PMC5525462_01
Port-wine angioma in the right cervicodorsal region of the patient compromising scapular region and shoulder. The angioma extends to the homolateral pectoral region (not seen in this picture)
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F1
He displayed a port-wine angioma in the right cervicodorsal and chest region [Figure 1].
(a) Sagittal cervicodorsal T2-weighted MRI revealing the AVM from C5-D2, with multiple flow voids compromising the whole thickness of the spine and severe intensity changes up to well above in the first cervical spinal segment. (b) Axial plane T2-weighted MRI at the level of C7
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F2
The spinal MRI (repeated in our institution for lack of quality of the first one) showed intraspinal tortuous blood vessels in the saggital plane from C5-D2, with no predominant variceal component and many flow voids images in the axial plane, occupying the whole thickness of the cord at the aforementioned levels [Figure 2].
(a) Early arterial phase DSA in the right cervical region, showing a high-flow compact spinal AVM nidus with a main feeding trunk (white arrow) and multiple smaller ones. (b) Venous phase of the same angiogram, displaying multiple abnormal varicoceal draining veins extending well above the compact nidus in the cervical region
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F3
We programmed surgery 9 days after arrival prior to obtaining a cervical DSA showing right-sided predominance of arterial feeding pedicles and several tortuous varicosal drain veins [Figure 3].
Intraoperative photography before the microsurgical resection, showing prominent tortuous vessels in the subarachnoid space
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F4
The dura was exposed and incised in the regular cefalocaudal fashion, showing underneath the varicosal draining shunted veins in the dorsal archnopial compartment [Figure 4].
(a) Ten days postoperative sagittal MRI showing complete removal of the AVM and significant improvement of the hyperintensity in the cervical spinal cord [Figure 2]. (b) Same postoperative MRI in the axial plane at the level of C7 demonstrating no flow voids inside the spinal cord. (c) Seven weeks postoperative angiogram showing no residual AVM nidus
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F5