Completely extradural intraspinal arteriovenous malformation in the lumbar spine: a case report

Journal of Medical Case Reports

Oliver Gembruch²  Johannes van de Nes¹  Ulrich Sure²  Michael Forsting³  Adrian Ringelstein³  Saravanabavaan Suntharalingam³ 

[1] Department of Neuropathology, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany;Department of Neurosurgery, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany;Department of Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany

关键词: Spinal vascular malformation;    Intraspinal extradural lesion;    Arteriovenous malformation;   

Others  :  1181115
DOI  :  10.1186/1752-1947-8-216

 received in 2013-10-20, accepted in 2014-03-19,  发布年份 2014

【 摘 要 】

Introduction

Spinal vascular malformations can be classified in arteriovenous malformations, cavernomas, and capillary telangiectasias. Arteriovenous malformations are the most common spinal vascular anomaly and may be located intra- and/or perimedullary. According to their nidus type and hemodynamic flow patterns, they can be differentiated into fistulous, glomerular and juvenile categories. In our case, a hyperintense extradural mass was misinterpreted as a neurinoma. The histological analysis revealed typical signs of an arteriovenous malformation.

Case presentation

A 57-year-old Caucasian woman presented with back pain and hypesthesia in digiti two to four of her left foot. Magnetic resonance imaging showed a long-segment intraspinal extradural soft-tissue mass in the left L4 - S1 paravertebral region with homogeneous enhancement of contrast medium. Due to another similar lesion in the lower ankle and additional cutaneous manifestations, the suspected diagnosis was a systemic disease with neurinomas (e.g. Recklinghausen’s disease). To clear up the origin and type of this lesion exploratory surgery with a hemilaminectomy of L5 was performed. This showed abnormally arterialized, dilated, and tortuous vessels. After complete resection, the intra-operative impression of an arteriovenous malformation was confirmed by a neuropathologist.

Conclusions

Completely extradural intraspinal arteriovenous malformations in the lumbar spine are extremely rare. In magnetic resonance imaging they are often misinterpreted as a tumor. Arteriovenous malformations can cause compression and venous congestion, or mask symptoms like a spinal disk herniation.

In cases presenting with these symptoms and magnetic resonance imaging findings, an extradural intraspinal arteriovenous malformation should be considered as a possible diagnosis. Pre-operative angiography or magnetic resonance imaging angiography can be used to verify the diagnosis.

【 授权许可】

   
2014 Suntharalingam et al.; licensee BioMed Central Ltd.

【 图 表 】

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