Anterior spinal arteryをmain feederとするanterior medullo-spinal junctionに局在するAVMのsurgical management

Abstract

This 12-year-old boy suffered from a progressive gait disturbance. MRI and CT scan displayed a large arteriovenous malformation (AVM) located at the anterior medullo-spinal junction. The main feeder was the left anterior spinal artery. This was fed also by bilateral lateral spinal arteries originating from the vertebral artery and bilateral radicular arteries at the C3 level. Transoral feeder clipping of the anterior spinal artery was successfully performed. Several technical problems were overcome: prevention of liquorrhea using bone graft, abdominal fatty tissue and spinal drainage, selection of an appropriate clip with a small head, monitoring tolerance of occlusion of the anterior spinal artery with the spinal evoked potentials and with confirmation of respiratory function and movement of the four extremities under reduction of the depth of anesthesia. The patient recovered from the intervention completely.Six months later the patient underwent a feeder clipping of the lateral spinal artery and radicular artery on the left side using the monitoring method mentioned above. The patient endured the operation without any new deficits. Then left hemiplegia appeared two weeks later and three weeks after that the patient expired due to an intramedullary hemorrhage at the site of AVM.