case_images: PMC11097694_01
case_images: Large patch of port wine stain lesion overlying the thoracic spinal region of a 12-year-old male patient with Cobb syndrome present since birth.
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case_images: The patient was noted to have a large patch of port wine stain lesion overlying his thoracic spinal region present since birth (Figure 1).
case_images: T2 weighted spinal magnetic resonance imaging (MRI) with and without contrast obtained in a 12-year-old male patient with Cobb syndrome showing an intramedullary T2 hypointense signal at T3-T4 with adjacent central hyperintensity within the cord extending to T6 inferiorly with associated adjacent cord edema/syrinx.
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case_images: Spinal MRI with and without contrast was obtained which showed an intramedullary T2 hypointense signal at T3-T4 with adjacent central hyperintensity within the cord extending to T6 inferiorly with associated adjacent cord edema indicating rupture (Figure 2).
case_images: Pre-operative digital subtraction angiography (DSA) in a 12-year-old male patient with Cobb syndrome showing multiple arteriovenous malformations (AVMs) within the spinal and paraspinal tissues involving T4-T7 vertebral elements, most extensively at T4 and T5.
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case_images: T4-T7 vertebral elements, most extensively T4 and T5 (Figure 3). There were also several foci of arteriovenous shunting from T2-T5 most extensively involving the T3 and T4 segments. The main nidus, measuring approximately 1.2 cm, was predominantly supplied by the anterior spinal artery.
case_images: Digital subtraction angiography (DSA) in a 12-year-old male patient with Cobb syndrome after embolization of a 4 mm anterior spinal artery aneurysm located at the confluence of the main arteriovenous malformation (AVM) nidus. Partial embolization of the main AVM nidus was also achieved, resulting in complete aneurysm occlusion and no identifiable residual inflow into the main nidus or its 3 mm intranidal aneurysm.
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case_images: Post-embolization imaging demonstrated preservation of anterior spinal artery axis cranial and caudal to the embolized segment, with no residual opacification of the aneurysm, the main AVM nidus, or its intranidal aneurysm. (Figure 4).