Spinal cord AVM

A 44yo woman presented with sudden onset flaccid paraparesis and a sensory level at T12. MRI demonstrated acute haemorrhage in the distal cord and conus medullaris. MR angiography confirmed the presence of an arteriovenous malformation. Under general anaesthesia, spinal angiography was performed, demonstrating a glomus-type medullary AVM of the spinal cord. A microcatheter was advanced along the anterior spinal artery and the nidus and draining vein occluded with ethyl vinyl alcohol copolymer. The patient made an excellent recovery and regained normal power and sensation in her lower limbs. The montage demonstrates initial angiography performed in the right L2 lumbar artery (left) showing supply via the anterior spinal artery (ASA) to a compact AVM nidus with two intranidal aneurysms (almost certainly the cause of haemorrhage), draining to the coronal perimedullary venous plexus. The second image (middle) shows superselective angiography through the microcatheter, which has its tip at the junction between the ASA and the nidus. The third image (right) shows post embolisation angiography in the right L2 lumbar artery. The embolic cast is clearly visible, and the ASA proximal to the nidus remains patent, although it is not seen on this late-phase angiogram.

Credit: Dr Jason Wenderoth