surgery was performed.

Results

Intraoperative finding revealed that the feeding artery and draining vein were not on the FT but on the CE, resulting in the proper diagnosis of AVF of the CE. Surgical clips were applied to the draining vein closest to the fistula, and postoperatively the symptom improved gradually. Although we thoroughly reevaluated spinal angiography and MR images postoperatively, AVF of the CE fed by the PRA and that of the FT were not distinguishable.

Conclusions

The authors described a case of AVF of the CE fed by the PRA and demonstrated the difficulty of the differentiation from that of the FT. The utmost precautions are necessary when endovascular treatment is selected.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Abbreviations

AVF:

Arteriovenous fistula

ASA:

Anterior spinal artery

CE:

Cauda equina

FT:

Filum terminale

MR:

Magnetic resonance

PRA:

Proximal radicular artery

PSA:

Posterior spinal artery

References

  1. Ohtonari T, Ota S, Nishihara N, Suwa K, Ota T, Sekihara Y, Tanaka A, Koyama T (2011) Arteriovenous fistula in a nerve root of the cauda equina fed by a proximal radiculo-medullary artery: a report of two cases. Interv Neuroradiol 17(2):217–223

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Rodesch G, Hurth M, Alvarez H, Tadié M, Lasjaunias P (2002) Classification of spinal cord arteriovenous shunts: proposal for a reappraisal—the Bicêtre experience with 155 consecutive patients treated between 1981 and 1999. Neurosurgery 51(2):374–380

    PubMed  Google Scholar 

  3. Hong T, Park JE, Ling F, terBrugge KG, Tymianski M, Zhang HQ, Krings T (2017) Comparison of three different types of spinal arteriovenous shunts below the conus in clinical presentation, radiologic findings, and outcomes. AJNR Am J Neuroradiol 38(2):403–409

    Article  PubMed  CAS  Google Scholar 

  4. Namba K (2016) Vascular anatomy of the cauda equina and its implication on the vascular lesions in the caudal spinal structure. Neurol Med Chir (Tokyo) 56(6):310–316

    Article  Google Scholar 

  5. Djindjian M, Ribeiro A, Ortega E, Gaston A, Poirier J (1988) The normal vascularization of the intradural filum terminale in man. Surg Radiol Anat 10(3):201–209

    Article  PubMed  CAS  Google Scholar 

  6. Parke WW, Gammell K, Rothman RH (1981) Arterial vascularization of the cauda equina. J Bone Jt Surg Am 63(1):53–62

    Article  CAS  Google Scholar 

  7. Chanthanaphak E, Pongpech S, Jiarakongmun P, Kobkitsuksakul C, Chi CT, Terbrugge KG (2013) Filum terminale arteriovenous fistulas: the role of endovascular treatment. J Neurosurg Spine 19(1):49–56

    Article  PubMed  Google Scholar 

  8. Fischer S, Aguilar Perez M, Bassiouni H, Hopf N, Bäzner H, Henkes H (2013) Arteriovenous fistula of the filum terminale: diagnosis, treatment, and literature review. Clin Neuroradiol 23(4):309–314

    Article  PubMed  CAS  Google Scholar 

  9. Krishnan P, Banerjee TK, Saha M (2013) Congestive myelopathy (Foix–Alajouanine syndrome) due to intradural arteriovenous fistula of the filum terminale fed by anterior spinal artery: case report and review of literature. Ann Indian Acad Neurol 16(3):432–436

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lim SM, Choi IS, David CA (2011) Spinal arteriovenous fistulas of the filum terminale. AJNR Am J Neuroradiol 32(10):1846–1850

    Article  PubMed  CAS  Google Scholar 

  11. Takami T, Yamagata T, Mitsuhashi Y, Hayasaki K, Ohata K (2012) Direct surgery for spinal arteriovenous fistulas of the filum terminale with intraoperative image guidance. Spine (Phila Pa 1976) 37(24):e1524–e1528

    Article  Google Scholar 

  12. Takeuchi M, Niwa A, Matsuo N, Joko M, Nakura T, Aoyama M, Yokoi T, Takayasu M (2014) Pathomorphological description of the shunted portion of a filum terminale arteriovenous fistula. Spine J 14(2):e7–e10

    Article  PubMed  Google Scholar 

  13. Troude L, Melot A, Brunel H, Roche P (2016) Arteriovenous malformation of the filum terminale: an exceptional case. J Neurosurg 124(6):1712–1715

    Article  PubMed  Google Scholar 

  14. Haddad S, Condette-Auliac S, Ozanne A, Roccatagliata L, Rodesch G (2012) Arteriovenous fistula of the filum terminale: radiological diagnosis and therapeutic management by embolization. J Neuroradiol 39(5):368–372

    Article  PubMed  Google Scholar 

  15. Jin YJ, Kim K-J, Kwon OK, Chung SK (2010) Perimedullary arteriovenous fistula of the filum terminale: case report. Neurosurgery 66(1):e219–e220

    Article  PubMed  Google Scholar 

  16. Trinh VT, Duckworth EAM (2011) Surgical excision of filum terminale arteriovenous fistulae after lumbar fusion: value of indocyanine green and theory on origins (a technical note and report of two cases). Surg Neurol Int 2(1):63

    Article  PubMed  PubMed Central  Google Scholar 

  17. Macht S, Chapot R, Bieniek F, Hanggi D, Turowski B (2012) Unique sacral location of an arteriovenous fistula of the filum terminale associated with diastematomyelia and lowered spinal cords. Neuroradiology 54(5):517–519

    Article  PubMed  Google Scholar 

  18. Sharma P, Ranjan A, Lath R (2014) Arteriovenous fistula of the filum terminale misdiagnosed and previously operated as lower lumbar degenerative disease. Asian Spine J 8(3):365–370

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tender GC, Vortmeyer AO, Oldfield EH (2005) Spinal intradural arteriovenous fistulas acquired in late adulthood: absent spinal venous drainage in pathogenesis and pathophysiology. Report of two cases. J Neurosurg Spine 3(6):488–494

    Article  PubMed  Google Scholar 

  20. Mitha AP, Murphy EE, Ogilvy CS (2006) Type A intradural spinal arteriovenous fistula. Case report. J Neurosurg Spine 5(5):447–450

    Article  PubMed  Google Scholar 

  21. Kumar A, Deopujari CE, Mhatre M (2011) Misdiagnosis in a case of non-compressive myelopathy due to a lumbar spinal intradural fistula supplied by the artery of Adamkiewicz. Surg Neurol Int 2(1):12

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Witiw CD, Fallah A, Radovanovic I, Wallace MC (2011) Sacral intradural arteriovenous fistula treated indirectly by transection of the filum terminale: technical case report. Neurosurgery 69(3):e780–e784

    Article  PubMed  Google Scholar 

  23. Orendácová J, Cízková D, Kafka J, Lukácová N, Marsala M, Sulla I, Marsala J, Katsube N (2001) Cauda equina syndrome. Prog Neurobiol 64(6):613–637

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Satoru Tanioka, Naoki Toma, Hiroshi Sakaida, Yasuyuki Umeda & Hidenori Suzuki

Authors
  1. Satoru Tanioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoki Toma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroshi Sakaida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasuyuki Umeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hidenori Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Satoru Tanioka.

Ethics declarations

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tanioka, S., Toma, N., Sakaida, H. et al. A case of arteriovenous fistula of the cauda equina fed by the proximal radicular artery: anatomical features and treatment precautions. Eur Spine J 27 (Suppl 3), 281–286 (2018). https://doi.org/10.1007/s00586-017-5129-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-017-5129-0

Keywords

Search

Navigation