Successful endovascular treatment for pediatric ruptured cervical spinal perimedullary arteriovenous fistula: A case report

Perimedullary arteriovenous fistulas (PMAVFs) are rare spinal vascular lesions, particularly in pediatric patients. We present a pediatric case of a ruptured cervical PMAVF, successfully treated with endovascular embolization, along with a review of relevant literature. A 10-year-old boy with no significant medical history initially presented with neck pain and fatigue, progressing to paralysis in his upper limbs and eventually all extremities. His condition further deteriorated, leading to impaired consciousness and respiratory distress, necessitating transfer to our pediatric intensive care unit for intubation and management. Head magnetic resonance images revealed medullary edema and dilated veins in the posterior cranial fossa. At the same time, contrast-enhanced computed tomography of the neck showed an intramedullary hematoma centered at C4, with edema extending from the medulla oblongata to T3 and dilated vessels surrounding the lesion. Angiography confirmed a varix rupture of the PMAVF with feeders from the right C4 dorsal root artery and the right ascending cervical artery. Endovascular embolization was performed using 33% n‑butyl‑2-cyanoacrylate through a microcatheter placed just beyond the fistula. The shunt was successfully occluded. Postoperatively, following a tracheotomy, the patient was gradually weaned off the ventilator. With rehabilitation, he showed significant improvement in spinal cord function, including regaining the ability to transfer with a walker. Endovascular embolization is a viable treatment option for pediatric PMAVF, as demonstrated in this case, where a single-stage procedure achieved successful occlusion and significant neurological recovery.