Abstract
A 47-year-old woman was admitted to our hospital with a giant spinal arteriovenous malformation (AVM) causing heart failure and thoracic myelopathy. Angiography revealed that the spinal AVM had multiple feeding vessels branching from the 5th through 12th intercostal arteries. The drainage vein flowed to the azygos vein and superior vena cava. The AVM destroyed the 7th thoracic vertebra. The cardiac output was 16.7l/min and the shunt ratio was 64% before treatment. Embolization with cyanoacrylate was performed because the operation was considered to be associated with a significant risk of paraplegia and organ ischemia. The cardiac output decreased to 11.6l/min and the shunt ratio was reduced to 32%. After embolization the patient demonstrated no symptoms of either heart failure or sensory deficits. During embolization, provocative tests using sodium amytal and lidocaine with magnetic stimulation were also performed. The above findings suggest that provocative tests and magnetic stimulation are useful to predict paraplegia, which could result from embolization while, in addition, embolization is considered to be a useful treatment for multiple shunt and nidus in this region.
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References
Atwood GF, King TD, Graham TP, Canent RV, Ebert PA, Spach MS (1975) Thoracic arteriovenous fistula. Am J Dis Child 129:233–236
Soler P, Mehta AV, Garcia OL, Kaiser G, Tamer D (1981) Congenital systemic arteriovenous fistula between the descending aorta, azygos vein, and superior vena cava. Chest 80:647–649
Gamba PG, Longo M, Zanon GF, Guglielmi M (1991) Arteriovenous fistula between descending aorta and hemiazygos vein. Eur J Pediatr Surg 1:49–50
Lawdahl RB, Routh WD, Vitek JJ, McDowell HA, Gross GM, Keller FS (1989) Chronic arteriovenous fistulas masquerading as arteriovenous malformations: diagnostic considerations and therapeutic implications. Radiology 170:1011–1015
Rothschild BM, Cohn L, Aviza A, Yoon BH (1982) Aortic aneurysm producing back pain, bone destruction, and paraplegia. Clin Orthop 164:123–125
Riche MC, Freitas-Modenesi J, Djindjian M, Merland JJ (1982) Arteriovenous malformations (AVM) of the spinal cord in children: a review of 38 cases. Neuroradiology 22:171–180
Wakai S, Inoh S, Iwanaga H, Nagai M, Sato T, Izumi J (1992) Successful surgical obliteration of a huge intradural arteriovenous fistula of the spinal cord in a child. Child's Nerv Syst 8:347–350
Nichols DA, Rufenacht DA, Jack CR Jr, Forbes GS (1992) Embolization of spinal dural arteriovenous fistula with polyvinyl alcohol particles: Experience in 14 patients. Am J Neuroradiol 13:933–940
Willinsky R, terBrugge K, Montanera W, Wallace MC, Gentili F (1993) Spinal epidural arteriovenous fistulas: arterial and venous approaches to embolization. Am J Neuroradiol 14:812–817
Erba SM, Horton JA, Latchaw RE, Yonas H, Sekhar L, Schramm V, Pentheny S (1988) Balloon test occlusion of the internal carotid artery with stable Xenon/CT cerebral blood flow imaging. Am J Neuroradiol 9:533–538
Wada J, Rasmussen T (1960) Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance. J Neurosurg 17:266–282
Horton JA, Kerber CW (1986) Lidocaine injection into external carotid branches: provocative test to preserve cranial nerve function in therapeutic embolization. Am J Neuroradiol 7:105–108
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Kuga, T., Esato, K., Zempo, N. et al. Successful management of a giant spinal arteriovenous malformation with multiple communications between primitive arterial and venous structures by embolization: Report of a case. Surg Today 26, 756–759 (1996). https://doi.org/10.1007/BF00312103
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DOI: https://doi.org/10.1007/BF00312103