Embolization of a dural arteriovenous fistula of the ventral cervical spinal canal in a nine-year-old boy.

Abstract

A 9-year-old patient presented with an acute left hemiparesis secondary to an intradural hemorrhage of the cervical spinal cord. Angiography revealed a dural arteriovenous (AV) fistula with multiple venous aneurysms fed by a radicular branch of the right vertebral artery. This AV fistula did not contribute blood flow to the cervical segment of the spinal cord, which was tested by an intra-arterial injection of methohexital. Interruption of the fistula was possible by transluminal embolization with polyvinyl alcohol and silk. At a 6-month follow-up, the patient was neurologically intact, and angiography demonstrated no AV fistula. This case illustrates an unusual presentation of a dural AV fistula. Dural AV fistulas are rare in the cervical region and extremely unusual in patients less than 20 years of age. The lesion proved to be amenable to transluminal embolization alone, without the need for surgery, with a dramatic resolution of the neurological deficit.