Engorged and tortuous intradural filum terminale vein as a sign of a sacral dural arteriovenous malformation
Introduction
Spinal dural arteriovenous (AV) malformation was first described by Kendall and Logue in 1977 [1] when they reported a series of ten patients with spinal vascular malformations in whom the nidus was located in the dura or extradura and drained by the intrathecal veins. In spite of the advent of magnetic resonance imaging (MRI), spinal angiography remains the diagnostically decisive neuroimaging procedure in patients with spinal dural AV malformations. However, one of the most challenging aspects of performing spinal angiography is localizing the level(s) of the fistulous tract(s). Lumbar and thoracic spinal angiographies are usually performed first because 80% of the nidi are around these sites [2]. If the nidus is not found after studying all of the thoracic and lumbar radicular arteries, a delayed film with injection of the artery of Adamkiewicz will be usually obtained [2]. If the delayed films indicate the presence of venous hypertension, pelvic, cervical, or even the intracranial studies will be performed to exclude other location dural AV malformation. The whole process of selective catheterization can be lengthy and tedious. In this report, we showed a case of sacral dural AV malformation with an engorged and tortuous intradural filum terminale vein shown on preangiographic myelography and MR imaging. The anatomy of filum terminale vein is reviewed and its relationship with the sacral dural AV malformation is discussed.
Section snippets
Case report
A 67-year-old male suffered from progressive bilateral feet and legs numbness for 2 years. Recent 4 months, he experienced aggravated numbness, soreness and muscle cramps of the legs especially after walking for a long distance. Reviewing his medial history, no major systemic disease was told.
Neurological examination demonstrated a left leg muscle power decrease (grade 4) and absence of left knee and ankle jerks. Muscle wasting at the left gastrocnemius and the extensor digitorum longus was
Discussion
Sacral spinal dural AV malformation is rare. A review of literature reveals only 15 such cases [2], [3], [4], [5]. Among them, the age of onset, sex predominance and clinical features are not essentially different from those encountered with more superiorly located nidi [2], [3], [4]. They also frequently occur on middle-age male with symptoms of progressive myelopathy or cauda equina syndrome [3]. Therefore, the clinical features are not sufficient to differentiate sacral dural AV malformation
Acknowledgements
This study was partly supported by grant NSC 89-2320-B-182A-028 (to C.J. Chen) from the National Science Council, Taiwan.
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The Shunt Point of the Sacral Dural Arteriovenous Fistula: A Case Report and Literature Review
2020, World NeurosurgeryCitation Excerpt :Moreover, magnetic resonance imaging revealed decreased edema of the spinal cord (Figure 8). To our knowledge, 36 cases of sacral dAVF have been investigated previously.3,5-19 In these previous reports, we found angiographic images of the sacral dAVF represented as figures in 20 cases.3,5-12,14-19
Clinical Characteristics of Lumbosacral Spinal Dural Arteriovenous Fistula (DAVF)–Comparison with Thoracic DAVF
2018, World NeurosurgeryCitation Excerpt :To establish prompt diagnosis of lumbosacral DAVF, careful inspection of MRI for serpentine signal flow voids is crucial. While several lumbosacral DAVF cases have been reported,6-8,14,15 clinical presentations were considered similar to thoracic DAVF.1,2 Our study was one of the few studies that compared lumbosacral with thoracic DAVFs.16
Remote Lesions of Synchronous Sacral and Cervical Dural Arteriovenous Fistulas: A Case Report
2017, World NeurosurgeryCitation Excerpt :Then, we opted to intervene because of the risk of SAH with ascending venous drainage into the intracranial sinus.22 Although fistulas can have rare feeders, such as the lateral sacral artery of the internal iliac artery, pelvic arteriography should be performed first if the lesion is suspicious.20,23 We also propose, as Chen and Hsu23 described, the sign on MRI of an engorged and tortuous intradural vein in the sacral region as an indication of a sacral DAVF.
Sacral dural arteriovenous fistula presented as an acute isolated thoracic myelopathy: Clinical and surgical importance
2014, Clinical Neurology and NeurosurgeryCitation Excerpt :Therefore a good understanding of the spinal vasculature is mandatory when conducting spinal angiography, as fistulas can have rare feeders such as lateral sacral artery of the internal iliac artery (as same as our case) (Fig. 2), which would be missed otherwise. In such cases pelvic arteriography should be performed first [10]. In our case the pathophysiology of the fistula induced myelopathy is due to an increase in venous pressure caused by shunting of arterial blood into the venous side.