Ruptured arteriovenous malformation of Conus medullaris in infancy: A case report of an extremely rare emergency.

Background: Ruptured arteriovenous malformation (AVM) of conus medullaris in the pediatric population is extremely rare. This pathology can lead to severe permanent sequela if it is not treated properly. However, controversy over management protocols persists especially in pediatric patients.

Methods: We report a 5-month-old infant admitted for an AVM of conus medullaris with a hemorrhagic complication. The child presented with sudden lower limb weakness. Magnetic Resonance Imaging (MRI) demonstrated the etiology as a bleeding AVM of the conus medullaris causing massive spinal cord compression and surrounding edema. Because of the very young age and the emergency presentation, digital subtraction angiography was not feasible. Emergency surgery was indicated aiming at evacuating the hematoma and decompressing the spinal cord. Intraoperatively, after bilateral laminectomy, the spinal cord showed massive edema, the hematoma was removed and duroplasty was performed with autologous fascia. Two weeks postoperatively, the patient limb motor function on both sides showed gradual improvement.

Conclusions: Thorough clinical examination and MRI investigation played an important role in early and accurate diagnosis of this pathology. Decision on emergency management strategy needs to be carefully made involving neurosurgeons, neurologists, and radiologists. Definitive management might not be achieved by a single surgical procedure and requires a combination of different treatment modalities. Conclusions: Ruptured arteriovenous malformation of conus medullaris at a very young age is a clinical formidable challenge. This type of neurological emergency requires prompt diagnosis and treatment to limit the irreversible injury and enhance functional recovery. Multidisciplinary collaboration is crucial to achieving these goals.