Impact of non-contrast enhanced volumetric MRI-based feeder localization in the treatment of spinal dural arteriovenous fistula

2016 ◽  
Vol 9 (2) ◽  
pp. 178-182 ◽  
Author(s):  
Santhosh Kumar Kannath ◽  
Bejoy Thomas ◽  
P Sankara Sarma ◽  
Jayadevan Enakshy Rajan
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Definitive Treatment ◽  
Spinal Angiography ◽  
Vertebral Level ◽  
Spinal Dural Arteriovenous Fistula ◽  
Historical Cohort ◽  
Contrast Enhanced ◽  
The Impact

BackgroundThe preoperative localization of the feeder of spinal dural arteriovenous fistula (SDAVF) could simplify the diagnostic spinal angiographic procedure. Localization by non-contrast-enhanced MRI-based techniques is an attractive option. However, the usefulness of such an approach for evaluation of SDAVF has not yet been reported.ObjectiveTo study the impact of non-contrast MRI-based feeder localization, followed by targeted spinal angiography, in the evaluation of SDAVF before endovascular intervention.Materials and methodsProspectively collected data were analyzed and the level of the feeder was localized preoperatively. The procedural time for targeted spinal angiography was calculated and compared with that of a historical cohort, who underwent routine spinal angiographic examination before the study period. Follow-up MRI was carried out to assess the reliability of this model for detection of occasional metachronous lesions that might be missed with this approach.ResultsSeven patients underwent targeted spinal angiography during the study. The feeder level was accurately identified in five patients and was localized to one vertebral level in six patients. The correlation between MRI and DSA was statistically significant. The number of spinal levels assessed was fewer and overall procedure time was significantly shorter compared to historical cohort (58 min vs 162 min, respectively; p<0.001). Intervention was coupled with targeted angiography in two patients. Follow-up MRI demonstrated flow voids in one patient, who had recurrent fistula at one vertebral level below the previously embolized feeder.ConclusionsThe non-contrast MRI-based localization technique can reliably detect the level of feeder and help in therapeutic planning of SDAVF. The localization techniques potentially shorten the angiographic procedure and may facilitate simultaneous endovascular definitive treatment. Inclusion of follow-up MRI may be useful for detection of synchronous or metachronous lesions if a targeted approach is adopted. Additionally, this helps to identify failed endovascular therapy.

scholarly journals Treatment strategy to maximize the treatment outcome of spinal dural arteriovenous fistula after initial endovascular embolization attempt at diagnostic angiography

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Heui Seung Lee ◽  
Hyun-Seung Kang ◽  
Sung Min Kim ◽  
Chi Heon Kim ◽  
Seung Heon Yang ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Functional Outcomes ◽  
Dural Arteriovenous Fistula ◽  
Functional Improvement ◽  
Initial Attempt ◽  
Spinal Dural Arteriovenous Fistula ◽  
Complete Occlusion ◽  
Additional Surgery ◽  
Incomplete Occlusion

AbstractInitial attempt of endovascular treatment (EVT) for spinal dural arteriovenous fistula (SDAVF) is preferred because of concurrent diagnosis and treatment. However, outcomes following further treatment with initial EVT are not well studied. We retrospectively reviewed 71 patients with SDAVF to evaluate treatment outcomes of SDAVF after an initial EVT attempt. Pretreatment and posttreatment functional states were assessed by the Aminoff-Logue scale (ALS). In the case of incomplete occlusion or recurrence, overall outcomes after further treatments were compared. Of the 71 patients, 56 underwent initial EVT. Complete occlusion was achieved by initial EVT in 37 of 56 patients (66.1%). Multiple feeders were more frequently observed in patients with incomplete occlusion than complete occlusion after initial EVT (73.7% vs. 27%, P < 0.001). Among 19 patients with incomplete occlusion upon initial EVT, 14 underwent additional surgery, 13 of whom (92.9%) obtained improved or stationary functional outcomes. Functional improvement was not observed in patients who had repeated EVT or follow-up without further treatment. Recurrence was observed in 8 of 37 patients with complete occlusion upon initial EVT. Additional surgery achieved improved functional outcomes in cases of incomplete occlusion of SDAVF after the initial EVT attempt or recurrence rather than repeated EVT or follow-up.

Spinal Dural Arteriovenous Fistula: Is There a Role for Intraoperative Contrast-Enhanced Ultrasound?

