case_images: PMC10895013_01
case_images: Preoperative multimodal neuroimaging evaluation. (A) Diffuse abnormal central-cord T2-weighted image hyperintensity that suggested spinal cord congestion extending from the level of the thoracic region, seen on magnetic resonance imaging (MRI) with contrast, along with a single dilated flow void that ran from the lumbosacral area to the conus medullaris (arrow). (B) Contrast-enhanced MR angiography (CE-MRA) showed a venous pouch at the lumbosacral region, with drainage cranially from the filum terminale until the cervical level (arrow). (C) Sacral arteriovenous malformation (AVM) was impressed in the left sacral region, with enlargement of the venous pouch before it enters the intradural region (arrow). (D) Oblique projection of angiography from the left internal iliac artery demonstrating that a venous pouch was seen at the left L5-S1 region that was associated with sacral AVM that was fed by hypertrophied lateral sacral arteries (LSA) S1 (asterisk), S2 (arrow), and the sacral branch of the iliolumbal artery (ILA) (arrow head).
case_images: fneur-15-1326182-g0001.jpg
case_images: PMC10895013_01_fneur-15-1326182-g0001.jpg
case_images: F1
case_images: T2-weighted image hyperintensity that suggested spinal cord congestion extending from the level of the thoracic region (Figure 1A). Contrast-enhanced MR angiography (CE-MRA) showed perimedullary vein engorgement drainage, cranially from the filum terminale until the cervical level (Figure 1B). The Spinal AVM was impressed in the left sacral region, with enlargement of the venous pouch before it entered the intradural region (Figure 1C). AVM that was fed by multiple arteries with early venous drainage into the filum terminale and drainage to the perimedullary vein cranially, consistent with an SEDAVF type 1 (Figure 1D). After multidisciplinary team meetings and discussion with the patient, transarterial embolization was performed.