A case of spinal arteriovenous fistula complicated with congenital spinal lipoma and successfully treated with endovascular therapy

Spinal cord lipomas concurrent with spinal arteriovenous fistulas (SAVFs) are rare, and their natural history and optimal treatment remain unclear. We report the case of a 44-year-old woman with a history of surgical intervention at 2 months of age for myelomeningocele, with the possibility of lipmyelomingocele based on the surgical history, who presented with progressive paralysis and paresthesia in both lower extremities over 3 years. She was diagnosed with an SAVF concurrent with a congenital spinal lipoma, and transarterial embolization was performed after confirming the absence of neurological symptoms during a provocation test. Postoperative imaging showed reduced T2-weighted high-intensity signals in the spinal cord, and 3 months after the procedure, her neurological symptoms improved significantly, allowing her to transition from nonambulatory wheelchair dependence to ambulation with a double cane. This case highlights the need for detailed imaging and vascular evaluation in patients with spinal lipomas and SAVFs, especially in cases involving the filum terminale type, which is closely associated with the anterior spinal artery. Proximal occlusion may occur if feeders have multiple branches or a long distance to the drainer, increasing the risk of incomplete treatment. A provocation test before embolization can enhance both safety and efficacy.