Teaching NeuroImage: Arteriovenous Fistula of Cauda Equina Fed by the Proximal Radicular Artery

A 66-year-old man presented with a 2-year history of weakness and numbness in his lower limbs and occasional urinary incontinence. Spinal MRI showed spinal edema and prominent flow voids. Selective angiography of the right T10 segmental artery revealed an arteriovenous fistula of cauda equina (CEAVF) fed by the proximal radicular artery (PRA), the downward extension of anterior spinal artery (Figure 1). Intraoperatively, the fistula, draining vein, and feeding artery running along a nerve root were identified. The fistula was resected successfully (Figure 2), and the symptoms gradually improved. Spinal CEAVF is extremely rare.1,2 This case demonstrates the microscopic angioarchitecture of CEAVF.

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