Child pial arteriovenous fistula of the conus medullaris presenting with spinal cord venous congestion: Case report and literature review

Background: Pediatric pial arteriovenous fistula (AVFs) of the conus medullaris is a very rare condition. Over these two last decade, only 21 Cases was reported in literature about AVF Spinal cord. On those 21 cases only seven (7) cases was involved conus medullaris. We report a case of spinal pial AVF of conus medullaris in 12-Year-old female. Case description: Twelve (12) years old girl was admitted in the emergency department of our hospital with back and leg pain evolving for about one year ago with sudden onset gait disorders. Sagittal T2- weighted MRI of the spine showed spinal cord oedema signal with intramedullary haemorrhage in the conus medullaris. Spinal angiography showed a pial arteriovenous fistula of conus medullaris supplied by the two spinal posterior arteries. Methylprednisolone intravenous (80 mg/24 h) was started empirically and we performed embolization with coils and glue. Heparin therapy was used in per-procedure and post-procedure, then switched by the Acetylsalicylic acid (Aspirin) on preventive dose for 3 months with physiotherapy and right foot lift splint. The pain rapidly resolved after treatment and complete return of lower extremity strength was noted at 9 month follow up. Conclusion: Urgent endovascular embolization could be suggest in patients with a moderate neurological presentation.Meeting concertation between neuro-endovascular specialist and neurosurgeon might be mandatory to choose the optimal management.