scholarly journals Four-dimensional digital subtraction angiography for exploration of spinal cord vascular malformations: preliminary experience

2020 ◽  
Vol 13 (1) ◽  
pp. 69-74
Author(s):  
Frédéric Clarençon ◽  
Stéphanie Lenck ◽  
Eimad Shotar ◽  
Anne-Laure Boch ◽  
Etienne Lefevre ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Vascular Malformations ◽  
Venous Drainage ◽  
Digital Subtraction ◽  
Drainage Pattern ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Precise Understanding ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Spinal Epidural

BackgroundThe precise understanding of the angioarchitecture of spinal vascular malformations (SVMs) is often difficult to reach with conventional digital subtraction angiography (DSA). The purpose of our study was to evaluate the potential of four-dimensional DSA (4D-DSA) (Siemens Healthcare) in the exploration of SVMs.MethodsWe retrospectively studied all patients who underwent spinal DSA, including 4D-DSA acquisition, from July 2018 to June 2019 at a single institution. All spinal DSA acquisitions were performed under general anesthesia. 4D-DSA acquisitions were acquired with the protocol '12 s DSA Dyna4D Neuro'. 12 mL of iodixanol 320 mg iodine/mL were injected via a 5 F catheter (1 mL/s during the 12 s 4D-DSA acquisition). Inter-rater (three independent reviewers) and intermodality agreements were assessed.ResultsNine consecutive patients (six men, three women, mean age 55.3±19.8 years) with 10 SVMs (spinal dural arteriovenous fistulas n=3, spinal epidural arteriovenous fistulas n=2, spinal pial arteriovenous fistulas n=2, and spinal arteriovenous malformations n=2; one patient had two synchronous pial fistulas) had spinal DSA, including 4D-DSA acquisition. Inter-rater agreement was good and moderate for the venous drainage pattern and the SVM subtype, respectively. In 9 of 10 cases, the quality of the acquisition was graded as good. Satisfactory concordance between 4D-DSA and the selective microcatheterization was observed in 90% of cases for the location of the shunt point.Conclusion4D-DSA acquisition may be helpful for a better understanding of the angioarchitecture of SVMs. Larger series are warranted to confirm these preliminary results.

Accuracy and pitfalls of multidetector-row computed tomography in detecting spinal dural arteriovenous fistulas

2010 ◽  
Vol 12 (3) ◽  
pp. 243-248 ◽  
Author(s):  
Satoshi Yamaguchi ◽  
Tetsuya Nagayama ◽  
Kuniki Eguchi ◽  
Masaaki Takeda ◽  
Kazunori Arita ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Nerve Root ◽  
Multidetector Row Computed Tomography ◽  
Digital Subtraction ◽  
Selective Angiography ◽  
Multidetector Row ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Spinal Epidural

Object The purpose of this study was to evaluate the accuracy of multidetector-row CT angiography (MDCTA) in demonstrating spinal dural arteriovenous fistulas (SDAVFs). Methods The authors studied 10 patients with SDAVFs, including 2 with spinal epidural AVFs, who underwent preoperative MR imaging, MDCTA, and digital subtraction angiography (DSA). In the evaluation of coronal sections of multiplanar reformation MDCTA images, inspection was focused on the presence of the following findings: 1) dilated perimedullary veins in the spinal canal; 2) focal enhancement of the nerve root, suggesting the location of the AVF, around the dural sleeve; and 3) a radicular vein that drains the AVF into perimedullary veins. The utility of MDCTA was assessed by comparing its findings with those of DSA in each case. Results Digital subtraction angiography confirmed that the AVFs were located in the thoracic spine in 4 patients and in the lumbar spine in 6 patients, and MDCTA detected dilated perimedullary veins in all 10 patients. In 8 patients, there was focal enhancement of the nerve root. The radicular vein that drains the AVF into the perimedullary veins was found in 8 cases. In 8 cases, the MDCTA-derived level and side of the AVF and its feeder corresponded with those shown by DSA. In 2 patients, however, the MDCTA-derived side of the feeder was on the side contralateral to the feeding artery confirmed by DSA. These lesions were interpreted as spinal epidural AVFs with perimedullary drainage. In 2 cases, MDCTA could not detect the multiplicity of their feeders. Conclusions The use of MDCTA preceding DSA can be helpful to focus the selective catheter angiography on certain spinal levels. However, one should keep in mind that epidural AVFs with perimedullary drainage may resemble SDAVFs and also that MDCTA cannot exclude the possibility of multiple feeders. Further research should elucidate how broadly selective angiography should explore around the MDCTA-suggested target.

