This piece depicts a rare combination of two vascular pathologies in a newborn. First, a perimedullary arteriovenous fistula (PMAVF): an abnormal connection between an artery and a vein on the surface of the spinal cord. Second, a paraspinal arteriovenous malformation (AVM): a tangled mass of abnormal vessels.

The left side of the piece shows the locations of the lesions and the branches that supply them at vertebral levels T11 and L4. The inset shows the relationship of the PMAVF and abnormal feeding vessels to the spinal cord and the correct location for the catheter, which are crucial elements in achieving closure of the fistula. Dashed lines in the first image indicate the opening along the pedicles shown in the inset. The draining veins exit from the spinal canal at level L5 is also shown.

PURPOSE

The relationship between the two lesions is difficult to appreciate on angiography, even for experienced interventionalists. This full-page book chapter illustration clarifies this relationship for Interventional Neuroradiologists.

EQUIPMENT / TECHNIQUE

Photoshop, Osirix