Spinal dural arteriovenous fistulas: outcome and prognostic factors

2012 ◽  
Vol 32 (5) ◽  
pp. E11 ◽  
Author(s):  
Marco Cenzato ◽  
Alberto Debernardi ◽  
Roberto Stefini ◽  
Giuseppe D'Aliberti ◽  
Maurizio Piparo ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Neurological Status ◽  
Anatomical Location ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
Thoracic Level ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Better Than

The aim of this study is to review the clinical outcome of patients treated for spinal dural arteriovenous malformations and investigate the presence of pretreatment indicators of outcome after short- and midterm follow-up. The authors retrospectively reviewed the records of 65 consecutive patients treated either surgically or endovascularly in 3 neurosurgery departments between 1989 and 2009. After treatment, 80% of patients reported improvement of at least 1 symptom. Motor symptoms improved more than sensory disorders, pain, or sphincter impairment. Spinal dural arteriovenous fistulas at the thoracic level, and in particular at the lower level, responded better than those in other spinal areas. Spinal dural arteriovenous fistula is a rare pathology with a malignant course that should be treated aggressively. This study appears to confirm that neurological status before treatment, anatomical location of the fistula, and symptoms at presentation are all factors that can predict outcome. Early diagnosis of spinal dural arteriovenous malformations in the lower thoracic area in patients with an Aminoff scale score < 3 was associated with the most favorable outcome.

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.

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.

Absence of abnormal vessels in the subarachnoid space on conventional magnetic resonance imaging in patients with spinal dural arteriovenous fistulas

2012 ◽  
Vol 32 (5) ◽  
pp. E15 ◽  
Author(s):  
Timothy R. Miller ◽  
Clifford J. Eskey ◽  
Alexander C. Mamourian
Keyword(s):  
Resonance Imaging ◽  
Mri Findings ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
Conventional Mri ◽  
Limited Experience ◽  
Dural Arteriovenous Fistulas ◽  
Uncommon Condition ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistula (DAVF) is an uncommon condition that can be difficult to diagnose. This often results in misdiagnosis and treatment delay. Although conventional MRI plays an important role in the initial screening for the disease, the typical MRI findings may be absent. In this article, the authors present a series of 4 cases involving patients with angiographically proven spinal DAVFs who demonstrated cord T2 prolongation on conventional MRI but without abnormal subarachnoid flow voids or enhancement. These cases suggest that spinal DAVF cannot be excluded in symptomatic patients with cord edema based on conventional MRI findings alone. Dynamic Gd-enhanced MR angiography (MRA) was successful in demonstrating abnormal spinal vasculature in all 4 cases. This limited experience provides support for the role of spinal MRA in patients with abnormal cord signal and symptoms suggestive of DAVF even when typical MRI findings of a DAVF are absent.

Spinal dural arteriovenous fistulas: Long-term follow-up of 44 treated patients

Neurology ◽  
2004 ◽  
Vol 62 (10) ◽  
pp. 1839-1841 ◽  
Author(s):  
K. Jellema ◽  
C. C. Tijssen ◽  
W. J.J. van Rooij ◽  
M. Sluzewski ◽  
P. J. Koudstaal ◽  
...  
Keyword(s):  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Long Term Follow Up ◽  
Spinal Dural Arteriovenous Fistulas

Surgical and endovascular treatment of spinal dural arteriovenous fistulas: long-term disability assessment and prognostic factors

2001 ◽  
Vol 94 (2) ◽  
pp. 199-204 ◽  
Author(s):  
Joon K. Song ◽  
Fernando Viñuela ◽  
Y. Pierre Gobin ◽  
Gary R. Duckwiler ◽  
Yuichi Murayama ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Mr Imaging ◽  
Symptom Onset ◽  
Disability Score ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Fine Print

Object. The authors assessed clinical outcomes of patients with treated spinal dural arteriovenous fistulas (DAVFs) and investigated prognostic factors. Methods. Thirty consecutive patients with spinal DAVFs were treated at the authors' institution during the past 15 years: seven underwent surgery; seven underwent surgery after failed embolization; and 16 underwent embolization alone. The outcomes of gait and micturition disability were analyzed. Follow up averaged 3.4 years (range 1 month–11.8 years). Age, duration of symptoms, pre- and postintervention magnetic resonance (MR) imaging findings, and preintervention disability were correlated with outcome. Seventeen patients (57%) experienced improved gait, 12 (40%) were unchanged, and one (3%) was worse. In 11 patients (37%) micturition function was improved, in 15 (50%) it was unchanged, and in four (13%) it was worse. Gait disability, as measured by the Aminoff—Logue Scale, was significantly improved after treatment, from 3.4 ± 1.4 (average ± standard deviation) to 2.7 ± 1.5 (p = 0.007). Mean micturition disability scores decreased, but not significantly, from 1.9 ± 1 to 1.6 ± 1.1 (p = 0.20). Preintervention gait disability was not associated with improvement except for patients with Aminoff—Logue Scale Grade 4 disability (eight of nine improved; p = 0.024). For patients treated within 13 months of symptom onset, mean micturition disability decreased (p = 0.035). No association was found between clinical improvement and age, a symptom duration less than 30 months, or pre- and postintervention MR imaging—documented spinal cord edema. Conclusions. Spinal DAVF treatment significantly improved patients' mean gait disability score by almost one grade at last follow up. The mean micturition disability score was not significantly improved, unless treatment was performed within 13 months of symptom onset. Longer and more uniform follow-up study is needed to determine if improved and stabilized clinical outcomes are sustained.

