Transradial approach in the treatment of a sacral dural arteriovenous fistula: a technical note

Sacral dural arteriovenous fistulas (SDAVFs) are rare, constituting no more than 10% of all spinal dural fistulas. They are most commonly fed by the lateral sacral artery (LSA), a branch of the internal iliac artery (IIA). Catheterization of this vessel requires either a crossover at the aortic bifurcation in cases of right femoral access or retrograde catheterization from the ipsilateral common femoral artery. We present the case of a 79-year-old man with tethered cord syndrome and a symptomatic SDAVF fed by two feeders from the left LSA. Spinal diagnostic angiography was made exceptionally challenging by an aorto-bi-iliac endograft, and selective catheterization of the left IIA was not possible. The patient could not undergo surgery due to multiple comorbidities, therefore embolization was considered the best approach. The procedure was carried out through a transradial access (TRA) with Onyx and n-butyl cyanoacrylate. The SDAVF was successfully treated and the patient made a full neurological recovery.

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The Bilateral Sacral Origin of a Spinal Dural Arteriovenous Fistula: A Case Report

Iranian Journal of Radiology ◽

10.5812/iranjradiol.115118 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Ehsan Mohammad Hosseini ◽

Alireza Rasekhi ◽

Keyvan Eghbal ◽

Abdolkarim Rahmanian ◽

Arash Saffarrian ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Internal Iliac Artery ◽

Dorsal Surface ◽

Spinal Dural Arteriovenous Fistula ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Internal Iliac ◽

Magnetic Resonance Imaging Mri ◽

Spinal Dural Arteriovenous Fistulas ◽

Progressive Weakness

: Spinal dural arteriovenous fistulas (SDAVFs) are characterized by an abnormal connection between a spinal radicular artery and a perimedullary vein, mainly fed by a radicular artery at the nerve root sleeve. Here, we describe the case of a 40-year-old woman, presenting with progressive weakness of the lower extremities and the sphincter. Thoracic magnetic resonance imaging (MRI) showed spinal cord edema and signal voids on the dorsal surface of the cord. Spinal angiography demonstrated a SDAVF with a nidus at the sacral level; the feeder of the arteriovenous fistula was a lateral sacral artery, as a branch of the internal iliac artery. The lateral sacral artery was subselectively catheterized, and SDAVF was embolized with 25% n-butyl cyanoacrylate (NBCA) glue (glue: lipiodol ratio, 1:3). After embolization, no definite residual connection was visualized between the arterial and venous systems.

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Sacral dural arteriovenous fistulas: a diagnostic and therapeutic challenge – single-centre experience of 13 cases and review of the literature

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013307 ◽

2017 ◽

Vol 10 (4) ◽

pp. 415-421 ◽

Cited By ~ 10

Author(s):

Andrea Gioppo ◽

Giuseppe Faragò ◽

Caterina Giannitto ◽

Luigi Caputi ◽

Andrea Saladino ◽

...

Keyword(s):

