Endovascular Treatment of a C2-5 Spinal Arteriovenous Metameric Syndrome

Abstract

Objective and importance: Spinal arteriovenous metameric syndrome (SAMS) is a complex of vascular malformations involving the skin, paraspinal soft tissue, spine, and spinal cord in the same metamere. Treatment of this condition is often difficult due to the extent of the lesion. We report a case of successful palliative management of SAMS presenting predominantly with radiculopathy. Clinical presentation: A 19-year-old male patient presented with weakness and hypesthesia of the right upper extremity, plus spasticity of the right lower extremity. Workup imaging studies indicated C2 to C5 spinal cord arteriovenous malformation (AVM) and paraspinal arteriovenous fistula (AVF) with destruction of C2 and C3 vertebrae. Intervention: Due to the extensive nature of the AVF/AVM, the goal of treatment was to neurologically stabilize the patient using endovascular embolization. After the first embolization with N-butyl cyanoacrylate, the patient made immediate neurological recovery to normal. Recurrence of the same symptoms 4 months after the first embolization prompted an additional 3 procedures over the next 3 months. The patient remained neurologically normal after the second procedure. Follow-up CT at 27 months after the initial procedure demonstrated osseous formation of the vertebral body at the embolized level, as well as progressive destruction at the untreated level. Therefore, the patient underwent another embolization with Onyx and is currently undergoing close follow-up. Conclusion: Although cure of SAMS is difficult, improvement of neurological symptoms can be achieved with targeted endovascular embolization. Ossification and possible prevention of destruction of vertebral bodies can be realized by embolizing intraosseous lesions. Close follow-up is necessary to detect neurological and radiographical progression of the condition. © 2008, The Japanese Society for Neuroendovascular Therapy. All rights reserved.