Effective endovascular procedure for childhood ruptured spinal cord perimedullary arteriovenous fistula - Case study
Successful Management of Ruptured Cervical Perimedullary Arteriovenous Fistula in a Pediatric Patient
A rare case of a ruptured cervical perimedullary arteriovenous fistula (PMAVF) in a 10-year-old boy has been successfully managed through endovascular embolization.
The boy, with no significant medical history, experienced neck pain, fatigue, and paralysis in his upper limbs. His condition worsened, leading to paralysis in all extremities, impaired consciousness, and respiratory distress.
Head magnetic resonance images revealed medullary edema and dilated veins in the posterior cranial fossa. Contrast-enhanced computed tomography of the neck showed an intramedullary hematoma centered at C4, with edema extending from the medulla oblongata to T3 and dilated vessels surrounding the lesion.
Angiography confirmed a varix rupture of a PMAVF with feeders from the right C4 dorsal root artery and the right ascending cervical artery. The shunt was successfully occluded during the endovascular embolization procedure using 33% n‐butyl‐2-cyanoacrylate.
PMAVFs are rare spinal vascular diseases, especially in pediatric patients. They are characterized by abnormal direct connections between arteries and veins on the spinal cord surface, leading to high-pressure venous drainage and potential hemorrhage. These fistulas often present with hemorrhage or progressive myelopathy and require urgent treatment.
Symptoms in pediatric cases can be nonspecific but frequently include acute or subacute neurological changes related to hemorrhage or mass effect from hematoma. MRI and angiography are essential for diagnosis, revealing cord edema and feeding arteries with early venous filling.
Following the successful treatment, the boy was transferred to a pediatric intensive care unit for intubation and management. After a tracheotomy, he was gradually weaned off the ventilator. With rehabilitation, the patient showed significant improvement in spinal cord function, including the ability to transfer with a walker.
This report describes a unique case of a ruptured cervical PMAVF in a child, managed successfully with endovascular embolization. Endovascular embolization and open surgical intervention are recognized as therapeutic strategies for PMAVFs. Prompt treatment is critical to prevent permanent deficits from venous hypertension or hemorrhage.
- In light of the success in managing the ruptured cervical PMAVF, research on the potential benefits of CBD for mental health and neurological disorders could prove beneficial for future treatment plans, particularly in pediatric patients.
- As PMAVFs are associated with high-pressure venous drainage and potential hemorrhage, health-and-wellness advocates may raise awareness about the importance of early detection and treatment of such medical-conditions to prevent long-term complications.
- In correlation with advances in science and health-and-wellness, further studies exploring the impact of PMAVFs on mental health are warranted, considering the strain these conditions can have on a patient's overall well-being and quality of life.
