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case_images: Initial magnetic resonance imaging (MRI) of the lumbar spine.(A, B) Sagittal T2-weighted MRI showing lumbar spondylosis, spinal cord edema, and flow voids around the cord at the Th11-L1 level.
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case_images: Preoperative thoracic magnetic resonance imaging (MRI). (A) Sagittal T2-weighted MRI showing spinal cord edema and flow voids around the cord at the Th7-L1 level. (B) Sagittal T1-weighted MRI showing spinal cord edema. (C) Sagittal contrast-enhanced MRI showing heterogeneous enhancement of the spinal cord at the Th10-L1 level.
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case_images: Preoperative computed tomography (CT) scan. (A, B) Coronal CT showing a premedullary vessel at the level of Th11/12 and a dilated premedullary drainage vein.
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case_images: Th11 pedicle (Figure 3A). These vessels were connected to intraspinal tortuous vessels, suggesting perimedullary draining veins (Figure 3B).
case_images: (A) Three-dimensional digital subtraction angiography (DSA) image of the right Th11 and Th12 segmental arteries showing the spinal dural arteriovenous fistula (SDAVF), intradural arterialized vein, and dilated premedullary veins. (B) Anteroposterior (AP) view DSA image of the right Th11 segmental artery showing a shunt lesion from selective catheterization of the right Th11 radicular branch with a tangle of arterialized veins noted in the central spinal canal. The fistula is noted at the right Th11 nerve sheath. (C) Post-treatment radiograph showing the presence of n-butyl-2-cyanoacrylate. (D) Post-treatment AP view DSA image of the right Th11 and Th12 segmental arteries showing the disappearance of SDAVF.
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case_images: Shepherd hook catheter (Figure 4A). Specific and significant findings on angiography included a fistula supplied by the right Th11 radicular artery draining into the right Th11 radicular veins. Complete angiographic obliteration of the fistula was achieved (Figure 4).
case_images: (A) Post-treatment sagittal T2-weighted MRI of the thoracolumbar spine showing the disappearance of edema and flow voids. (B) Coronal computed tomography revealing n-butyl-2-cyanoacrylate at Th11/12 vertebral foramen.
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case_images: Postoperative MRI revealed the expected improvement in spinal cord edema and the disappearance of abnormally dilated vascular flow voids around the spinal cord (Figure 5A), and coronal computed tomography revealed n-butyl-2-cyanoacrylate at Th11/12 vertebral foramen (Figure 5B).