Surgical Treatment of an Intramedullary Glomus Spinal Arteriovenous Malformation with Acute Hemorrhage: Tips and Pitfalls from a Case Report

Intramedullary glomus arteriovenous malformations (AVMs) are rare type II spinal vascular malformation with a high propensity for hemorrhage.Acute hemorrhage requires urgent intervention, but the optimal management strategy remains a topic of debate.A 25-year-old man presented with sudden-onset complete quadriplegia below C5 after acute intramedullary hemorrhage from a glomus AVM at C4-C5.Emergency spinal angiography showed that the lesion received blood from both the deep cervical and ascending cervical arteries.Urgent endovascular embolization of the ventral and dorsal feeders with Onyx (ethylene-vinyl alcohol copolymer) was immediately followed by microsurgical resection through a partial C3 laminectomy and C4-C6 laminoplasty.The nidus and hematoma were successfully removed en bloc under intraoperative neurophysiological monitoring.By three months postoperatively, upper limb motor function had gradually recovered to grade 3-4, whereas lower limb recovery remained minimal at grade 1. Ultra-early surgery is carefully considered for patients with severe neurological deficits caused by acute hemorrhage, as illustrated by this case.This approach may be technically feasible and may facilitate effective hematoma evacuation and nidal resection.However, it may yield only partial neurological recovery, particularly in the upper limbs, and does not guarantee definitive long-term functional restoration.Extensive preoperative embolization of anterior spinal artery feeders requires extreme caution because of the risk of injury to critical pedicle arteries.Management of these complex lesions requires a highly selective strategy combining embolization and surgery with thorough hematoma evacuation.