СLINICAL ASPECTS, DIAGNOSTICS AND MICROSURGICAL TREATMENT OF SPINAL DURAL ARTERIOVENOUS FISTULAS (LECTURE)

The lecture is dedicated to spinal dural arteriovenous fistula – infrequent disorder which not well known among wide range of neurosurgeons. The findings on etiology, clinic and treatment are presented.

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Spinal Dural Arteriovenous Fistula Presenting with Myelopathy

Cerebrovascular Neurosurgery ◽

10.1093/med/9780190887728.003.0030 ◽

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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Spinal dural arteriovenous fistula associated with a spinal perimedullary fistula

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.3.241 ◽

2006 ◽

Vol 4 (3) ◽

pp. 241-245 ◽

Cited By ~ 20

Author(s):

Timo Krings ◽

Volker A. Coenen ◽

Martin Weinzierl ◽

Marcus H. T. Reinges ◽

Michael Mull ◽

...

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Vascular Malformations ◽

Venous Drainage ◽

Elevated Pressure ◽

Spinal Dural Arteriovenous Fistula ◽

Arteriovenous Fistulas ◽

Progressive Myelopathy ◽

Dural Arteriovenous Fistulas

✓ Among spinal cord vascular malformations, dural arteriovenous fistulas (DAVFs) must be distinguished from intradural malformations. The concurrence of both is extremely rare. The authors report the case of a 35-year-old man who suffered from progressive myelopathy and who harbored both a DAVF and an intradural perimedullary fistula. During surgery, both fistulas were identified, confirmed, and subsequently obliterated. The fistulas were located at two levels directly adjacent to each other. Although the incidence of concurrent spinal DAVFs is presumed to be approximately 2%, the combination of a dural and an intradural fistula is exceedingly rare; only two other cases have been reported in the literature. One can speculate whether the alteration in venous drainage caused by the (presumably congenital) perimedullary fistula could possibly promote the production of a second dural fistula due to elevated pressure with concomitant venous stagnation and subsequent thrombosis. The authors conclude that despite the rarity of dual pathological entities, the clinician should be aware of the possibility of the concurrence of more than one spinal fistula in the same patient.

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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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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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Spinal dural arteriovenous fistula presenting with paraplegia following lumbar puncture

Journal of Neurosurgery Spine ◽

10.3171/2013.3.spine12888 ◽

2013 ◽

Vol 19 (1) ◽

pp. 57-60 ◽

Cited By ~ 6

Author(s):

Guus Koerts ◽

Vincent Vanthuyne ◽

Maxime Delavallee ◽

Herbert Rooijakkers ◽

Christian Raftopoulos

Keyword(s):

Arteriovenous Fistula ◽

Lumbar Puncture ◽

Dural Arteriovenous Fistula ◽

Treatment Options ◽

Venous Hypertension ◽

Spinal Dural Arteriovenous Fistula ◽

Segmental Artery ◽

Arteriovenous Fistulas ◽

Underlying Mechanisms ◽

Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas are rare lesions with an annual incidence of 1 per 100,000 population. In patients with this disease, an abnormal vascular dural shunt exists between a dural branch of a segmental artery and a subdural radicular vein that drains the perimedullary venous system, leading to venous hypertension and secondary congestive myelopathy. Generally, patients present with progressive paraparesis, urinary disturbances, and gait ataxia. In this report the authors describe a 61-year-old woman with a spinal dural arteriovenous fistula who developed an acute paraplegia after a nontraumatic lumbar puncture. The possible underlying mechanisms and treatment options are discussed.

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Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation

Journal of Neurosurgery ◽

10.3171/2021.1.jns202861 ◽

2021 ◽

pp. 1-10

Author(s):

Isaac Josh Abecassis ◽

R. Michael Meyer ◽

Michael R. Levitt ◽

Jason P. Sheehan ◽

Ching-Jen Chen ◽

...

Keyword(s):

Natural History ◽

Arteriovenous Fistula ◽

Outcomes Research ◽

Intracranial Aneurysms ◽

Dural Arteriovenous Fistula ◽

Aneurysm Rupture ◽

External Carotid ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas

OBJECTIVE There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non–flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. RESULTS Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). CONCLUSIONS Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%–5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.

