PMC5551288_01
(a) MRI on admission. T2-weighted images reveal spinal cord edema from T3 extending inferiorly (arrows), with associated enlarged perimedullary veins in the thoracic cord (arrowheads). (b) Spinal cord edema is shown to extend to the conus medullaris (arrows)
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F1
SDAVF [Figure 1].
Anterior view of selective injection of the left sixth intercostal artery via a 4 Fr catheter demonstrates a spinal dural arteriovenous fistula supplied by a radiculomeningeal artery (large arrow) and drained through enlarged perimedullary veins (small double arrows). The course of the left sixth intercostal artery was tortuous and its orifice was narrow (arrowheads)
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F2
Spinal angiography was performed using a 4 Fr catheter (Michaelson, Cook, Bloomington, IN, USA). Selective injection of the left sixth intercostal artery revealed a SDAVF that was supplied by a radiculomeningeal artery and drained through the perimedullary veins [Figure 2].
Anterior (a) and lateral views (b). A 5 Fr guiding catheter is inserted into the left sixth intercostal artery orifice (large arrow). A buddy wire is shown in the left sixth intercostal artery (arrowheads) and a dual-lumen microballoon catheter is shown in the dorsal spinal artery (small double arrows) during balloon inflation
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F3
Insertion of the microguidewire into the distal left sixth intercostal artery as a buddy wire stabilized the guiding catheter in the artery orifice [Figure 3]. A 0.0165-inch inner diameter dual-lumen microballoon catheter (Scepter XC 4 x 11 mm, Microvention/Terumo, Tustin, CA, USA) was inserted into the dorsal spinal artery over a 0.014-inch outer diameter microguidewire (CHIKAI, Asahi Intecc, Nagoya, Japan) [Figure 3] and the balloon was inflated.
(a) Unsubtracted fluoroscopic image obtained postprocedure shows the Onyx cast. Note the dense penetration of Onyx into the proximal perimedullary veins (arrowheads). (b) Anterior view of selective injection of the left sixth intercostal artery postprocedure demonstrates occlusion of the spinal dural arteriovenous fistula
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F4
A postprocedure selective injection of the left sixth intercostal artery revealed the Onyx cast and occlusion of the SDAVF [Figure 4].
Axial (a) and coronal (b) views from multiplanar reconstructed dyna-computed tomography obtained postprocedure reveal the dense penetration of Onyx from the radiculomeningeal artery (arrow) to the proximal perimedullary vein (arrowheads)
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F5
Postprocedure multiplanar reconstructed dyna-computed tomography imaging showed the dense deposition of Onyx from the radiculomeningeal artery to the proximal perimedullary veins [Figure 5].
MRI obtained 3 months postprocedure reveals the resolution of spinal cord edema, and enlarged perimedullary veins were no longer visible
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F6
The thoracic MRI 3 months postprocedure revealed the spinal cord edema had resolved, and the enlarged perimedullary veins were no longer visible [Figure 6].