Intramedullary arteriovenous malformation with associated intranidal aneurysm: Case report and review of the literature

Background: Spinal arteriovenous malformations (AVMs) are rare vascular lesions presenting either with subtle progressive myelopathy or acute intramedullary/subarachnoid hemorrhage with associated neurological deficits. Far more uncommonly, AVMs are associated with intra-nidal aneurysms, which provide a further challenge in their management. Nevertheless, if untreated, these lesions lead to severe disability with a poor percentage of neurological recovery. Due to the lack of general guidelines, a neurosurgical and endovascular multidisciplinary approach is mandatory to achieve the best outcome in the management of such conditions. Case description: We provide a case of a 12-year-old girl presenting with a history of progressive lower limbs hyposthenia and sphincter dysfunction, presenting with acute excruciating back pain. Radiological assessments revealed a thoracic anterior intramedullary AVM associated with intranidal aneurysm, determining spinal cord compression. Discussion and conclusions: After a multidisciplinary evaluation, patient underwent a microsurgical resection of the lesion, with exclusion of the lesion from the spinal circulation and spinal cord decompression. On three-months neuroradiological follow-up, complete refilling of the spinal aneurysm was detected, and patient underwent a new microsurgical approach. Definitive exclusion of the vascular lesion was then achieved. Critical discussion of the choice of treatment along with a review of the pertinent literature is provided.