Filum terminale arteriovenous fistulas: the role of endovascular treatment

J Neurosurg Spine. 2013 Jul;19(1):49-56. doi: 10.3171/2013.4.SPINE12685. Epub 2013 May 17.


Object: The authors describe the clinical presentation, imaging features, and management of patients presenting with filum terminale arteriovenous fistulas (FTAVFs) and the role of transarterial treatment in their management.

Methods: The authors retrospectively reviewed data obtained in 10 patients with FTAVFs diagnosed between January 1990 and December 2011.

Results: Most patients (70%) were male, and the age of the population ranged from 31 to 72 years (mean 58.2 years). Clinical presentation was progressive paraparesis and sensory loss in the lower extremities in 9 cases, back pain in 7, radicular pain in 3, bowel/bladder disturbance in 5, and impotence in 1. The duration of symptoms varied between 2 and 24 months. Initial MRI studies showed intramedullary increased T2 signal, swollen cord, and dilated perimedullary veins in all patients. One patient had syringomyelia, presumably caused by venous hypertension transmitted by the perimedullary venous system. Embolization was attempted in 7 patients and was curative in 6 patients. Surgery was performed in the other 4 patients in whom embolization was unsuccessful or deemed not feasible. There was no treatment-related complication in either group. Symptoms, venous congestion in the cord, and syringomyelia improved on follow-up in all patients.

Conclusions: Embolization should be considered the treatment of choice for FTAVFs and can effectively treat the majority of patients presenting with an FTAVF. In a smaller group of patients in whom the angioarchitecture is unfavorable, open surgery is recommended.

MeSH terms

  • Adult
  • Aged
  • Angiography
  • Arteriovenous Fistula / surgery
  • Arteriovenous Fistula / therapy*
  • Cauda Equina / blood supply*
  • Contrast Media
  • Embolization, Therapeutic / instrumentation
  • Embolization, Therapeutic / methods*
  • Enbucrilate / administration & dosage
  • Ethiodized Oil
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Peripheral Nervous System Diseases / etiology
  • Peripheral Nervous System Diseases / surgery
  • Peripheral Nervous System Diseases / therapy*
  • Retrospective Studies
  • Treatment Outcome
  • Vascular Surgical Procedures / methods*


  • Contrast Media
  • Ethiodized Oil
  • Enbucrilate