{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:56:48Z","timestamp":1767833808952,"version":"3.49.0"},"reference-count":22,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Cauda equina arteriovenous fistulas (AVFs) fed by the proximal radicular artery are exceedingly rare. Spinal dural arteriovenous fistulas (DAVFs) in the sacral region are rare and usually misdiagnosed. We report a case of a cauda equina AVF with concomitant sacral DAVF. We also review the coexistence of multiple types of spinal vascular malformations in a single patient.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>A 54-year-old man presented with progressive weakness of the lower extremities for 1 month. Magnetic resonance imaging (MRI) of the lumbosacral and thoracic spine showed spinal cord congestion, extending from the conus medullaris to the level of T7, and abnormal tortuous and dilated flow void, running from the level of L5 to T12 along anterior surface of the spinal cord. Spinal angiography demonstrated the fistula at the level of L2 below the conus medullaris. Based on intraoperative findings, the cauda equina AVF supplied by the proximal radicular artery with cranial drainage through the enlarged radicular vein was confirmed and successfully obliterated. Another enlarged arterialized radicular vein running parallel to another cauda equina nerve root is observed with unknown origin. After the operation, the patient showed mild improvement of his symptoms. Follow-up MRI and contrast-enhanced MR angiography revealed an another sacral DAVF vascularized by the lateral sacral artery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>The coexistence of different spinal vascular malformations in a same patient is extremely rare. Most authors of several studies hypothesized that venous hypertension and thrombosis due to the presence or treatment of the first spinal vascular lesion may produce a second DAVF.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_612_2021","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T14:10:36Z","timestamp":1629123036000},"page":"405","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cauda equina arteriovenous fistula supplied by proximal radicular artery and concomitant sacral dural arteriovenous fistula: A case report and literature review"],"prefix":"10.25259","volume":"12","author":[{"given":"Prasert","family":"Iampreechakul","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Punjama","family":"Lertbutsayanukul","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Somkiet","family":"Siriwimonmas","sequence":"additional","affiliation":[{"name":"Department of Radiology, Bumrungrad International Hospital, Bangkok, Thailand."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2021,8,16]]},"reference":[{"key":"10.25259\/SNI_612_2021\/ref-1","first-page":"2","article-title":"Classification of spinal arteriovenous malformations and implications for treatment","volume":"8","author":"Anson","year":"1992","journal-title":"BNI Q"},{"key":"10.25259\/SNI_612_2021\/ref-2","first-page":"96","article-title":"Concurrent spinal dural and intradural arteriovenous fistulas. Case report","volume":"95","author":"Dam-Hieu","year":"2001","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_612_2021\/ref-3","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1136\/neurintsurg-2017-013307","article-title":"Sacral dural arteriovenous fistulas: A diagnostic and therapeutic challenge-single-centre experience of 13 cases and review of the literature","volume":"10","author":"Gioppo","year":"2018","journal-title":"J Neurointerv Surg"},{"key":"10.25259\/SNI_612_2021\/ref-4","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.neurad.2019.07.004","article-title":"Primary conus medullaris arteriovenous shunt and secondary lumbo-sacral epidural arteriovenous fistula: One malformation can hide another","volume":"48","author":"Gu\u00e9don","year":"2021","journal-title":"J Neuroradiol"},{"key":"10.25259\/SNI_612_2021\/ref-5","doi-asserted-by":"crossref","first-page":"403","DOI":"10.3174\/ajnr.A5001","article-title":"Comparison of 3 different types of spinal arteriovenous shunts below the conus in clinical presentation, radiologic findings, and outcomes","volume":"38","author":"Hong","year":"2017","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_612_2021\/ref-6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1177\/159101990200800109","article-title":"Concomitant conus medullaris arteriovenous malformation and sacral dural arteriovenous fistula of the filum terminale","volume":"8","author":"Hsu","year":"2002","journal-title":"Interv Neuroradiol"},{"key":"10.25259\/SNI_612_2021\/ref-7","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3171\/spi.2006.4.3.241","article-title":"Spinal dural arteriovenous fistula associated with a spinal perimedullary fistula: Case report","volume":"4","author":"Krings","year":"2006","journal-title":"J Neurosurg Spine"},{"key":"10.25259\/SNI_612_2021\/ref-8","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/0090-3019(95)80035-F","article-title":"Spinal dural arteriovenous fistulas supplied by branches of the internal iliac arteries","volume":"43","author":"Larsen","year":"1995","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_612_2021\/ref-9","doi-asserted-by":"crossref","first-page":"1041.e7","DOI":"10.1016\/j.wneu.2017.06.149","article-title":"Concomitant