Extraspinal Vascular Malformation with Retrograde Drainage through a Radicular Vein: Treatment with Percutaneous Transgluteal Embolization.

Background: Spinal arteriovenous fistulas have abnormal connections between spinal arteries and veins. Early diagnosis and management are essential for preventing permanent neurologic deficits. Although symptoms of myelopathy are commonly related to established types of spinal arteriovenous fistulas within the spine, extraspinal arteriovenous anomalies may also result in similar pathology and pose challenges to conventional endovascular treatment.

Case Description: A 61-year-old man presented with progressive weakness and decreasing sensation in the lower extremities. He had a remote history of craniopharyngioma surgery and deep venous thrombosis. Examination showed decreased strength and reflexes in the lower extremities. Magnetic resonance imaging demonstrated T2 cord signal changes and flow voids within the spinal canal. Angiogram showed bilateral internal iliac artery arteriovenous malformations with retrograde flow into a radicular vein and venous congestion of the medullary veins. Percutaneous transgluteal puncture of the superior gluteal vein was performed, and the abnormal inflow to the radicular vein was obliterated with coiling and Onyx embolization. The patient had significant clinical improvement, and follow-up imaging demonstrated resolution of T2 cord signal changes and flow voids.

Conclusions: Extraspinal vascular malformations with vascular myelopathy are extremely rare. They include a broad spectrum of complex vascular disorders and often require alternate endovascular approaches.