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Combined surgical and endovascular approach to treat a ventrally located perimedullary arteriovenous fistula

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Abstract

Perimedullary arteriovenous fistulae (PMAVFs) (also called type IV spinal cord arteriovenous malformations) are rare lesions. They are located in the subarachnoid space or just under the pia. The shunt occurs between the anterior spinal artery (ASA) and/or posterior spinal artery (PSA) and a network of perimedullary veins. The aim of the treatment, surgical or endovascular, is to occlude the fistula. This article presents a unique treatment strategy of a demanding strictly ventral PMAVF in the lower thoracic cord. A posterior surgical approach with spinal cord rotation followed by direct puncture of a distally located arterial feeder was achieved. Precise identification of the fistula with superselective contrast injections was obtained and accurate catheterization of the venous pouch with a microcatheter was performed. Complete occlusion of the PMAVF was achieved with coils.

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Authors and Affiliations

  1. Neurosurgery & Interventional Neuroradiology Department, Hygeia Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece

    Ioannis Ioannidis, Nikolaos Nasis, Sotirios Plakas, Christos Chrysicopoulos & Alexander Andreou

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  1. Ioannis Ioannidis
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  2. Nikolaos Nasis
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  3. Sotirios Plakas
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  4. Christos Chrysicopoulos
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  5. Alexander Andreou
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Correspondence to Ioannis Ioannidis.

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Ioannidis, I., Nasis, N., Plakas, S. et al. Combined surgical and endovascular approach to treat a ventrally located perimedullary arteriovenous fistula. Childs Nerv Syst 37, 645–648 (2021). https://doi.org/10.1007/s00381-020-04947-2

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  • DOI: https://doi.org/10.1007/s00381-020-04947-2

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