Paediatric Spinal Arteriovenous Malformations: Angioarchitecture and Endovascular Treatment

1998 ◽  
Vol 4 (2) ◽  
pp. 127-139 ◽  
Author(s):  
D.J. Emery ◽  
R.A. Willinsky ◽  
P.E. Burrows ◽  
D. Armstrong ◽  
W. Montanera ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Malformations ◽  
High Flow ◽  
Low Flow ◽  
Arteriovenous Fistulae ◽  
Arteriovenous Fistulas ◽  
Patient Pain ◽  
Spinal Arteriovenous Malformations ◽  
Clinical Records ◽  
Spinal Cord Arteriovenous Malformation

This is a retrospective review of the clinical records and imaging of 14 children with spinal arteriovenous malformations referred to the neurointerventional service at our institution. The lesions are categorized by anatomic location into subpial (5 cases), epidural (3 cases), and paraspinal (6 cases). There were no dural arteriovenous fistulas in this group. The subpial lesions include both the intramedullary arteriovenous malformations (2 cases) and the perimedullary arteriovenous fistulas (3 cases). Two of the patients with perimedullary fistulas were first cousins and both had Rendu-Osler-Weber syndrome. The six paraspinal lesions were vertebral-vertebral fistulas with five of these located at the first cervical metamere. Eleven cases (79%) were arteriovenous fistulas and three cases (21%) were arteriovenous malformations with a nidus. There were nine (82%) high flow arteriovenous fistulae and two (18%) low flow arteriovenous fistulae. The ages range from seven months to 15 years, with a mean age of seven years. There were nine males and five females. Clinical presentations included: bruit alone (6 patients), progressive scoliosis (1 patient), pain (2 patients), neurologic deficit (4 patients) and one case of Cobb's syndrome. Management included: no treatment (1 patient), endovascular embolisation (10 patients) and surgery (3 patients). Of the patients who underwent endovascular treatment all were treated from the arterial side. Two patients were treated by N-butyl cyanoacrylate (NBCA) alone, two with NBCA and coils, one with balloons alone, three with balloons and coils and two with coils alone. In the endovascular treatment group, nine fistulae were completely obliterated (all high flow fistulae) and one patient had partial treatment (a spinal cord arteriovenous malformation). There were no complications from endovascular treatment.

Progressive Gait Dysfunction

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Spinal Vascular Malformations ◽  
Gait Dysfunction ◽  
Dural Arteriovenous Fistulas ◽  
Neurological Change ◽  
Spinal Arteriovenous Malformations

Spinal vascular malformations are rare, with dural arteriovenous fistulas (AVFs) accounting for the majority of the pathology. Unlike spinal arteriovenous malformations, which cause abrupt neurological change as a result of hemorrhage, spinal dural AVFs tend to result in a progressive myelopathy through venous congestion and cord edema. If diagnosed and treated early with endovascular embolization or microsurgery, some deficits may be reversible.

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 Diagnosis and Endovascular Treatment of Vertebral Arteriovenous Fistulas in Neurofibromatosis Type 1

2000 ◽  
Vol 6 (3) ◽  
pp. 239-250 ◽  
Author(s):  
Y. Hori ◽  
K. Goto ◽  
N. Ogata ◽  
K. Uda
Keyword(s):  
Endovascular Treatment ◽  
Neurofibromatosis Type 1 ◽  
Material Selection ◽  
Skin Pigmentation ◽  
Clinical Status ◽  
Initial Step ◽  
Neurofibromatosis Type ◽  
High Flow ◽  
Arteriovenous Fistulas

We present diagnostic problems, strategies, techniques and material selection for endovascular treatment of high flow arteriovenous fistula (AVF) of tortuous and fragile vertebral artery (VA) with neurofibromatosis type 1 (NF1). Diagnosis of NF1 was easy in four of our cases because of neurofibromatosis, skin pigmentation and various skeletal abnormalities. These stigmas of NF1 were lacking in one case, and the only clue to the diagnosis was ovoid bone defects of the skull vault. Diagnosis was made by performing biopsy of scalp neurofibromas incidentally found on CT. In two initial cases, venous varix were packed with coils by transvenous approach after the transarterial embolisation failed to completely cure the fistula. In three recent cases, blood flow through the fistula was markedly reduced as an initial step by placing detachable coils into the distal and proximal stumps of the afferent VA. Then a liquid adhesive was injected under systemic hypotension to completely occlude the fistula. Control angiography revealed that the AVFs were completely occluded in all cases. Long-term angiographical and clinical status have been stable in all cases. Trying to attain complete occlusion of fistulas using detachable balloons is not an appropriate treatment option for high flow fistulas situated on markedly dilated, tortuous and fragile VAs of patients with NF1. Also, trapping of fistulas is not justified because of the numerous potential feeding pedicles, and makes the following procedure difficult.

The Role of Intravascular Embolization Prior to Radiosurgery of Cerebral Arteriovenous Malformations

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 171-176 ◽  
Author(s):  
H.K. Inoue ◽  
Y. Nagaseki ◽  
I. Naitou ◽  
M. Negishi ◽  
M. Hirato ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Latency Period ◽  
High Flow ◽  
Low Flow ◽  
Flow Volume ◽  
Cerebral Arteriovenous Malformations ◽  
Venous Obstruction ◽  
Risk Of Hemorrhage

The role of intravascular embolization prior to radiosurgery of cerebral arteriovenous malformations was evaluated based on the basis of the results of gamma knife radiosurgery in relation to hemorrhage and early obliteration after treatment. Nine of 213 patients experienced hemorrhage 4 to 42 months after radiosurgery. All AVMs in these patients had dilated feeding arteries, and the flow of the AVM was rapid and/or high. An intranidal aneurysm was seen in one patient. Drainage of all AVMs consisted of a single and/or deep draining veins, and venous obstruction was found in six. Sixty-three of 87 patients followed for more than four years after radiosurgery were examined angiographically, and total obliteration of AVM was observed in 52 of them (82.5%). Early obliteration was found in 19 of the 34 patients examined within 12 months. The obliteration rate was significantly higher in slow- and low-flow AVMs (73.9%) than in rapid- and/or high-flow AVMs (18.2%). It is concluded that the role of intravascular embolization prior to radiosurgery is not only decreasing the size of the AVM but decreasing the risk of hemorrhage and shortening the latency period by decreasing their flow rate and flow volume.

Spinal Dural Arteriovenous Fistula Presenting with Myelopathy

2019 ◽  
pp. 279-286
Author(s):  
Vinayak Narayan ◽  
Anil Nanda
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Endovascular Embolization ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Degenerative Spinal Disease ◽  
Spinal Arteriovenous Malformations ◽  
Spinal Dural Arteriovenous Fistulas

Abstract: Spinal dural arteriovenous fistulas are a rare cause of congestive myelopathy. Symptoms are insidious in onset and may be confused with degenerative spinal disease. MRI characteristically shows edema of the spinal cord with serpiginous flow voids that follow the surface of the spinal cord. Careful evaluation with spinal angiography is required to ensure accurate diagnosis. Spinal dural arteriovenous fistulas differ from spinal arteriovenous malformations in that most fistulas have only a single fistulous point without a nidus. Spinal dural arteriovenous fistulas may be treated successfully with either surgical resection or endovascular embolization depending on their anatomy. Earlier treatment is associated with better outcomes.

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