Spinal Cord ◽

Clinical Presentation ◽

Vascular Abnormalities ◽

Arteriovenous Fistulas ◽

Endovascular Embolisation ◽

Imaging Characteristics ◽

Dural Arteriovenous Fistulas ◽

Internal Iliac ◽

Clinical Records

BackgroundSacral dural arteriovenous fistulas (DAVFs) are rare vascular abnormalities of the spine characterised by slowly progressive symptoms that can mimic different myelopathy disorders.ObjectTo report our single Institution experience with sacral DAVFs.MethodsWe retrospectively reviewed the clinical records of patients admitted from 1 January 2006 to 31 December 2016 with a diagnosis of sacral DAVFs, treated by endovascular embolisation or surgical clipping. Clinical presentation, imaging characteristics, treatment results and follow-up were analysed.ResultsWe identify 13 patients with sacral DAVFs supplied by lateral sacral arteries. Clinical presentation was characterised by different degrees of motor weakness and sphincter disturbances. In all patients, spinal MRI showed spinal cord hyperintensities with enhancement and prominent perimedullary vessels. Selective internal iliac angiography was mandatory to identify the exact location of the fistula. A complete embolisation was achieved in eight patients performing a single endovascular embolisation and in three patients performing a single surgical disconnection: two patients required combined procedures. Follow-up imaging showed a complete resolution of the spinal cord hyperintensities in 81% of patients and a reduction of the intramedullary enhancement in 91%. Gait improvement was observed in 73% of patients, while remaining stable in 27%. Sphincter disturbances improved in 36% of patients and remained stable in 64%.ConclusionAwareness of sacral location of DAVFs is critical because standard spinal angiography will not identify sacral supplies, unless internal iliac arteries are properly examined. In our experience, the endovascular treatment show results comparable to surgery when the fistula point is correctly disconnected.

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Microscope-assisted endoscopic interlaminar ligation of spinal arteriovenous fistulas: technical note

Journal of Neurosurgery Spine ◽

10.3171/2015.12.spine15366 ◽

2016 ◽

Vol 25 (3) ◽

pp. 394-397 ◽

Cited By ~ 3

Author(s):

Chen Wang ◽

Chien-Min Chen ◽

Fang Shen ◽

Xiao-Dong Fang ◽

Guang-Yu Ying ◽

...

Keyword(s):

Technical Note ◽

Endoscopic Management ◽

Short Term ◽

Endoscopic Techniques ◽

Arteriovenous Fistulas ◽

Interlaminar Approach ◽

Dural Arteriovenous Fistulas ◽

Spinal Arteriovenous Malformations ◽

Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations, and microsurgical ligation is the treatment modality most frequently used for these lesions. Developments in endoscopic techniques have made endoscopy an even less invasive alternative to routine microsurgical approaches in spine surgery, but endoscopic management of SDAVF or other intradural spinal lesions has not been reported to date. The authors describe the use of a microscope-assisted endoscopic interlaminar approach for the ligation of the proximal draining vein of an L-1 SDAVF in a 58-year-old man. A complete cure was confirmed by postoperative angiography. The postoperative course was uneventful, and short-term follow-up showed improvements in the patient's neurological function. The authors conclude that the endoscopic interlaminar approach with microscope assistance is a safe, minimally invasive, innovative technique for the surgical management of SDAVFs in selected patients.

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Covered Stent in the Superior Gluteal Artery in a Hybrid Approach to Treat Internal Iliac Artery Aneurysm: A Technical Note

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2015.03.025 ◽

2015 ◽

Vol 26 (7) ◽

pp. 1040-1045 ◽

Cited By ~ 3

Author(s):

Maxime Noël-Lamy ◽

Kong Teng Tan ◽

Thomas Lindsay

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

Hybrid Approach ◽

Artery Aneurysm ◽

Covered Stent ◽

Technical Note ◽

Superior Gluteal Artery ◽

Iliac Artery Aneurysm ◽

Internal Iliac Artery Aneurysm ◽

Internal Iliac

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Single stage transcranial exposure of large dural venous sinuses for surgically-assisted direct transvenous embolization of high-grade dural arteriovenous fistulas: technical note

Acta Neurochirurgica ◽

10.1007/s00701-012-1462-6 ◽

2012 ◽

Vol 154 (10) ◽

pp. 1855-1859 ◽

Cited By ~ 16

Author(s):

James K. Liu ◽

Osamah J. Choudhry ◽

Stanley L. Barnwell ◽

Johnny B. Delashaw ◽

Aclan Dogan

Keyword(s):

Technical Note ◽

Single Stage ◽

High Grade ◽

Transvenous Embolization ◽

Arteriovenous Fistulas ◽

Venous Sinuses ◽

Dural Arteriovenous Fistulas ◽

Dural Venous Sinuses

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Direct transforaminal Onyx embolization of intracranial dural arteriovenous fistulas: technical note and report of five cases