Fusion Technique Using Three-Dimensional Digital Subtraction Angiography in the Evaluation of Complex Cerebral and Spinal Vascular Malformations

2016 ◽  
Vol 85 ◽  
pp. 353-358 ◽  
Author(s):  
Kenji Fukuda ◽  
Toshio Higashi ◽  
Masakazu Okawa ◽  
Mitsutoshi Iwaasa ◽  
Hiroshi Abe ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Vascular Malformations ◽  
Three Dimensional ◽  
Digital Subtraction ◽  
Fusion Technique ◽  
Spinal Vascular Malformations

scholarly journals Rare association between spinal dural arteriovenous fistulas and dysraphisms: Report of two cases and review of the literature with a focus on pitfalls in diagnosis and treatment

2017 ◽  
Vol 23 (5) ◽  
pp. 458-464 ◽  
Author(s):  
Giacomo Talenti ◽  
Giovanni Vitale ◽  
Giacomo Cester ◽  
Alessandro Della Puppa ◽  
Roberto Faggin ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Diagnosis And Treatment ◽  
Review Of The Literature ◽  
Arteriovenous Fistulas ◽  
Rare Association ◽  
Spinal Vascular Malformations ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Arteriovenous Malformations ◽  
Spinal Dural Arteriovenous Fistulas

Spinal vascular malformations are uncommon yet important spinal pathologies commonly classified in congenital and acquired lesions. Spinal lipomas consist of three subtypes: intramedullary lipomas, lipomyelo(meningo)celes and lipomas of the filum. Although the association of spinal arteriovenous malformations (AVM) with other congenital anomalies is well known, the coexistence of dural arteriovenous fistulas (AVF) and tethered spinal cord is exceptionally rare and only eight cases have been reported. We present two cases from our institution and speculate on the possible origin of such a rare but insidious association. We review the current literature with a focus on possible pitfalls in diagnosis and treatment.

scholarly journals Endovascular management of spinal dural arteriovenous fistulas

2009 ◽  
Vol 26 (5) ◽  
pp. E15 ◽  
Author(s):  
Walavan Sivakumar ◽  
Gabriel Zada ◽  
Parham Yashar ◽  
Steven L. Giannotta ◽  
George Teitelbaum ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Endovascular Management ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Embolic Agents ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Object Spinal dural arteriovenous fistulas (DAVFs) are the most common spinal vascular malformations and can be a significant cause of myelopathy, yet remain inefficiently diagnosed lesions. Over the last several decades, the treatment of spinal DAVFs has improved tremendously due to improvements in neuroimaging, microsurgical, and endovascular techniques. The aim of this paper was to review the existing literature regarding the clinical characteristics, classification, and endovascular management of spinal DAVFs. Methods A search of the PubMed database from the National Library of Medicine and reference lists of all relevant articles was conducted to identify all studies pertaining to spinal DAVFs, spinal dural fistulas, and spinal vascular malformations, with particular attention to endovascular management and outcomes. Results The ability to definitively treat spinal DAVFs using endovascular embolization has significantly improved over the last several decades. Overall rates of definitive embolization of spinal DAVFs have ranged between 25 and 100%, depending in part on the embolic agent used and the use of variable stiffness microcatheters. The majority of recent studies in which N-butyl cyanoacrylate or other liquid embolic agents were used have reported success rates of 70–90%. Surgical treatment remains the definitive option in cases of failed embolization, repeated recanalization, or lesions not amenable to embolization. Clinical outcomes have been comparable to surgical treatment when the fistula and draining vein remain persistently occluded. Improvements in gait and motor function are more likely following successful treatment, whereas micturition symptoms are less likely to improve. Conclusions Endovascular embolization is an increasingly effective therapy in the treatment of spinal DAVFs, and can be used as a definitive intervention in the majority of patients that undergo modern endovascular intervention. A multidisciplinary approach to the treatment of these lesions is required, as surgery is required for refractory cases or those not amenable to embolization. Newer embolic agents, such as Onyx, hold significant promise for future therapy, yet long-term follow-up studies are required.

