Surgical treatment of Type I spinal dural arteriovenous fistulas

2012 ◽  
Vol 32 (5) ◽  
pp. E3 ◽  
Author(s):  
Alexander E. Ropper ◽  
Bradley A. Gross ◽  
Rose Du
Keyword(s):  
Low Flow ◽  
Bladder Function ◽  
Neurological Deficits ◽  
Type I ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Epidemiological Characteristics

Object Type I spinal dural arteriovenous fistulas (SDAVFs) are low-flow vascular shunts fed by radicular arteries in patients who most often present with myelopathy. Although some fistulas are amenable to endovascular embolization, nearly all can be treated with direct microsurgical obliteration. Methods The authors reviewed their experience in treating 214 craniospinal arteriovenous malformations and/or fistulas over the last 8 years. Of these, 19 were spinal (9%), of which 15 (79%) were Type I SDAVFs. The authors reviewed the patients' epidemiological characteristics, presenting symptoms, and SDAVF angioarchitecture in all cases. They subsequently analyzed surgical obliteration rates and outcomes of all 11 patients who underwent fistula microsurgical obliteration. Results In all patients who underwent microsurgical treatment, complete angiographic obliteration of the fistula was achieved. At follow-up, 10 (91%) of 11 patients exhibited improvement, 1 patient (9%) was the same, and no patients were worse. Specifically, 8 (73%) of 11 patients had improvement in strength and sensation, 5 (71%) of 7 had improvement of bowel/bladder function, and 3 (60%) of 5 had improvement of preoperative paresthesias. There were no wound infections, CSF leaks, or permanent neurological deficits. Conclusions Microsurgical treatment of SDAVF provides direct access to the fistula point, allowing for high obliteration rates with excellent long-term improvement of preoperative deficits and limited periprocedural complications.

scholarly journals Open and endovascular treatment of spinal dural arteriovenous fistulas: a 10-year experience

2017 ◽  
Vol 26 (4) ◽  
pp. 519-523 ◽  
Author(s):  
Matthew J. Koch ◽  
Christopher J. Stapleton ◽  
Pankaj K. Agarwalla ◽  
Collin Torok ◽  
John H. Shin ◽  
...  
Keyword(s):  
Vascular Malformations ◽  
Management Strategies ◽  
Case Series ◽  
Endovascular Embolization ◽  
Definitive Treatment ◽  
Type I ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

OBJECTIVE Vascular malformations of the spine represent rare clinical entities with profound neurological implications. Previously reported studies on management strategies for spinal dural arteriovenous fistulas (sDAVFs) appeared before the advent of modern liquid embolic agents. Authors of the present study review their institutional experience with endovascularly and surgically treated sDAVFs. METHODS The authors performed a retrospective, observational, single-center case series on sDAVFs treated with endovascular embolization, microsurgical occlusion, or both between 2004 and 2013. The mode, efficacy, and clinical effect of treatment were evaluated. RESULTS Forty-seven patients with spinal arteriovenous malformations were evaluated using spinal angiography, which demonstrated 34 Type I sDAVFs (thoracic 20, lumbar 12, and cervical 2). Twenty-nine of the patients (85%) were male, and the median patient age was 63.3 years. Twenty patients underwent primary endovascular embolization (16 Onyx, 4 N-butyl cyanoacrylate [NBCA]), and 14 underwent primary surgical clipping. At a mean follow-up of 36 weeks, according to angiography or MR angiography, 5 patients treated with endovascular embolization demonstrated persistent arteriovenous shunting, whereas none of the surgically treated patients showed lesion persistence (p = 0.0237). Thirty patients (88%) experienced some resolution of their presenting symptoms (embolization 17 [85%], surgery 13 [93%], p = 1.00). CONCLUSIONS Microsurgical occlusion remains the most definitive treatment modality for sDAVFs, though modern endovascular techniques remain a viable option for the initial treatment of anatomically amenable lesions. Treatment of these lesions usually results in some clinical improvement.