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2013-010890 ◽

2013 ◽

Vol 6 (7) ◽

pp. 500-504 ◽

Cited By ~ 5

Author(s):

Pedro Saura ◽

Javier Saura ◽

Antonio Pérez-Higueras ◽

Mario Martínez-Galdámez

Keyword(s):

Technical Note ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas

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Bilateral Cervical Spinal Dural Arteriovenous Fistulas with Intracranial Venous Drainage Mimicking a Foramen Magnum Dural Arteriovenous Fistula

Interventional Neuroradiology ◽

10.1177/159101991301900413 ◽

2013 ◽

Vol 19 (4) ◽

pp. 483-488 ◽

Cited By ~ 6

Author(s):

Steven W. Hetts ◽

Joey D. English ◽

Shirley I. Stiver ◽

Vineeta Singh ◽

Erin J. Yee ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Foramen Magnum ◽

Venous Hypertension ◽

Complex Case ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Diagnostic Angiography ◽

Spinal Dural Arteriovenous Fistulas

We describe a unique case of bilateral cervical spinal dural arteriovenous fistulas mimicking an intracranial dural arteriovenous fistula near the foramen magnum. We review its detection via MRI and digital subtraction angiography and subsequent management through surgical intervention. Pitfalls in diagnostic angiography are discussed with reference to accurate location of the fistula site. The venous anastomotic connections of the posterior midline spinal vein to the medial posterior medullary vein, posterior fossa bridging veins, and dural venous sinuses of the skull base are discussed with reference to problem-solving in this complex case. The mechanism of myelopathy through venous hypertension produced by spinal dural fistulas is also emphasized.

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Three-Dimensional Endoscopic Magnification for Treatment of Thoracic Spinal Dural Arteriovenous Fistulas: Technical Note

Operative Neurosurgery ◽

10.1093/ons/opx122 ◽

2017 ◽

Vol 14 (3) ◽

pp. 259-266

Author(s):

Alexander G Weil ◽

Sami Obaid ◽

Chiraz Chaalala ◽

Daniel Shedid ◽

Elsa Magro ◽

...

Keyword(s):

Minimally Invasive ◽

Technical Note ◽

Minimally Invasive Approach ◽

Tubular Retractor ◽

Invasive Approach ◽

Arteriovenous Fistulas ◽

Tunnel Vision ◽

Thoracic Spinal ◽

Dural Arteriovenous Fistulas ◽

Spinal Dural Arteriovenous Fistulas

Abstract BACKGROUND Treatment of thoracic spinal dural arteriovenous fistulas (DAVFs) by microsurgery has recently been approached using minimally invasive spine surgery (MISS). The advantages of such an approach are offset by difficult maneuverability within the tubular retractor and by the creation of “tunnel vision” with reduced luminosity to a remote surgical target. OBJECTIVE To demonstrate how the pitfalls of MISS can be addressed by applying 3-D endoscopy to the minimally invasive approach of spinal DAVFs. METHODS We present 2 cases of symptomatic thoracic DAVFs that were not amenable to endovascular treatment. The DAVFs were excluded solely via a minimally invasive approach using a 3-D endoscope. RESULTS Two patients underwent exclusion of a DAVF following laminotomy, one through a midline 5-cm incision and the other through a paramedian 3-cm incision using minimally invasive nonexpandable tubular retractors. The dura opening, intradural exploration, fistula exclusion, and closure were performed solely under endoscopic 3-D magnification. No incidents were recorded and the postoperative course was marked by clinical improvement. Postoperative imaging confirmed the exclusion of the DAVFs. Anatomical details are exposed using intraoperative videos. CONCLUSION When approaching DAVFs via MISS, replacing the microscope with the endoscope remedies the limitations related to the “tunnel vision” created by the tubular retractor, but at the expense of losing binocular vision. We show that the 3-D endoscope resolves this latter limitation and provides an interesting option for the exclusion of spinal DAVFs.

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