PMC6170626_01
MR images of the spinal cord of case 1, before and after treatment. (A) Myelopathic changes in the thoracic spinal cord (white arrows) (B) Myelopathic changes in the conus medullaris (thick arrow) and thickened torturous vessels (thin arrows). (C)T1WI sequence shows a filum terminale lipoma (black arrow). (D) A transverse section at the L1/L2 level shows myelopathic changes. (E-G) Follow-up images demonstrate the resolution of myelopathic changes and the disappearance of the thickened veins.
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F1
The MRI also showed tortuous veins on the spinal cord surface (Figure 1C). T2 hyperintensive changes in the thoracic spine and conus (Figures 1A,B,D). Those changes were consistent with neurologic deficit and, after exclusion of inflammatory demyelinating diseases, based on a brain MRI and an aquaporin-4 antibody test, diagnosed as myelopathy. Due to described torturous veins on the spinal cord surface (Figure 1B), the patient underwent spinal digital subtraction angiography (DSA). A follow-up MRI showed resolution of the myelopathic changes (Figures 1E-G).
PMC6170626_02
Images of the spinal cord of case 2, before and after treatment. (A) T2-weighted MRI: Tethered cord and sacral lipoma. (B) DSA: SDAVF at the S2-S3 level supplied by the lateral sacral arteries. (C) DSA: Tortuous veins on the posterior surface of the cervical spinal cord. (D) T2-weighted MRI: Tortuous vein on the posterior surface of the tethered spinal cord (arrow). (E) TOF MRI: Draining vein (arrow) at the atlanto-occipital junction level. (F) X-ray of the sacral area shows embolic agents after three embolizations. (G) Lumbar T2-weighted MRI: After the last embolization, tortuous vessels are visible on the posterior surface of the spinal cord (arrow). (H) Follow-up MRI: at 6 months after the surgery, the tortuous veins are no longer observed on the posterior surface of the spinal cord (arrow).
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F2
It also showed tortuous veins on the posterior surface of the spinal cord (Figures 2A,D). Tortuous draining veins were present on the posterior surface of the entire spinal cord and terminated intracranially (Figures 2B,C,E). Despite good occlusion of the fistula observed in a DSA, the tortuous vessels remained visible in the follow-up MRI (Figures 2F,G). After 6 months, a follow up MRI showed the absence of tortuous vessels on the posterior surface of the spinal cord and a significant reduction in the myelopathic changes (Figure 2H).