Abstract：
Intraosseous occurrence of a spinal AVM is anecdotal, with only four such cases reported previously. This is the first report of a spinal intraosseous AVM in the cervical vertebrae. A 44-year-old male patient presented with a 2-month history of progressive quadriparesis and bladder dysfunction. Magnetic resonance imaging showed multiple flow voids within the C4 and C5 vertebral bodies, and an extradural component causing cord compression. CT showed extensive bony destruction at both levels. The diagnosis of an intraosseous AVM was confirmed with spinal angiography. The AVM was noted to be fed by branches from the ascending cervical arteries and the vertebral artery. The nidus was draining into the vertebral venous plexus and thence into the jugular vein through the marginal sinus. The patient underwent partial embolization of the AVM. Surgical resection was attempted but found to be unfeasible due to torrential bleeding. A 360-degree stabilization along with decompressive laminectomies was performed, resulting in clinical improvement and disease stabilization at one year follow-up. The case and its management dilemmas are discussed in light of a brief literature review.
摘要：
脊柱AVM的骨内发生是轶事，以前只有四例这样的病例报告。这是颈椎中脊髓骨内AVM的第一份报告。一名44岁的男性患者有2个月的进行性四肢瘫痪和膀胱功能障碍病史。磁共振成像显示C4和C5椎体内有多个流动空隙，和导致脊髓压迫的硬膜外部分。CT显示两个级别的骨广泛破坏。脊髓血管造影证实了骨内AVM的诊断。注意到AVM是由上行颈动脉和椎动脉的分支喂养的。鼻窦排入椎静脉丛，然后通过边缘窦排入颈静脉。患者接受了AVM的部分栓塞。试图进行手术切除，但发现由于大出血而不可行。进行了360度稳定和减压层切除术，在一年的随访中导致临床改善和疾病稳定。通过简要的文献综述，讨论了该案例及其管理困境。
