Spinal intradural perimedullary arteriovenous fistula with varix in infant

A rare occurrence of type IV spinal arteriovenous malformation (intradural perimedullary arteriovenous fistula) is described in an 18-month-old boy in itially misdiagnosed with Guillain-Barre syndrome. An intramedullary mixed- intensity mass lesion at Th1 was demonstrated by magnetic resonance imaging together with flow voids over the dorsal aspect of the swollen spinal cord . Angiography demonstrated an intradural perimedullary arteriovenous fistul a including an intraparenchymal vascular pocket. After partial embolisation of the posterior spinal arteries through the left intercostal-radicular ar tery, the arteriovenous fistula was removed completely together with an org anised haematoma. The fistula directly opened into a vascular pocket, which was confirmed pathologically to be a varix. The postoperative course was u neventful, and the patient resumed ambulation within 4 months. The case, su bclassifiable as a type IVb spinal perimedullary AVF, was unique given its location and the patient's age at presentation. (C) 2000 Harcourt Publisher s Ltd.