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

Abstract

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.