Distortion and retraction injury at the hair-pin portion of the radiculomedullary artery during endovascular therapy for arteriovenous fistulas of the filum terminale

• Published in: Interdisciplinary neurosurgery : Advanced techniques and case management Vol. 23; p. 100898
• Main Authors: Ryu, Bikei, Sato, Shinsuke, Niimi, Yasunari
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.03.2021; Elsevier
• Subjects: Anterior spinal artery; Distortion; Endovascular; Filum terminale; Injury; Radiculomedullary artery; Spinal arteriovenous fistula; Spinal arteriovenous fistula; Endovascular; Injury; Anterior spinal artery; Distortion; Radiculomedullary artery; Filum terminale
• ISSN: 2214-7519; 2214-7519
• DOI: 10.1016/j.inat.2020.100898

Filum terminale arteriovenous fistulas (FTAVFs) are rare spinal arteriovenous shunt. Transarterial embolization via the radiculomedullary artery (RMA)–anterior spinal artery (ASA) axis is generally accepted as a standard technique. However, embolization via the RMA–ASA axis, which involves long distances and tortuous running, is technically challenging. We report a 25-year-old man with multiple FTAVFs supplied from the Th9 RMA–ASA axis. Retraction injury and distortion of the hair-pin portion of the RMA occurred due to microcatheter withdrawal after n-butyl-2-cyanoacrylate injection from the RMA–ASA axis. We attempted to repair the RMA distortion by microcatheter manipulation without worsening the neurological condition. Transarterial embolization via the RMA–ASA axis is associated with risk of vessel injury during catheter withdrawal through the involved long distance and its tortuous course.