Fistulas to the ventral epidural venous plexus, which are usually slow-flow lesions, are called arteriovenous fistulas. Usually AVFs drain only into the epidural venous system and present with compressive myelopathy or radiculopathy due to enlarged epidural veins. Lesions have been reported that drain primarily into the ventral epidural venous plexus and then secondarily into the intradural/medullary venous system. These lesions can cause venous hypertension or sub-arachnoid hemorrhage (SAH). Most of the reported cases are sacral, with arterial supply from the lateral sacral arteries.2
The treatment for AVF consists of endovascular acrylate (n-butyl-cyanoacrylate) (NBCA) embolization, with obliteration of the proximal draining venous system or surgical obliteration.
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