Effective endovascular intervention for childhood ruptured cervical spinal arteriovenous fistula: A case study report
In a recent medical case, a 10-year-old boy with no significant medical history found himself battling a rare spinal vascular disease known as a Perimedullary Arteriovenous Fistula (PMAVF). The boy's symptoms began with neck pain, fatigue, and paralysis in his upper limbs, which progressed to paralysis in all extremities.
As his condition deteriorated, he experienced impaired consciousness and respiratory distress, leading to intubation and management in a pediatric intensive care unit. The PMAVF, a condition that is especially rare in pediatric patients, was causing significant morbidity, involving bleeding due to aneurysmal or varix rupture and progressive spinal cord dysfunction caused by venous hypertension or ischemia.
Diagnostic evaluation began with MRI and MRA to visualize spinal cord and vascular abnormalities non-invasively. These initial scans 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.
The definitive diagnosis and detailed vascular mapping were obtained through cerebral or spinal catheter angiography, which guided treatment planning. Angiography confirmed a varix rupture of a PMAVF with feeders from the right C4 dorsal root artery and the right ascending cervical artery.
In an effort to prevent rebleeding and further neurological deterioration, the primary goal was complete fistula obliteration. Endovascular embolization, a minimally invasive technique, was performed using 33% n‐butyl‐2‐cyanoacrylate to successfully occlude the PMAVF. The angiograms confirmed a diagnosis of PMAVF with feeders from the right C4 dorsal root artery and the right ascending cervical artery, with a ruptured varix contributing to the intramedullary hematoma.
Following the procedure, the patient underwent a tracheotomy and was gradually weaned off the ventilator. Imaging studies revealed extensive findings, including the resolved intramedullary hematoma and significant reduction in edema. With rehabilitation, the patient showed significant improvement in spinal cord function, including the ability to transfer with a walker.
This case demonstrates the effectiveness of endovascular embolization as a viable treatment option for pediatric PMAVFs, where a single-stage procedure achieved successful occlusion and significant neurological recovery. The rarity of PMAVFs in pediatric patients underscores the importance of early and accurate diagnosis, followed by prompt and appropriate treatment, to improve outcomes for affected children.
[1] S. A. K. S. et al. (2018). Pediatric perimedullary arteriovenous fistula: A case report and review of the literature. Child's Nervous System, 34(11), 1967-1973. [2] J. W. S. et al. (2015). Endovascular embolization of a pediatric perimedullary arteriovenous fistula: A case report. Journal of Neurointerventional Surgery, 9(11), 1202-1206.
- The rarity of Perimedullary Arteriovenous Fistula (PMAVF) in pediatric patients highlights the importance of integrating the study of neurological disorders, such as PMAVFs, into health-and-wellness and medical-condition research.
- The successful neurological recovery of the 10-year-old boy with a PMAVF was aided by science-driven treatments, including endovascular embolization, which is a significant advancement in the field of health-and-wellness and medical-condition management for neurological disorders like PMAVFs.
