case_images: PMC11743362_01
case_images: Increased density within the fourth ventricle (A) and a lamellar high-density shadow in the anterior part of the medulla oblongata (B) suggest hemorrhage.
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case_images: F1
case_images: On admission, cranial computed tomography (CT) revealed hemorrhage in the fourth ventricle and minor bleeding in the anterior portion of the medulla oblongata (Figures 1A,B).
case_images: The results of CTA (A) and DSA (B) did not show any significant abnormalities.
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case_images: F2
case_images: Following admission, cranial computed tomography angiography (CTA) and digital subtraction angiography (DSA) were performed, neither of which revealed significant intracranial vascular malformations (Figures 2A,B).
case_images: Preoperative imaging of the spinal cord vascular malformation. (A) T2-weighted MRI shows a slightly hypointense, tortuous signal beneath the extradural dura mater extending from the C4 to T3 levels. (B) Enhanced MRI reveals nodular enhancement, particularly at the T2-T3 level. (C) Digital subtraction angiography (DSA) demonstrates that the right intercostal artery at the level of the 6th to 7th rib drains into the intramedullary vein at the T2 level, with multiple tortuous and thickened vascular networks extending from the cervical segment to the T2 level of the spinal cord.
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case_images: F3
case_images: Enhanced imaging revealed significant, uneven enhancement (Figures 3A,B). Subsequent complete spinal angiography demonstrated drainage from the right T6-T7 intercostal artery to intramedullary veins, with a network of tortuous, thickened vessels extending from the T2 to the cervical segment of the spinal cord (Figure 3C).
case_images: Intraoperative findings and management of the SCVMs. (A) Malformed blood vessels were observed on the ventral side of the spinal cord, accompanied by localized aneurysmal dilation. (B) Intraoperative fluorescence angiography revealed patency of the feeding artery, but no significant enhancement of the aneurysmal dilation. (C) The thrombus was identified within the aneurysmal dilation. (D) Temporary occlusion of the feeding artery was performed, and subsequent fluorescence angiography showed no enhancement of the malformed vessels. (E) Complete resection of the SCVM was achieved.
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case_images: F4
case_images: Intraoperatively, the malformed vessels were located ventrally on the spinal cord, with localized aneurysmal dilation significantly compressing the surrounding spinal cord tissue (Figure 4A). This was confirmed intraoperatively, as the aneurysmal dilation was filled with thrombus (Figures 4B,C). The feeding artery was temporarily occluded, and subsequent fluorescence angiography showed no enhancement of the malformed vessels (Figure 4D). Furthermore, intraoperative cortical evoked potentials remained stable, and the feeding artery, along with the aneurysmal dilation, was completely resected (Figure 4E).
case_images: Postoperative MRI did not reveal any significant abnormal signals (A,B); postoperative DSA showed no evidence of abnormal vasculature (C).
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case_images: F5
case_images: Follow-up thoracic spine MRI revealed no definitive lesions (Figures 5A,B), and subsequent complete spinal angiography confirmed the absence of spinal vascular malformations (Figure 5C).