PMC9479585_01
(a) Sagittal T2 sequence showing multiple flow voids. (b) Digital substraction angiography (DSA) showing filar artery and dilated vein running together (red arrowheads). (c) DSA showing feeder from the right medullary artery (red arrowhead).
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F1
MRI was normal. MRI spine revealed multiple flow voids at lumbosacral level in T2 with cord signal changes at dorsolumbar level [Figure 1a]. On spinal digital substraction angiography (DSA), filar fistula at L4-L5 level was found [Figure 1b] with feeder from the right medullary artery arising from the left D11 level [Figure 1c].
Intraoperative visualization of dilated vein under indigocyanine green dye (a) and under microscope (b).
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F2
Indigocyanine green (ICG) was injected to identify feeding and draining vessels [Figure 2a]. Vein and fistula were also localized which were running parallel to the artery [Figure 2b].