Abstract
Arteriovenous malformations (AVMs) of the spine include a broad spectrum of lesions that vary from a simple arteriovenous fistulous connection to a more complex net of abnormal vessels involving multiple spinal levels. These entities are poorly studied and understood because of their rarity and are often either managed conservatively with observation if the lesion is complex, or treated surgically or interventionally in the presence of an accessible and distinct fistulous connection. Most surgeons avoid intervening on more intricate lesions until they become symptomatic with progressive neurological decline.We describe the case of a 38-year-old man who presented with severe sharp back pain after an appendectomy procedure. A magnetic resonance angiogram (MRA) revealed an arteriovenous malformation of the conus medullaris, with a compact glomus-type nidus and arterial feeders originating from an enlarged artery of Adamkiewicz. The malformation was resected through a posterior midline approach, and the patient was neurologically intact at his discharge on postoperative Day 2. Follow-up angiography showed complete obliteration of the lesion. Our operative video is meant to serve as a step-by-step and systematic guide to the approach and management of conus arteriovenous spinal lesions, which can be difficult to treat.We provide a pre- and postoperative radiological description of the anomaly as well as a technical guide to the resection of a spinal vascular lesion. This video could serve as an operative guide and reference to neurosurgeons—both established and in training—when confronting similar disease processes in the future.
Highlights
Arteriovenous malformations (AVMs) of the conus medullaris are rare entities whose natural history is defined by continued progression once they become symptomatic [1]
The aim of this report is to provide the reader with surgical pearls that can make resection easier, for conus lesions, and with visual aid and support through a commented video case
Preoperative embolization can carry significant risk compared to cranial vascular malformations because of the terminal nature and the caliber of vessels of the spinal cord [5]
Summary
Arteriovenous malformations (AVMs) of the conus medullaris are rare entities whose natural history is defined by continued progression once they become symptomatic [1]. They usually have an intradural component, with or without dural and epidural vessels, and can present different degrees of parenchymal involvement [2]. The aim of this report is to provide the reader with surgical pearls that can make resection easier, for conus lesions, and with visual aid and support through a commented video case. How to cite this article Aoun S G, El Ahmadieh T Y, Plitt A R, et al (February 05, 2019) Resection of an Intramedullary Glomustype Arteriovenous Malformation of the Conus Medullaris: Technical Note and Step-by-step Surgical Video.
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