Spinal Arteriovenous Fistula from Anterior Spinal Artery: Embolization Technique
A 28-year-old Nigerian lady presented with a 4-year history of gradually progressive weakness and numbness involving both lower limbs and urinary frequency. Examination revealed a spastic paraparesis with a pyramidal pattern of weakness and a sensory level corresponding to D9 level. MRI revealed edema in lower dorsal cord (Fig. 79.1). Dilated tortuous flow voids were seen particularly anterior to the cord. Spinal angiogram revealed an enlarged radiculo-medullary artery arising from right D9 level and feeding the arteriovenous fistula at D9–D10 levels (Fig. 79.1a). Delayed run showed a venous aneurysm and a descending vein (Fig. 79.1b). Another feeder was seen from left 12th intercostal artery and ascending to the same level of the fistula (Fig. 79.2c–e). In view of the anterior midline location of both the feeding arteries, the central vertical segments represented anterior spinal artery. The branch arising from ASA and feeding the AVF represented enlarged sulco-commissural artery.