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Combined endovascular and surgical resection of a giant lumbosacral arteriovenous malformation in a patient with Cobb syndrome
  1. Alejandro M Spiotta1,2,
  2. Muhammad Shazam Hussain2,
  3. Thomas J Masaryk2,3,
  4. Ajit A Krishnaney1,4
  1. 1Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Department of Interventional Neuroradiology, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Ajit A Krishnaney, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA; krishna{at}ccf.org

Abstract

Objective and importance Cobb syndrome is a rare condition that includes a cutaneous nevus with an associated spinal vascular lesion at the same dermatome. We present a challenging case of a progressively symptomatic massive lumbosacral arteriovenous malformation (AVM) in a patient with Cobb's syndrome requiring a multimodality approach including staged preoperative transarterial and transvenous endovascular embolization followed by surgical excision and wound reconstruction.

Clinical presentation The patient presented with a massive lumbosacral AVM with symptoms of congestive heart failure. Angiography demonstrated arterial feeders predominantly from internal iliac, median sacral and lumbar segmental arteries.

Intervention The patient underwent staged transarterial and transvenous endovascular embolization resulting in 90% reduction in the AVM size, followed by surgical resection of the lesion. The patient made an excellent recovery with improvement in his symptoms of congestive heart failure.

Conclusion The treatment algorithm for massive AVMs must be individualized. A combination of staged embolization and subsequent surgery may be required to obtain a good result. Through this carefully planned multidisciplinary approach a previously incurable lesion in this patient with Cobb syndrome was able to be treated successfully.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Cleveland Clinic.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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