Microsurgical Treatment of Perimedullary Fistulae

Perimedullary arteriovenous fistulae (PMAVF) are a form of spinal intradural vascular malformation wherein there is an arteriovenous shunt irrigated by elements of the intrinsic spinal cord circulation and drained via the coronal venous plexuses without the presence of a nidus. They may present with ischemic radiculomyelopathy or more rarely hemorrhage. Many are amenable to endovascular cure, but where this is not feasible, microsurgical disconnection provides as safe and highly effective alternative providing the angioarchitecture of the shunt is appreciated.