Conus Medullaris Arteriovenous Malformation – a Case Report

Česká verzia

Authors: M. Smrčka ¹; V. Juráň ¹; O. Navrátil ¹; J. Sedmík ²; A. Šprláková-Puková ²
Authors place of work: LF MU a FN Brno Neurochirurgická klinika ¹; LF MU a FN Brno Radiodiagnostická klinika ²
Published in the journal: Cesk Slov Neurol N 2013; 76/109(4): 508-511
Category: Case Report

Summary

Conus medullaris AVM is a very rare lesion. Only a few case reports have been described in the literature. The first cohort of 16 patients was described by Spetzler in April 2012. These AVMs are very complex, high‑flow lesions in eloquent area. The most frequent symptoms are paraparesis, sphincter disorders and pain. The lesion presents with bleeding in one third of patients. The authors describe a case of 30‑years old female with a half year history of slowly progressing symptoms. Her conus medullaris AVM was excised by microsurgery with a good result. This is the first case of a successfully treated conus medullaris AVM published in the Czech Republic. A literature review and our own experience suggest that the choice of treatment has to be individual. A combination of endovascular obliteration followed by microsurgical excision or microsurgical excision only is the most commonly used treatment modality. Good treatment results are possible in a large proportion of patients.

Key words:
arteriovenous malformation – conus medullaris – microsurgery – endovascular treatment

Zdroje

1. Wilson DA, Abla AA, Uschold TD, McDougall CG,Albuquerque FC, Spetzler RF. Multimodality treatment of conus medullaris arteriovenous malformations: 2 decades of experience with combined endovascular and microsurgical treatments. Neurosurgery 2012; 71(1): 100– 108.

2. Spetzler RF, Detwiler PW, Riina HA, Porter RW. Modified classification of spinal cord vascular lesions. J Neurosurg 2002; 96 (Suppl 2): 145– 156.

3. Carangelo B, Casasco AE, Vallone I, Peri G, Cerase A,Venturi C et al. Total occlusion of a conus medullaris pial arteriovenous malformation obtained with one session of superselective embolization. J Neurosurg Sci 2009; 53(3): 119– 123.

4. Tubbs RS, Mortazavi MM, Denardo AJ, Cohen-Gadol AA. Arteriovenous malformation of the conus supplied by the artery of Desproges- Gotteron. J Neurosurg Spine 2011; 14(4): 529– 531.

5. Hsu SW, Rodesch G, Luo CB, Chen YL, Alvarez H,Lasjaunias PL. Concomitant conus medullaris arteriovenous malformation and sacral dural arteriovenous fistula of the filum terminale. Interv Neuroradiol 2002; 8(1): 47– 53.

6. Misra BK, Purandare HR. Application of indocyanine green videoangiography in surgery for spinal vascular malformations. J Clin Neurosci 2012; 19(6): 892– 896.

7. Djindjian R. Spinal vascular malformations. J Neurosurgery 1976; 45(6): 727– 728.