scholarly journals Microscope-assisted endoscopic interlaminar ligation of spinal arteriovenous fistulas: technical note

2016 ◽  
Vol 25 (3) ◽  
pp. 394-397 ◽  
Author(s):  
Chen Wang ◽  
Chien-Min Chen ◽  
Fang Shen ◽  
Xiao-Dong Fang ◽  
Guang-Yu Ying ◽  
...  
Keyword(s):  
Technical Note ◽  
Endoscopic Management ◽  
Short Term ◽  
Endoscopic Techniques ◽  
Arteriovenous Fistulas ◽  
Interlaminar Approach ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Arteriovenous Malformations ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations, and microsurgical ligation is the treatment modality most frequently used for these lesions. Developments in endoscopic techniques have made endoscopy an even less invasive alternative to routine microsurgical approaches in spine surgery, but endoscopic management of SDAVF or other intradural spinal lesions has not been reported to date. The authors describe the use of a microscope-assisted endoscopic interlaminar approach for the ligation of the proximal draining vein of an L-1 SDAVF in a 58-year-old man. A complete cure was confirmed by postoperative angiography. The postoperative course was uneventful, and short-term follow-up showed improvements in the patient's neurological function. The authors conclude that the endoscopic interlaminar approach with microscope assistance is a safe, minimally invasive, innovative technique for the surgical management of SDAVFs in selected patients.

Embolization of spinal dural arteriovenous fistulas: importance of occlusion of the draining vein

2005 ◽  
Vol 2 (5) ◽  
pp. 580-583 ◽  
Author(s):  
Korné Jellema ◽  
Menno Sluzewski ◽  
Willem Jan van Rooij ◽  
Cees C. Tijssen ◽  
Guus N. Beute
Keyword(s):  
Treatment Option ◽  
Additional Treatment ◽  
The Other ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Fine Print

Object. The aim of this study was to assess whether glue-induced occlusion of the draining vein predicts permanent closure of the fistula following embolization of spinal dural arteriovenous fistulas (SDAVFs). Methods. Between 1994 and 2004, 36 consecutive patients with an SDAVF were treated at the authors' institution. Twelve patients underwent surgery and 24 glue-based embolization. In 12 of 24 embolization procedures the draining vein was occluded and no recurrence or persistent fistula was seen during the follow-up period. In the other 12 patients the glue had not reached the draining vein and in eight of these the fistula recurred, necessitating additional treatment. Conclusions. In embolization of SDAVFs penetration of the glue into the draining vein predicts permanent closure of the fistula. When penetration of the glue into the draining vein can be expected, embolization is the preferred treatment option. In other cases surgery should be the treatment of choice.

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 The Bilateral Sacral Origin of a Spinal Dural Arteriovenous Fistula: A Case Report

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.

Magnetic resonance imaging findings in treated spinal dural arteriovenous fistulas: lack of correlation with clinical outcomes

2011 ◽  
Vol 14 (4) ◽  
pp. 548-554 ◽  
Author(s):  
Timothy J. Kaufmann ◽  
Jonathan M. Morris ◽  
Andrea Saladino ◽  
Jay N. Mandrekar ◽  
Giuseppe Lanzino
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Clinical Outcomes ◽  
Imaging Findings ◽  
Urinary Function ◽  
Arteriovenous Fistulas ◽  
Imaging Characteristics ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Object Little information is available on follow-up MR imaging after treatment of spinal dural arteriovenous fistulas (DAVFs). The authors studied MR imaging findings in treated spinal DAVFs in relation to clinical outcomes. Methods A retrospective review of patients with spinal DAVFs who had undergone both pre- and postoperative spinal MR imaging was conducted. Postoperative MR images were obtained as routine follow-up studies or because of subjective or objective clinical deterioration. Several pre- and posttreatment MR imaging characteristics were evaluated by 2 neuroradiologists blinded to the clinical outcome. Clinical outcomes of motor, sensory, and urinary function (in relation to the patient's preoperative status) at the time of the postoperative MR imaging were obtained from the clinical record. The chi-square, Fisher exact, and rank-sum tests were performed to correlate imaging findings and changes with clinical outcomes. Results Thirty-four patients met inclusion criteria. Treatment was surgical in 33 patients and endovascular in 1 patient. Follow-up MR imaging was performed at a mean 168 ± 107 days after treatment. Twenty-seven patients (79.4%) were either clinically stable or improved, and 7 (20.6%) experienced worsening in one or more clinical outcomes. Most patients were found to have improvement of MR imaging changes. However, some degree of persistent spinal cord signal abnormality, enhancement, and swelling was observed in 31 (91.2%), 29 (85.3%), and 18 (52.3%) patients, respectively. Changes in these MR imaging characteristics compared with preoperative MR imaging did not correlate with clinical outcomes (p > 0.05), with the one exception of a significant correlation between change in urinary function and extent of spinal cord contrast enhancement (p = 0.026), a correlation of uncertain importance. Ten of the 34 patients underwent posttreatment digital subtraction angiography, and 3 of these patients had recurrent/residual DAVFs. Worsening of motor function significantly correlated with recurrent/residual DAVF (p = 0.053). Conclusions Spinal cord abnormalities persist on postoperative MR imaging studies in patients with treated spinal DAVFs, and although they tend to mildly improve with time, these changes may not correlate with clinical outcomes. However, regardless of imaging findings, worsening motor function may correlate with a recurrent or residual DAVF.

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