Arteriovenous Malformation of the Medulla oblongata Supplied by the Anterior Spinal Artery in a Child: Treatment by Microsurgical Obliteration of the Feeding Artery

• Published in: Pediatric neurosurgery Vol. 33; no. 6; pp. 293 - 297
• Main Authors: Ito, Masanori, Yamamoto, Takuji, Mishina, Hideto, Sonokawa, Tadao, Sato, Kiyoshi
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.12.2000; S. Karger AG
• Subjects: Arteries - physiopathology; Arteries - surgery; Arteriovenous Fistula - diagnostic imaging; Arteriovenous Fistula - surgery; Biological and medical sciences; Cerebral Angiography; Child, Preschool; Humans; Intracranial Arteriovenous Malformations - diagnostic imaging; Intracranial Arteriovenous Malformations - physiopathology; Intracranial Arteriovenous Malformations - surgery; Male; Medical sciences; Medulla Oblongata - blood supply; Microsurgery - methods; Neurology; Original Paper; Pia Mater - blood supply; Vascular diseases and vascular malformations of the nervous system; Medulla; Arteriovenous fistula; Far lateral approach; Arteriovenous malformation; Anterior spinal artery; Human; Intracranial; Nervous system diseases; Brain stem; Cardiovascular disease; Congenital disease; Cerebral disorder; Vascular disease; Case study; Treatment; Surgical obliteration; Surgery; Central nervous system disease; Medulla oblongata; Child; Cerebrovascular disease
• ISSN: 1016-2291; 1423-0305
• DOI: 10.1159/000055974

We report a unique case of a 3-year-old boy with a pial arteriovenous malformation (AVM) in the medulla. The patient presented with a subarachnoid hemorrhage. Magnetic resonance (MR) imaging revealed a 3 × 1 cm flow void area in the premedullary cistern that was compressing the medulla posteriorly. Cerebral angiography and MR angiography showed an aneurysm-like vascular pouch that was fed by the anterior spinal artery and had multiple draining veins. The case was diagnosed as a fistula-type AVM. Treatment options consisted of endovascular embolization or open surgery. We used a left far lateral approach to obliterate the anterior spinal artery. Immediately after the clip was applied to the feeding artery, the pouch began to shrink, and the color of the draining veins changed from red to blue. An intraoperative angiography showed that the AVM had disappeared. The patient recovered fully 1 month after surgery. This case was classified as fistula-type AVM, pial arteriovenous fistula (AVF). Microsurgical obliteration of the anterior spinal artery is considered to be the treatment of choice for perimedullary AVF located in the premedullary cistern if the endovascular treatment is not considered to be feasible.