lumbosacral perimedullary arteriovenous fistula and spinal dural arteriovenous fistula","volume":"105","author":"Li","year":"2017","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_612_2021\/ref-10","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/159101990501100113","article-title":"Metachronous multiplicity of spinal cord arteriovenous fistula and spinal dural AVF in a patient with hereditary haemorrhagic telangiectasia","volume":"11","author":"Ling","year":"2005","journal-title":"Interv Neuroradiol"},{"key":"10.25259\/SNI_612_2021\/ref-11","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1177\/159101999900500105","article-title":"Multifocal and metameric spinal cord arteriovenous malformations","volume":"5","author":"Matsumaru","year":"1999","journal-title":"Review of 19 cases Interv Neuroradiol"},{"key":"10.25259\/SNI_612_2021\/ref-12","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.surneu.2003.05.002","article-title":"Recurrent spinal fistula as result of a rare combination of a perimedullary and peridural spinal fistula: Case report","volume":"61","author":"Morgalla","year":"2004","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_612_2021\/ref-13","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.3174\/ajnr.A6813","article-title":"Cauda equina and filum terminale arteriovenous fistulas: Anatomic and radiographic features","volume":"41","author":"Namba","year":"2020","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_612_2021\/ref-14","doi-asserted-by":"crossref","first-page":"310","DOI":"10.2176\/nmc.ra.2016-0006","article-title":"Vascular anatomy of the cauda equina and its implication on the vascular lesions in the caudal spinal structure","volume":"56","author":"Namba","year":"2016","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"10.25259\/SNI_612_2021\/ref-15","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1177\/159101990300900113","article-title":"Spinal arteriovenous malformation associated with a radicular arteriovenous fistula suggested a metameric disease. A case report","volume":"9","author":"Nishio","year":"2003","journal-title":"Interv Neuroradiol"},{"key":"10.25259\/SNI_612_2021\/ref-16","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.wneu.2020.06.022","article-title":"Concomitant sacral dural arteriovenous fistula and conus medullaris arteriovenous malformation with respective drainage veins: Case report and literature review","volume":"141","author":"Niu","year":"2020","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_612_2021\/ref-17","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1177\/159101991101700213","article-title":"Arteriovenous fistula in a nerve root of the cauda equina fed by a proximal radiculo-medullary artery: A report of two cases","volume":"17","author":"Ohtonari","year":"2011","journal-title":"Interv Neuroradiol"},{"key":"10.25259\/SNI_612_2021\/ref-18","first-page":"1109","article-title":"Double spinal dural arteriovenous fistulas: Report of two cases","volume":"14","author":"Pierot","year":"1993","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_612_2021\/ref-19","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1136\/neurintsurg-2017-013505","article-title":"Concomitant conus medullaris arteriovenous shunts and sacral dural arteriovenous fistulas: Pathophysiological links related to the venous drainage of the lesions in a series of five cases","volume":"10","author":"Rosi","year":"2018","journal-title":"J Neurointerv Surg"},{"key":"10.25259\/SNI_612_2021\/ref-20","doi-asserted-by":"crossref","first-page":"516","DOI":"10.2176\/nmc.52.516","article-title":"Deterioration after surgical treatment of spinal dural arteriovenous fistula associated with spinal perimedullary fistula","volume":"52","author":"Sasaki","year":"2012","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"10.25259\/SNI_612_2021\/ref-21","first-page":"145","article-title":"Modified classification of spinal cord vascular lesions","volume":"96","author":"Spetzler","year":"2002","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_612_2021\/ref-22","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s00586-017-5129-0","article-title":"A case of arteriovenous fistula of the cauda equina fed by the proximal radicular artery: Anatomical features and treatment precautions","volume":"27","author":"Tanioka","year":"2018","journal-title":"Eur Spine J"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/cauda-equina-arteriovenous-fistula-supplied-by-proximal-radicular-artery-and-concomitant-sacral-dural-arteriovenous-fistula-a-case-report-and-literature-review\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/cauda-equina-arteriovenous-fistula-supplied-by-proximal-radicular-artery-and-concomitant-sacral-dural-arteriovenous-fistula-a-case-report-and-literature-review\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T14:10:54Z","timestamp":1629123054000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/cauda-equina-arteriovenous-fistula-supplied-by-proximal-radicular-artery-and-concomitant-sacral-dural-arteriovenous-fistula-a-case-report-and-literature-review\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,16]]},"references-count":22,"alternative-id":["10.25259\/SNI_612_2021"],"URL":"https:\/\/doi.org\/10.25259\/sni_612_2021","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,16]]},"article-number":"405"}}