Anterior cervical pial arteriovenous malformation associated with a spinal aneurysm: a case report and a review of the literature.

Abstract Introduction Cervical pial arteriovenous malformations is an extremely rare condition which can present with progressive myelopathy or acute hemorrhage (subarachnoid or intramedullary). The classification process is still a topic of discussion, given the limited number of cases described as well as the correct therapeutic management. Here, we present a case of young female with anterior cervical pial avm associated with spinal aneurysm. Case presentation A 31-year-old female at the 5th month of pregnancy presented at the Emergency Room (ER) for tetraparesis, sphincter disturbances, burning dysaesthesia, Through MRA, a cervical pial arteriovenous malformation (AVM) with a spinal aneurysm has been diagnosed. After a multidisciplinary consult, a neurosurgical approach has been proposed to minimize the hemorrhagic risk. A laminectomy C2-C4 level was performed, followed by the identification of the AVM on the anterior-lateral left-sided surface of spinal cord. The lesion was associated with a thrombosed aneurysm at level of C2. Using neurophysiological monitoring, we performed a temporary clipping of afferent vessels to the AVM. The thrombosed aneurysm was removed. ICG fluorescine and intraoperative doppler confirmed completely resolution of AVM. The post-operative course has been regular with no complications recorded. Conclusion Surgical procedure with perioperative neuromonitoring is an effective way to treat anterior cervical pial avm associated with spinal aneurysm. A multidisciplinary approach is always suggested.