scholarly journals P.119 Minimally invasive surgical disconnection of a spinal dural arteriovenous fistula with the use of intraoperative digital subtraction angiography

2016 ◽  
Vol 43 (S2) ◽  
pp. S47-S48
Author(s):  
MD Staudt ◽  
B Wang ◽  
SP Lownie
Keyword(s):  
Minimally Invasive ◽  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Thoracic Myelopathy ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
Minimally Invasive Surgical ◽  
Femoral Puncture ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Open Surgical Approach

Background: Spinal dural arteriovenous fistulas (dAVF) are a significant but treatable cause of progressive myelopathy. The goal of treatment is disconnection of the fistula, which is often accomplished through an open surgical approach. We report two cases using a minimally invasive surgical (MIS) approach for dAVF ligation with intraoperative digital subtraction angiography (DSA) to confirm occlusion. Methods: Case report. Results: Two patients presented with progressive thoracic myelopathy and were identified to have fistulous connections at the left L1 and T8 levels respectively. Intraoperatively, a left femoral puncture was performed and a 5-French (40 cm) sheath was inserted. Patients were positioned prone and intraoperative spinal DSA was performed using the Siemens Zeego. Once the feeding radicular artery was visualized, image overlay and cross-hair laser was used to trace and localize the fistulous zone. A unilateral single level MIS hemi-laminectomy was performed. The fistulous zone and accompanying nerve root were exposed and small hemostatic clips were applied followed by surgically disconnection. Finally, intraoperatively video angiography as well as spinal DSA were performed for confirmation. Conclusions: MIS disconnection with intraoperative DSA is a safe and effective technique for treating spinal dAVFs. Patients benefit from quicker recovery and shorter hospital stay.

scholarly journals Spinal Epidural Arteriovenous Fistula: A Unique Pathway into the Perimedullary Vein

2009 ◽  
Vol 15 (4) ◽  
pp. 466-469 ◽  
Author(s):  
S.M. Lim ◽  
I.S. Choi
Keyword(s):  
Epidural Space ◽  
Clinical Symptoms ◽  
Vascular Malformations ◽  
Venous Pressure ◽  
Venous Plexus ◽  
Previous Surgery ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Spinal Epidural

Spinal dural arteriovenous fistulas (AVFs) are rare vascular malformations in the spinal dura, fed by dural branches of the radicular arteries, and drain primarily into intradural venous plexuses. They may cause elevated medullary venous pressure and produce a progressive myelopathy. We describe a case of AVF in the epidural space of the previous surgery site of L3 and it showed a unique complex venous pathway into the perimedullary vein, leading to classic clinical symptoms of venous congestion in the spinal cord. The shunt was draining into bilateral epidural venous plexus and then to the paravertebral veins at the level of L2. The venous outflow entered to the epidural space again and finally refluxed into the intradural perimedullary vein.

scholarly journals Embolization Tactics of Spinal Epidural Arteriovenous Fistulas

2021 ◽  
Author(s):  
Abdulrahman Hamad Al-Abdulwahhab ◽  
Yunsun Song ◽  
Boseong Kwon ◽  
Dae Chul Suh
Keyword(s):  
Clinical Outcomes ◽  
Preferential Flow ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Tertiary Hospital ◽  
Total Occlusion ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Before And After ◽  
Spinal Epidural