Borden-Shucart Type I dural arteriovenous fistulas: clinical course including risk of conversion to higher-grade fistulas

2012 ◽  
Vol 117 (3) ◽  
pp. 539-545 ◽  
Author(s):  
Manish N. Shah ◽  
James A. Botros ◽  
Thomas K. Pilgram ◽  
Christopher J. Moran ◽  
DeWitte T. Cross ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Clinical Course ◽  
Retrospective Chart Review ◽  
Annual Rate ◽  
Neurological Deficits ◽  
Type I ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Dural Arteriovenous Fistulas

Object The goal of this study was to determine the clinical course of Borden-Shucart Type I cranial dural arteriovenous fistulas (DAVFs) and to calculate the annual rate of conversion of these lesions to more aggressive fistulas that have cortical venous drainage (CVD). Methods A retrospective chart review was conducted of all patients harboring DAVFs who were seen at the authors' institution between 1997 and 2009. Twenty-three patients with Type I DAVFs who had available clinical follow-up were identified. Angiographic and clinical data from these patients were reviewed. Neurological outcome and status of presenting symptoms were assessed during long-term follow-up. Results Of the 23 patients, 13 underwent endovascular treatment for intolerable tinnitus or ophthalmological symptoms, and 10 did not undergo treatment. Three untreated patients died of unrelated causes. In those who were treated, complete DAVF obliteration was achieved in 4 patients, and palliative reduction in DAVF flow was achieved in 9 patients. Of the 19 patients without radiographic cure, no patient developed intracranial hemorrhage or nonhemorrhagic neurological deficits (NHNDs), and no patient died of DAVF-related causes over a mean follow-up of 5.6 years. One patient experienced a spontaneous, asymptomatic obliteration of a partially treated DAVF in late follow-up, and 2 patients experienced a symptomatic conversion of their DAVF to a higher-grade fistula with CVD in late follow-up. The annual rate of conversion to a higher-grade DAVF based on Kaplan-Meier cumulative event-free survival analysis was 1.0%. The annual rate of intracranial hemorrhage, NHND, and DAVF-related death was 0.0%. Conclusions A small number of Type I DAVFs will convert to more aggressive DAVFs with CVD over time. This conversion to a higher-grade DAVF is typically heralded by a change in patient symptoms. Follow-up vascular imaging is important, particularly in the setting of recurrent or new symptoms.

Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview

2012 ◽  
Vol 32 (5) ◽  
pp. E17 ◽  
Author(s):  
Jennifer E. Fugate ◽  
Giuseppe Lanzino ◽  
Alejandro A. Rabinstein
Keyword(s):  
Spinal Cord ◽  
Clinical Symptoms ◽  
Neurological Deficits ◽  
Intramedullary Spinal Cord ◽  
Lower Extremity Weakness ◽  
Arteriovenous Fistulas ◽  
Signal Abnormality ◽  
Dural Arteriovenous Fistulas ◽  
Sensory Disturbances ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (AVFs), the most common type of spinal cord vascular malformation, can be a challenge to diagnose and treat promptly. The disorder is rare, and the presenting clinical symptoms and signs are nonspecific and insidious at onset. Spinal dural AVFs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. Patients with severe neurological deficits at presentation tend to have worse posttreatment functional outcomes than those with mild or moderate pretreatment disability. However, improvement or stabilization of symptoms is seen in the vast majority of treated patients, and thus treatment is justified even in patients with substantial neurological deficits. The extent of intramedullary spinal cord T2 signal abnormality does not correlate with outcomes and should not be used as a prognostic factor.

scholarly journals Combined Endovascular and Surgical Treatment of Type I Spinal Dural Arteriovenous Fistulas

