Arteriovenous malformation of the medulla oblongata supplied by the anterior spinal artery in a child: Treatment by microsurgical obliteration of thefeeding artery

We report a unique case of a 3-year-old boy with a pial arteriovenous malfo rmation (AVM) in the medulla. The patient presented with a subarachnoid hem orrhage. Magnetic resonance (MR) imaging revealed a 3 x 1 cm flow void area in the premedullary cistern that was compressing the medulla posteriorly. Cerebral angiography and MR angiography showed an aneurysm-like vascular po uch that was fed by the anterior spinal artery and had multiple draining ve ins. The case was diagnosed as a fistula-type AVM. Treatment options consis ted of endovascular embolization or open surgery. We used a left far latera l approach to obliterate the anterior spinal artery. immediately after the clip was applied to the feeding artery, the pouch began to shrink, and the color of the draining veins changed from red to blue. An intraoperative ang iography showed that the AVM had disappeared. The patient recovered fully 1 month after surgery. This case was classified as fistula-type AVM, pial ar teriovenous fistula (AVF). Microsurgical obliteration of the anterior spina l artery is considered to be the treatment of choice for perimedullary AVF located in the premedullary cistern if the endovascular treatment is not co nsidered to be feasible. Copyright (C) 2001 S. Karger AG, Basel.