Purpose: Spinal epidural arteriovenous fistulas (SEDAVFs) show an epidural venous sac often with venous congestive myelopathy (VCM) due to intradural reflux at a remote level to which a transarterial approach would be difficult. We present 12 cases of SEDAVF with VCM and describe 3 main tactics for effective transarterial embolization.Materials and Methods: Among 152 patients with spinal vascular malformations diagnosed in our tertiary hospital between 1993 and 2019, 12 SEDAVF patients with VCM were included. Three different transarterial embolization tactics were applied according to the vascular configuration and microcatheter accessibility. We evaluated treatment results and clinical outcomes before and after treatment.Results: Transarterial embolization with glue (20–30%) was performed in all patients. The embolization tactics applied in 12 patients were preferential flow (n=2), plug-and-push (n=6), and filling of the venous sac (n=4). Total occlusion of the SEDAVF, including intradural reflux, was achieved in 11 (91.7%) of 12 patients, and partial occlusion was achieved in 1 patient. No periprocedural complications were reported. Spinal cord edema was improved in all patients for an average of 18 months after treatment. Clinical functional outcome in terms of the pain, sensory, motor, and sphincter scale and modified Rankin scores improved during a mean 25-month follow-up (6.3 vs. 3.3, P=0.002; 3.6 vs. 2.3, P=0.002, respectively).Conclusion: Endovascular treatment for 12 SEDAVF patients with VCM achieved a total occlusion rate of 91.7% without any periprocedural complication. The combined embolization tactics can block intradural reflux causing VCM, resulting in overall good clinical outcomes.

Cervical spine dural arteriovenous fistula presenting with congestive myelopathy of the conus

2009 ◽  
Vol 11 (4) ◽  
pp. 427-431 ◽  
Author(s):  
Sasikhan Geibprasert ◽  
Sirintara Pongpech ◽  
Pakorn Jiarakongmun ◽  
Timo Krings
Keyword(s):  
Cervical Spine ◽  
Clinical Symptoms ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Conus Medullaris ◽  
Imaging Findings ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Arteriovenous Shunts ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (DAVFs) are the spinal vascular malformations that are encountered most often, and they are usually encountered in the lower thoracic region. Cervical spine DAVFs are exceedingly rare and may be difficult to differentiate from radicular arteriovenous malformations, epidural arteriovenous shunts, or perimedullary AVFs. Typical angiographic findings in spinal DAVFs include a slow-flow shunt with converging feeding vessels from radiculomeningeal arteries draining via a radicular vein centripetally into perimedullary veins. The MR imaging findings such as spinal cord edema and perimedullary dilated vessels may be used to direct the spinal angiography that is needed to localize and classify the shunt. When the shunt is distant from the pathological imaging findings, the diagnosis may be difficult to establish, especially when the shunt is present at an atypical location such as the cervical spine. The authors present the case of a 51-year-old man presenting with lower thoracic and conus medullaris congestive edema due to a cervical spine DAVF that was located at the C-5 level. Transarterial embolization with N-butyl cyanoacrylate closed the proximal vein and completely obliterated the fistula. Clinical and imaging follow-up confirmed occlusion of the fistula, with improvement in clinical symptoms.

Metachronous double spinal dural arteriovenous fistulas

2006 ◽  
Vol 4 (6) ◽  
pp. 503-505 ◽  
Author(s):  
Tanvir Rizvi ◽  
Ajay Garg ◽  
Nalini K. Mishra ◽  
Shailesh B. Gaikwad ◽  
Vipul Gupta
Keyword(s):  
Dura Mater ◽  
Nerve Root ◽  
Vascular Malformations ◽  
Initial Examination ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

✓ Spinal dural arteriovenous fistulas (DAVFs), the most common of spinal vascular malformations, are AVFs in the dura mater of the nerve root and/or adjacent spinal dura. These fistulas are most often solitary and are fed by a single radicular artery that primarily supplies the dura mater. Multiple spinal DAVFs are rarely reported in the literature. Those that have been documented have been synchronous in their presentation in that they were found during the same examination or were present at the initial examination but missed and only recognized at the second examination. The authors report the case of a patient with two spinal DAVFs occurring at different spinal levels at different points in time (metachronous).

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