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554205-s-0035-1554205
Author(s):  
Miroslav Vukic ◽  
David Ozretic ◽  
Marko Rados ◽  
Sergej Marasanov ◽  
Marjan Rozankovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Type I ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

scholarly journals Management of spinal dural arteriovenouse fistula

2017 ◽  
Vol 31 (4) ◽  
pp. 474-483
Author(s):  
A. Chiriac ◽  
Georgiana Ion ◽  
N. Dobrin ◽  
I. Poeată
Keyword(s):  
Endovascular Treatment ◽  
Vascular Lesions ◽  
Short Discussion ◽  
Endovascular Techniques ◽  
Arteriovenous Fistulae ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
High Interest ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Abstract Spinal dural arteriovenous fistulas are rare vascular lesions whose management is still at high interest between specialists. If microsurgical treatment is still considered as treatment of choice for SDAVFs, endovascular treatment is increasingly grow in interest with the development of endovascular techniques and new embolization materials. In this article we made a short discussion about the spinal dural arteriovenous fistulae on aspects related to anatomy, pathophysiology, diagnosis and treatment, with some general conclusions.

Minimally invasive tubular retractor system for adequate exposure during surgical obliteration of spinal dural arteriovenous fistulas with the aid of indocyanine green intraoperative angiography

2012 ◽  
Vol 17 (2) ◽  
pp. 160-163 ◽  
Author(s):  
Atman Desai ◽  
Kimon Bekelis ◽  
Kadir Erkmen
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Successful Treatment ◽  
Indocyanine Green Angiography ◽  
Intraoperative Angiography ◽  
Tubular Retractor ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Effective surgical obliteration of spinal dural arteriovenous fistulas (DAVFs) traditionally requires laminectomy or hemilaminectomy to allow intradural exposure and occlusion of the draining vein. The authors present successful treatment of a spinal DAVF by using a tubular retractor system to provide minimally invasive exposure at the L5–S1 level adequate for both microsurgical treatment and intraoperative indocyanine green angiography.

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

2019 ◽  
Vol 21 (2) ◽  
pp. 53-65
Author(s):  
G. Yu. Evzikov ◽  
V. А. Parfenov ◽  
А. V. Farafontov ◽  
P. V. Kuchuk ◽  
S. А. Kondrashin ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Spinal Dural Arteriovenous Fistula ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Wide Range ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

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.

scholarly journals Timing, severity of deficits, and clinical improvement after surgery for spinal dural arteriovenous fistulas

2018 ◽  
Vol 29 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Michael M. Safaee ◽  
Aaron J. Clark ◽  
Jan-Karl Burkhardt ◽  
Ethan A. Winkler ◽  
Michael T. Lawton
Keyword(s):  
Clinical Improvement ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Symptom Duration ◽  
Selective Embolization ◽  
Arteriovenous Fistulas ◽  
Abnormal Gait ◽  
Improved Outcomes ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

OBJECTIVESpinal dural arteriovenous fistulas (dAVFs) are rare vascular abnormalities caused by arteriovenous shunting. They often form at the dural root sleeve between a radicular feeding artery and draining medullary vein causing venous congestion and edema, decreased perfusion, and ischemia of the spinal cord. Treatment consists of either surgical ligation of the draining vein or selective embolization via an endovascular approach. There is a paucity of data on which modality provides more durable and effective outcomes.METHODSThe authors performed a retrospective review of a prospectively maintained database by the senior author to assess clinical outcomes in patients undergoing surgical treatment of spinal dAVFs. Preoperative and postoperative motor and Aminoff-Logue Scale (ALS) scores were collected.RESULTSA total of 41 patients with 44 spinal dAVFs were identified, with a mean patient age of 64 years. The mean symptom duration was 14 months, with weakness (82%), urinary symptoms (47%), and sensory symptoms (29%) at presentation. The fistula locations were as follows: 30 thoracic, 9 lumbar, 3 sacral, and 2 cervical. Five patients had normal motor and ALS scores at presentation. Among the remaining 36 patients with motor deficits or abnormal gait and micturition at presentation, 78% experienced an improvement while the remaining 22% continued to be stable. There was a trend toward improved outcomes in patients with shorter symptom duration; mean symptom duration among patients with clinical improvement was 13 months compared with 22 months among those without improvement. Additionally, rates of improvement were higher for lower thoracic and lumbosacral dAVFs (85% and 83%) compared with those in the upper thoracic spine (57%). No patient developed recurrent fistulas or worsening neurological deficits.CONCLUSIONSSurgery is associated with excellent outcomes in the treatment of spinal dAVFs. Early diagnosis and treatment are critical, with a trend toward improved outcomes. No patient in this study had fistula recurrence or worsening of symptoms. Among patients with abnormal motor or ALS scores, 78% improved after surgery. Therapeutic embolization is an option for some lesions, but for cases with unfavorable anatomy where embolization is not feasible, surgery is a safe option associated with high success.

