Transvenous embolization through a cutaneous lumbar vein to treat a spinal epidural arteriovenous fistula: illustrative case.

backgroundEndovascular treatment with transarterial embolization (TAE) or transvenous embolization (TVE) is the mainstay of treatment for spinal epidural arteriovenous fistulas (SEDAVF). In cases of unsuccessful obliteration after TAE, the azygous veins are a commonly used access route for TVE; however, valve and metameric connections to the paraspinal veins complicate transvenous access. Here, the authors present a case of an SEDAVF that was successfully treated through the dominant cutaneous vein. OBSERVATIONS: A 68-year-old male presented with progressive myelopathy and urinary incontinence. MRI revealed a high signal around the spinal cord and a flow void on T2-weighted images. CT angiography revealed a dilated vessel arising from the spinal canal toward the spinal vein and the cutaneous layer of the lumbar back. Spinal angiography revealed an SEDAVF at the L3 spine level, which was fed by the dorsal somatic branches and drained into the spinal and cutaneous lumbar veins. After unsuccessful TAE attempts, complete obliteration of the SEDAVF was achieved using TVE through the cutaneous lumbar vein. The patient's symptoms improved within 3 months of embolization. LESSONS: Preoperative assessment of the localization of the draining system may be useful for identifying unknown but accessible draining veins in SEDAVF. https://thejns.org/doi/10.3171/CASE25329.