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Pediatric high-flow, cervical spinal, macro-arteriovenous fistula, treated with the endovascular cotton candy glue injection technique

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Abstract

Case report

A 3-year-old boy presented to our hospital with progressive neurological deficits. Spinal magnetic resonance imaging (MRI) revealed a perimedullary macro-arteriovenous fistula (PMAVF) resulting in a large venous pouch within the parenchyma of the lower cervical spinal cord.

Transarterial varix embolization of the fistula from the venous side was performed using N-butyl cyanoacrylate with tantalum powder. Postembolization angiography confirmed obliteration of the fistula, and MRI revealed thrombosis and reduction in size of the venous component. The patient’s clinical symptoms were reduced dramatically following the intervention, and no neurological complications occurred due to the treatment. The prognosis of spinal PMAVF depends primarily on the presence of medullar signs and symptoms and on time to treatment. The volume of the venous pouch after the intervention was markedly reduced, and complete clinical recovery was obtained. Urgent endovascular intervention, as seen in this case, is considered first-line therapy and aims to decrease the risk of neurological sequela.

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Authors and Affiliations

  1. Department of Radiology, Stroke Center Toho University Ohashi Medical Center, Ohashi 2-17-6, Meguro-ku, Tokyo, 153-8515, Japan

    Yuo Iizuka & Ehiichi Kohda

  2. Department of Radiology, National Center for Child Health and Development, Tokyo, Japan

    Yoshiyuki Tsutsumi, Hidekazu Masaki & Shunsuke Nosaka

  3. Department of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan

    Nobuhito Morota

  4. Department of Neurosurgery, Chiba Emergency Medical Center, Chiba, Japan

    Shigeki Kobayashi

  5. Department of Neurosurgery, Kyorin University, Tokyo, Japan

    Yoshifumi Konishi

Authors
  1. Yuo Iizuka
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  2. Ehiichi Kohda
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  3. Yoshiyuki Tsutsumi
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  4. Hidekazu Masaki
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  5. Shunsuke Nosaka
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  6. Nobuhito Morota
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  7. Shigeki Kobayashi
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  8. Yoshifumi Konishi
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Correspondence to Yuo Iizuka.

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Iizuka, Y., Kohda, E., Tsutsumi, Y. et al. Pediatric high-flow, cervical spinal, macro-arteriovenous fistula, treated with the endovascular cotton candy glue injection technique. Childs Nerv Syst 26, 1633–1638 (2010). https://doi.org/10.1007/s00381-010-1181-3

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  • DOI: https://doi.org/10.1007/s00381-010-1181-3

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