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Multimodal Intraoperative Monitoring During Microsurgical Treatment of Spinal Dural Arteriovenous Fistula

Turkish Journal of Anaesthesiology and Reanimation ◽

10.5152/tjar.2020.88942 ◽

2020 ◽

Vol 48 (5) ◽

pp. 423-426

Author(s):

Kadarapura Nanjundaiah Gopalakrishna ◽

◽

Prashanth Menon ◽

Prashant Singh ◽

Nupur Pruthi ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Intraoperative Monitoring ◽

Dural Arteriovenous Fistula ◽

Spinal Dural Arteriovenous Fistula ◽

Microsurgical Treatment

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Dural arteriovenous fistulas presenting with brainstem dysfunction: diagnosis and surgical treatment

Neurosurgical FOCUS ◽

10.3171/2012.2.focus1217 ◽

2012 ◽

Vol 32 (5) ◽

pp. E10 ◽

Cited By ~ 14

Author(s):

Charles Kulwin ◽

Bradley N. Bohnstedt ◽

John A. Scott ◽

Aaron Cohen-Gadol

Keyword(s):

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Craniocervical Junction ◽

Rare Entity ◽

Arteriovenous Fistulas ◽

Drainage Patterns ◽

Clinical Presentations ◽

Wide Range ◽

Brainstem Dysfunction ◽

Dural Arteriovenous Fistulas

A cerebral dural arteriovenous fistula (DAVF) is an acquired abnormal arterial-to-venous connection within the leaves of the intracranial dura with a wide range of clinical presentations and natural history. The Cognard classification correlates venous drainage patterns with neurological course, identifying 5 DAVF types with increasing rates of symptomatic presentation. A spinal DAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dural leaflets of the nerve root sleeve. A cervical DAVF is a rare entity, as most spinal DAVFs present as thoracolumbar lesions with myelopathy. In this paper the authors present 2 patients presenting initially with brainstem dysfunction rather than myelopathy secondary to craniocervical DAVF. The literature is then reviewed for similar rare aggressive DAVFs at the craniocervical junction presenting with brainstem symptomatology.

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Extracranial Dural Arteriovenous Fistula as a Cause of Mastoid Mass: A Case Report

Journal of Anesthesia and Anesthetic Drugs ◽

10.54289/jaad2100105 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Md Moshiur Rahman

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

External Jugular Vein ◽

Middle Income ◽

Arteriovenous Fistulas ◽

Middle Income Countries ◽

Dural Arteriovenous Fistulas ◽

Superior Longitudinal Sinus ◽

Transvenous Approach

Introduction: Dural arteriovenous fistulas account for 10 to 15% of intracranial arteriovenous malformations. They are defined as malformations to short-circuits between dural and extracranial arteries with dural venous sinuses. Its presentation is in frequent and its management is a challenge in low- and middle-income countries where there are difficulties in accessing high quality technological tools. Case: We present the case of an unusual dural arteriovenous fistula involving the mastoid region and draining into the external jugular vein and through emissary veins into the superior longitudinal sinus, which was treated transarterially. Conclusion: Endovascular management of intracranial dural arteriovenous fistulas can be a challenge. Endovascular treatment includes a transarterial or transvenous approach from the femoral artery or vein. There is little evidence on this subject, so it is necessary to carry out more studies to determine risk factors, intervention effects and medium- and long-term outcomes.

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Delayed Onset of Dural Arteriovenous Fistula Following Trauma

Reports ◽

10.3390/reports2020014 ◽

2019 ◽

Vol 2 (2) ◽

pp. 14

Author(s):

William Richardson ◽

Praveen Satarasinghe ◽

Michael T. Koltz

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Delayed Diagnosis ◽

Type Ii ◽

Unique Case ◽

Arteriovenous Fistulas ◽

Delayed Onset ◽

Dural Arteriovenous Fistulas ◽

Medical Histories ◽

Hospital Days

Dural Arteriovenous Fistulas (dAVF) are pathological shunts that are often idiopathic in presentation. However, it is reported that many patients presenting with dAVF have past medical histories notable for surgeries, hypercoagulation disorders, infections, and trauma. In trauma-linked dAVF, presentation generally occurs within 48 h post-incident. In the present case, the authors discuss the delayed onset of a Borden type II dAVF in a patient 12 hospital days post-trauma, as well as the course of treatment. This unique case provides a compelling demonstration for providers to be aware of the development of dAVF, even after the typical 48-hour post-trauma window. By being aware of the possibility of delayed dAVF presentation, delayed diagnosis or misdiagnosis can be avoided and emergent action can be taken.

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