Clipping of spinal arteriovenous fistula of the filum terminale under intraoperative angiography guidance

Arteriovenous fistula of the filum terminale (AVFFT) is an uncommon disease. We reported a case of this rare condition and we used intraoperative angiography to identify the completeness of fistula obliteration. A 53-year-old man presented with a history of low back pain and radiating pain of bilateral legs for 2 months. Lumbar spine magnetic resonance imaging revealed edema of conus medullaris at the T10–L1 level; engorged vein was also identified from L1 to L4. Digital subtraction angiography confirmed the diagnosis of AVFFT. Clipping of fistula was successfully performed, and complete obliteration was confirmed by intraoperative angiography. Magnetic resonance imaging follow-up showed no edema postoperatively. The patient's symptoms/signs improved tremendously. Both radiological and clinical outcomes were good after complete occlusion of the fistula was done. Hence, we suggested intraoperative angiography in hybrid OR as a useful tool to identify the fistulous point and confirm complete occlusion the fistula.