E-041 Combined endovascular embolization and surgical resection of a massive lumbosacral arteriovenous malformation in a patient with Cobb syndrome. (16th November 2010)

• Record Type: Journal Article
• Authors: Spiotta, A; Hussain, M; Sivapatham, T; Masaryk, T; Krishnaney, A
• Is Part Of: Journal of neurointerventional surgery. Volume 2(2010)Supplement 1
• Page Start: A42
• Page End: A42
• Publication Date: 2010-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/jnis.2010.003251.41
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Objective and importance: Cobb syndrome is a rare condition that includes a cutaneous nevus with an associated spinal vascular lesion at the same dermatome. We present a challenging case of a progressively symptomatic massive lumbosacral arteriovenous malformations (AVM) in a patient with Cobb's syndrome requiring a multimodality approach, including staged preoperative transarterial and transvenous endovascular embolization followed by surgical excision and wound reconstruction. Clinical presentation: The patient is a 25-year-old man with a massive lumbosacral AVM with symptoms of congestive heart failure. Angiography demonstrated arterial feeders predominantly from the internal iliac, median sacral and lumbar segmental arteries. Intervention: The patient underwent staged transarterial and transvenous endovascular embolization resulting in 90% reduction in the AVM size, followed by surgical resection of the lesion. The patient made an excellent recovery with improvement in his symptoms of congestive heart failure. Conclusion: The treatment algorithm for massive AVMs must be individualized. A combination of staged embolization and subsequent surgery may be required to obtain a good result. Through this carefully planned multidisciplinary approach, a previously incurable lesion in this patient with Cobb syndrome was able to be treated successfully.