Microsurgical Resection of Spinal Arteriovenous Malformation with Clipping of Anterior Spinal Artery Aneurysm

Spinal cord arteriovenous malformations (AVMs) are rare and usually present in younger patients. We present the case of a 76-year-old woman with a 2-year history of unsteady gait. She presented to us with sudden-onset thoracic pain, numbness, and weakness in both legs. She was found to have urinary retention, dissociative pain loss in the left leg, and weakness involving the right leg. Magnetic resonance imaging demonstrated an intramedullary spinal AVM with subarachnoid hemorrhage and cord edema. The spinal angiogram detailed the architecture of the AVM and revealed a flow-related aneurysm in the anterior spinal artery.The patient underwent T8-T11 laminoplasty with a T10 transpedicular approach to allow for ventral exposure of the cord. Initially, a microsurgical clipping of the aneurysm was performed, followed by a pial resection of the AVM. Postoperatively, the patient recovered her bladder control and motor function. She is now able to walk with a walker due to impaired proprioception. Videos 1-4 detail the key steps and techniques for safe clipping and resection.