Figure 2 Sagittal view of T2 weighted Contrast MRI showing intramedullary mass at thoracolumbar level
Under general anesthesia, a laminectomy at the D11-L2 level and exploration was performed by an experienced neurosurgeon. The findings were a large tortuous vascular channel on the dorsal surface of the spinal cord and a large tuft of vascular channels (nidus) on the right side of the dorsal root on the spinal cord at D12-L1 level. Excision of spinal AVM was done under GA, and AVM nidus was dissected off the pial surface of the spinal cord. First, the feeding artery was coagulated, followed by coagulation of the draining vein. Next, a feeding artery arising from neural foramen was coagulated and cut.
A tissue biopsy from nidus was taken and sent for histopathological examination, which further confirmed the diagnosis of spinal AV malformation. Postoperatively she was kept on vancomycin 500mg IV, fentanyl 50 microgram per hour IV, pregabalin 75 mg PO, amitriptyline, ondansetron 4 mg IV, labetalol, and thiamine. She was discharged after 12 days of surgery.
She was followed up 6 months later, on May 15, by phone call. There was mild improvement in the motor function of the patient after the operation. There were no complications or adverse effects.