Coexisting filum terminale arteriovenous fistula and filum terminale lipoma treated with single-stage surgery: illustrative case
Coexisting filum terminale arteriovenous fistula and filum terminale lipoma treated with single-stage surgery: illustrative case
复制标题
DOI：
10.3171/case22474
复制
发表时间：
2023-01
期刊：
影响因子：
--
通讯作者：
H. Yamazaki;T. Ozaki;Tomoki Kidani;Yosuke Fujimi;M. Nonaka;Masao Umegaki;C. Yokota;T. Fujinaka
中科院分区：
文献类型：
--
作者：
H. Yamazaki;T. Ozaki;Tomoki Kidani;Yosuke Fujimi;M. Nonaka;Masao Umegaki;C. Yokota;T. Fujinaka
终丝动静脉瘘（FTAVF）和终丝脂肪瘤（FTL）都很罕见。由于这种罕见性，有关同时发生的FTAVF和FTL的数据很少，最佳治疗方法仍有待确定。作者描述了1例采用一期手术治疗的FTAVF和FTL并存的患者。观察一名70多岁的男子被转介到作者的部门，因为怀疑脊髓血管畸形的磁共振成像，进行调查下肢无力，间歇性跛行，尿失禁。先前的影像学检查显示为终末脂肪瘤伴内部血流空。计算机断层扫描血管造影和数字减影血管造影显示FTAVF，供血动脉为骶外侧动脉。患者接受了手术治疗，目的是治愈。在同一程序中处理通过成像确定的FTL和脊髓栓系。术后数字减影血管造影显示无异常血管。患者于术后第19天出院回家。当考虑治疗时，重要的是要确定症状是否主要归因于FTL，脊髓栓系或FTAVF。一期治疗是有用的，因为它消除了FTAVF和导致其发展的因素。
BACKGROUND Both filum terminale arteriovenous fistulas (FTAVFs) and filum terminale lipomas (FTLs) are rare. Because of this rarity, there is a paucity of data regarding concomitant FTAVF and FTL, and the optimal treatment remains to be defined. The authors describe a patient with coexisting FTAVF and FTL treated with single-stage surgery. OBSERVATIONS A man in his 70s was referred to the authors’ department because of a suspected spinal vascular malformation seen on magnetic resonance imaging that was performed to investigate lower limb weakness, intermittent claudication, and urinary incontinence. Previous imaging had shown a terminal lipoma with an internal flow void. Computed tomography angiography and digital subtraction angiography revealed an FTAVF, the feeder being a lateral sacral artery. The patient was treated surgically with curative intent. The FTL and tethered cord that had been identified by imaging were treated in the same procedure. Postoperative digital subtraction angiography showed absence of the abnormal vessels. The patient was discharged home on the 19th postoperative day. LESSONS When considering treatment, it is important to determine whether symptoms are attributable mainly to FTL, tethered cord, or FTAVF. One-stage treatment is useful because it eliminates both the FTAVF and the factors that led to its development.