scholarly journals Type I spinal dural arteriovenous fistulas: historical review and illustrative case

2009 ◽  
Vol 26 (1) ◽  
pp. E3 ◽  
Author(s):  
Hendrik B. Klopper ◽  
Daniel L. Surdell ◽  
William E. Thorell
Keyword(s):  
Historical Review ◽  
Clinical Findings ◽  
Illustrative Case ◽  
Type I ◽  
Review Of The Literature ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Diagnosis Classification

Type I spinal dural arteriovenous fistulas are the most common vascular malformation of the spinal cord, and an important cause of reversible progressive myelopathy. This lesion remains underdiagnosed, with most patients presenting late in the course of the disease. In this article the authors provide a review of the literature with particular attention to historical aspects related to the pathophysiology, diagnosis, classification, clinical findings, natural history, and treatment of this lesion. An illustrative case is also provided.

scholarly journals Endovascular versus surgical treatment of cranial dural arteriovenous fistulas: a single-center 8-year experience

2021 ◽  
Author(s):  
Wilhelm Sorteberg ◽  
Angelika Sorteberg ◽  
Eva Astrid Jacobsen ◽  
Pål Rønning ◽  
Terje Nome ◽  
...  
Keyword(s):  
Treatment Modality ◽  
Specific Treatment ◽  
Type I ◽  
Type Ii ◽  
Residual Symptoms ◽  
Type Iii ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Primary Treatment Modality ◽  
Dural Arteriovenous Fistulas

Abstract Background Cranial dural arteriovenous fistulas (dAVFs) are rare lesions managed mainly with endovascular treatment (EVT) and/or surgery. We hypothesize that there may be subtypes of dAVFs responding better to a specific treatment modality in terms of successful obliteration and cessation of symptoms and/or risks. Methods All dAVFs treated during 2011–2018 at our hospital were analyzed retrospectively. Presenting symptoms, radiological variables, treatment modality, complications, and residual symptoms were related to dAVF type using the original Djindjian classification. Results We treated 112 dAVFs in 107 patients (71, 66% males). They presented with hemorrhage (n = 23; 21%), non-hemorrhagic symptoms (n = 75; 70%), or were discovered incidentally (n = 9; 8%). There were 25 (22%) type I, 29 (26%) type II, 26 (23%) type III, and 32 (29%) type IV fistulas. EVT was the primary treatment modality in 72/112 (64%) dAVFs whereas 40/112 (36%) underwent primary surgery with angiographic obliteration rates of 60% and 90%, respectively. Using a secondary treatment modality in 23 dAVFs, we obtained a final obliteration rate of 93%, including all type III/IV and 26/27 (96%) type II dAVFs. Except for headache, residual symptoms were rare and minor. Permanent neurological complications consisted of five cranial nerve deficits. Conclusions We recommend EVT as first treatment modality in types I, II, and in non-hemorrhagic type III/IV dAVFs. We recommend surgery as first treatment choice in acute hemorrhagic dAVFs and as secondary choice in type III/IV dAVFs not successfully occluded by EVT. Combining the two modalities provides obliteration in 9/10 dAVF cases at a low procedural risk.

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