Spontaneous closure of an incidental high-flow paravertebral arteriovenous fistula caused by vertebral giant cell tumor curettage: illustrative case
Journal
Journal of neurosurgery : case lessons
Journal Volume
1
Journal Volume
1
Journal Issue
18
Journal Issue
18
ISSN
2694-1902
Date Issued
2021-05-03
Author(s)
Abstract
Background: Paravertebral arteriovenous fistula (AVF) after spinal surgery is rarely reported in the literature. Its natural course is largely unknown.
Observations: The authors report a 31-year-old woman with a high-flow AVF after T12 vertebral giant cell tumor curettage. Eight months after the initial surgery, revision en bloc surgery was planned. Preoperative computed tomography angiography was performed for vascularity assessment, which incidentally revealed a large paravertebral early-enhanced venous sac. High-flow AVF was confirmed through subsequent spinal angiography. Endovascular embolization was scheduled before the surgery to avoid massive blood loss. However, the AVF closed spontaneously 1 month after the spinal angiography. The plan was changed to preoperative embolization; subsequently, three-level en bloc spondylectomy was performed smoothly.
Lessons: Iatrogenic AVF is possible, prompting investigation by vascular imaging when suspected. Embolization is a preferred treatment method when feasible. However, for iatrogenic etiology, the prothrombotic property of the contrast medium may induce the resolution. Multidisciplinary discussion can be very helpful before aggressive spinal surgery.
Subjects
AVF = arteriovenous fistula
CTA = computed tomography angiography
giant cell tumor
paravertebral arteriovenous fistula
spinal surgery
spontaneous regression
total en bloc spondylectomy
Publisher
American Association of Neurological Surgeons
Type
journal article