2017 ◽  
Vol 100 ◽  
pp. 712.e15-712.e18 ◽  
Author(s):  
Francesco Prada ◽  
Massimiliano Del Bene ◽  
Giuseppe Faragò ◽  
Francesco DiMeco
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Contrast Enhanced Ultrasound ◽  
Spinal Dural Arteriovenous Fistula ◽  
Contrast Enhanced

Outcome after the Treatment of Spinal Dural Arteriovenous Fistulae: A Contemporary Single-institution Series and Meta-analysis

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 77-88 ◽  
Author(s):  
Michael P. Steinmetz ◽  
Michael M. Chow ◽  
Ajit A. Krishnaney ◽  
Doreen Andrews-Hinders ◽  
Edward C. Benzel ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Retrospective Review ◽  
Initial Treatment ◽  
Dural Arteriovenous Fistula ◽  
Meta Analysis ◽  
Type I ◽  
Single Institution ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulae

Abstract OBJECTIVE: Spinal dural arteriovenous fistulae (Type I spinal AVMs) are the most common type of spinal vascular malformations. The optimal treatment strategy has yet to be defined, and endovascular embolization is being offered with increasing frequency. A 7-year single-institution retrospective review of outcome with surgical management of Type I spinal AVMs is presented along with a meta-analysis of existing literature. METHODS: For the institutional analysis, a retrospective review of all patients who underwent treatment at our institution for Type I spinal AVMs was performed. Between 1995 and the present (the time frame during which endovascular treatments were available), 19 consecutive patients were treated. Follow-up was performed by clinical examination or telephone interview, and functional status was measured by use of the Aminoff-Logue score. For the meta-analysis, a MEDLINE search between 1966 and the present was performed for surgical, endovascular, or combined treatment of spinal dural arteriovenous fistula. These series were included in a meta-analysis to evaluate success and failure rates, complications, and functional outcome. Specifically, embolization and microsurgery were compared. RESULTS: For the institutional analysis, 18 of 19 patients were available for long-term follow-up after surgery. There were no surgical failures, but one complication was seen. Patients demonstrated a statistically significant improvement in gait and bladder function after surgery. For the meta-analysis, 98% of those patients treated with microsurgery had their dural arteriovenous fistulae successfully obliterated after the initial treatment, compared with only 46% with embolization, as judged by radiographic or clinical follow-up. 89% percent of patients demonstrated improvement or stabilization in neurological symptoms after surgical treatment. Few complications were demonstrated with either surgery or embolization. CONCLUSION: At this point, surgery seems to be superior to embolization for the management of spinal dural arteriovenous fistula. The fistula is usually obliterated after the initial treatment, with few clinical or radiographic recurrences. The majority of patients either improve or stabilize after treatment. Few worsen, and the morbidity is minimal. It is reasonable to attempt initial embolization, especially at the time of the initial diagnostic spinal angiogram. The treating physicians and patients should be aware of the high chance of recurrence, and patients may ultimately require surgery or repeat embolization. After endovascular therapy, patients are committed to repeat angiography and probably embolization. For these reasons, it is the authors' opinion that surgery should be used as the first-line therapy for spinal dural arteriovenous fistulae.

scholarly journals SPINAL DURAL ARTERIOVENOUS FISTULA: CLINICAL CASE AND LITERATURE REVIEW

2018 ◽  
Vol 25 (2) ◽  
pp. 75-82
Author(s):  
R. A. Gapeshin ◽  
A. A. Yakovlev ◽  
A. G. Smochilin ◽  
A. V. Gavrichenko ◽  
M. S. Pushkaryov
Keyword(s):  
Arteriovenous Fistula ◽  
Clinical Case ◽  
Dural Arteriovenous Fistula ◽  
Screening Method ◽  
Magnetic Resonance Tomography ◽  
Spinal Angiography ◽  
Spinal Dural Arteriovenous Fistula ◽  
Initial Symptoms ◽  
Golden Standard ◽  
Neurological Exam

Spinal dural arteriovenous fistula (SDAVF) is a rare disease, however, with nonspecific initial symptoms, like back pain, parestesias, gait imbalance, weakness and numbness in extremities. Para- or tetraparesis, disturbance of deep sensation and pelvic organs functions may develop during the course of disease. There isn’t any specific laboratory tests. So, the diagnostics of dural fistulas is complex. The main screening method is magnetic resonance tomography (MRI), which may suspect or reveal dural fistula. Spinal angiography is a «golden standard» in diagnostics. Options of treatment include microsurgical separation or endovascular embolisation of fistula. The article presents a clinical case of SDAVF in thoracic region of spine. Related to complains, neurological exam and MRI data, the vascular mass was suspected and spinal angiography was per-formed to confirm the presence of SDAVF. After surgical treatment the patient was observed to rehabilitation course, which had improved his status. In sum, appropriate diagnostics, surgical intervention and rehabilitation are the main factors related to successful treatment of patients with SDAVF.

