Introduction Arteriovenous fistulas in spinal regions are recognized as spinal perimedullary arteriovenous fistulas (SPAVFs) and spinal dural arteriovenous fistulas (SDAVFs). several of them presented with subarachnoid hemorrhage (SAH).

Case Description 28 years old man with SAH was transferred from other general hospital. CT-angiogram demonstrated enlarged vessels on ventral portion of anterior medullary areaCerebral angiogram showed DAVFs had feeding arteries on posterior circulation and draining to perimedullary vein. First, we tried to perform the embolization using Onyx or nBCA. Far lateral transcondylar approach was selected to perform this case. Suboccipital craniotomy and C1 hemilaminectomy were done and ipsilateral V3 was exposed. Using several times of ICG, clipping was performed on main two feeding arteries. Feeding and drain pattern was atypical comparing with previous DAVFs on cervicomedullary junction or marginal sinus. During the procedure, SEP and MEP was dropped. But after repositioning of clip, all was recovered. Intraoperative angiogram showed the successful obliteration of DAVFs. After surgery, the consciousness of patient was improved and paraparesis was recovered gradually. On follow up MRA, there was no any fistulous..

Results If we do not performed the angiography before surgery, the patient should have a poor outcome after surgery. Especially, before considering the clipping or ligation management of complex vascular disease, we should perform the detailed cerebral angiography.

Disclosure of Interest no.