Misdiagnosis of Spinal Dural Arteriovenous Fistula: An Analysis of 12 Cases

2020 ◽  
Author(s):  
Baohui Yang ◽  
Shuai Cao ◽  
Xijing He ◽  
Haopeng Li
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Spinal Stenosis ◽  
Dural Arteriovenous Fistula ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Spinal Dural Arteriovenous Fistula ◽  
Flow Void ◽  
Spinal Cord Edema

Abstract Background: Spinal dural arteriovenous fistula (SDAVF) is a rare spinal vascular disease. The clinical misdiagnosis rate is very high. The highest misdiagnosis rate is reported in orthopedics. The specific reason for misdiagnosis remains unclear. Objective: To investigate the clinical and imaging manifestations of SDAVF, analyze the causes of misdiagnosis, propose countermeasures, and improve the orthopedists and other specialists’ understanding of this disease. Methods: The clinical data, diagnosis and treatment of 12 patients who had SDAVF that was misdiagnosed as a different disease were retrospectively analyzed, and the modified Aminoff-Logue Disability Scale (ALS) scores before and during follow-up were compared. Results: From 2014 to February 2019, 15 patients were diagnosed with SDAVF at our institution. Twelve (80%) were misdiagnosed; of these, 6 (50%) were misdiagnosed more than twice, and 6 patients (50%) were misdiagnosed at least once. The initial diagnoses included lumbar spinal stenosis and lumbar disc herniation (LDH) in 6 patients, cervical spinal stenosis in one patient, benign prostatic hyperplasia (BPH) in one patient, myelitis in 2 patients, and syringomyelia in one patient. After the initial diagnosis, one patient was misdiagnosed with LDH, one was misdiagnosed with subacute combined degeneration of the spinal cord, and 4 were misdiagnosed with myelitis. The clinical manifestations mainly included weakness and numbness of the lower limbs, urinary symptoms, and numbness of the perineal area. In the 12 misdiagnosed patients, magnetic resonance imaging(MRI) showed signs of spinal cord edema and typical or atypical flow-void patterns. One patient had undergone extended cervical decompression and lumbar decompression. All patients eventually underwent microsurgical treatment. The average follow-up duration was 0.9 years. The modified ALS scores showed significant improvement in gait, bladder function and bowel movement, and the differences before and during follow-up were statistically significant (P<0.05). Conclusion: When patients, especially those with bladder and bowel dysfunction, have symptoms such as weakness of the lower limbs and/or numbness, a diagnosis of SDAVF should be considered. Furthermore, if MRI shows signs of spinal cord edema and typical or atypical flow-void patterns, the diagnosis of SDAVF should be strongly considered, and further angiography is needed to confirm the diagnosis.

scholarly journals Utility of 3D SPACE T2-weighted volumetric sequence in the localization of spinal dural arteriovenous fistula

2016 ◽  
Vol 25 (1) ◽  
pp. 125-132 ◽  
Author(s):  
Santhosh Kumar Kannath ◽  
Praveen Alampath ◽  
Jayadevan Enakshy Rajan ◽  
Bejoy Thomas ◽  
P. Sankara Sarma ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Interobserver Agreement ◽  
Observer Agreement ◽  
Kappa Statistics ◽  
Mr Images ◽  
Volumetric Mri ◽  
Vertebral Level ◽  
Spinal Dural Arteriovenous Fistula ◽  
3D Space

OBJECTIVE The aim of this study was to investigate the utility of a heavily T2-weighted volumetric MRI sequence (3D sampling perfection with application-optimized contrasts using different flip-angle evolutions [SPACE]) in the feeder localization of spinal dural arteriovenous fistula (SDAVF). METHODS Patients who were diagnosed with SDAVF and who had 3D SPACE source images available for review were identified from a retrospective review of medical records. A total of 16 patients were identified, and MR images were analyzed separately by 2 blinded observers. The accuracy of the observation and interobserver agreement were measured by Kendall's tau and kappa statistics. RESULTS The site of fistula was accurately predicted by Observers 1 and 2 in 81% and 88% of cases, respectively, which improved to 94% when the level was considered within 1 vertebral level. The observer agreement with gold-standard angiography and interobserver agreement were found to be highly significant (p < 0.0001). CONCLUSIONS The 3D SPACE MRI sequence is valuable in the precise detection of the site of SDAVF. It may help to tailor digital subtraction angiography and thereby reduce the radiation exposure, contrast load, and study time.

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