scholarly journals Intraoperative microvascular Doppler monitoring of blood flow within a spinal dural arteriovenous fistula: a precious surgical tool

2001 ◽  
Vol 10 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Domenico Gerardo Iacopino ◽  
Maria Giusa ◽  
Alfredo Conti ◽  
Salvatore Cardali ◽  
Francesco Tomasello
Keyword(s):  
Flow Velocity ◽  
Arteriovenous Fistula ◽  
Clinical Results ◽  
Spinal Dural Arteriovenous Fistula ◽  
Surgical Closure ◽  
Spinal Arteriovenous Fistula ◽  
Surgical Tool ◽  
Reliable Monitoring ◽  
Velocity Changes ◽  
Monitoring Modality

The authors describe a case of spinal arteriovenous fistula (AVF) treated by a microvauscular Doppler–assisted surgical interruption of the arterialized vein. Microvascular Doppler monitoring represents a valid, widely available, non-invasive tool that enables identification, through flow spectrum analysis, of components of this type of vascular malformation. In this case because the location of the fistula was identified prior to opening the dura only minimally invasive surgery was required. Direct recordings of the arterialized draining vein and the nidus of the fistula demonstrated a pathological spectrum caused by the arterial supply and the disturbed venous outflow in which a high-resistance flow pattern and low diastolic flow resembling an arterial-like flow velocity were observed. The fistula was obliterated by interruption of the draining vein, and Doppler measurements provided information on flow velocity changes in the medullary veins from an arterial to a venous pattern. The absence of any residual flow in the AVF confirmed successful hemodynamic treatment. Intraoperative microvascular Doppler recording during surgical closure of spinal AVF is a widely available and reliable monitoring modality that helps to produce excellent clinical results.

Paraplegia after Tethered Cord Surgery: An Uncommon Combined Anomaly of Spinal Arteriovenous Fistula and Sacral Lipoma— Case Report

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. E598-E598 ◽  
Author(s):  
Arnold C. Cheung ◽  
Steven N. Kalkanis ◽  
Christopher S. Ogilvy
Keyword(s):  
Arteriovenous Fistula ◽  
Bladder Dysfunction ◽  
Tethered Cord ◽  
Transverse Sinus ◽  
Spinal Dural Arteriovenous Fistula ◽  
Spinal Arteriovenous Malformation ◽  
Spinal Arteriovenous Fistula ◽  
Progressive Paraparesis ◽  
Dural Avm

ABSTRACT OBJECTIVE AND IMPORTANCE: The coexistence of spinal arteriovenous malformation (AVM) with congenital abnormalities is relatively common. However, the association of a spinal AVM and lipoma is rare. We present an adult patient with this combined anomaly and discuss the clinical relevance of this case. CLINICAL PRESENTATION: A 42-year-old Caucasian man with progressive paraparesis initially underwent surgery for a tethered spinal cord. Postoperatively, he became paraplegic. He improved gradually over an interval of 8 months and, at that point, worsened again. Subsequent angiographic study revealed a spinal dural arteriovenous fistula located at S1–S2. Additionally, an occipital dural AVM was discovered near the transverse sinus. INTERVENTION: The spinal arteriovenous fistula was excised along with the sacral lipoma. The occipital arteriovenous fistula was embolized successfully at a later time. CONCLUSION: The patient had immediate improvement in sensory symptoms after surgery. At a 9 month follow-up examination, he had regained the ability to walk with crutches, but his bladder dysfunction persisted. Recognition of co-existing vascular anomalies, such as spinal AVMs, is important in patients with tethered cords. The mechanisms involved in this patient's worsening neurological condition after release of the tethered cord are discussed.

scholarly journals Surgical correction of a spinal arteriovenous fistula with an unusual presentation

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1
Author(s):  
Aaron Cohen-Gadol
Keyword(s):  
Arteriovenous Fistula ◽  
Nerve Root ◽  
Cervical Spinal Cord ◽  
Cervical Lesions ◽  
Spinal Dural Arteriovenous Fistula ◽  
Spinal Arteriovenous Fistula ◽  
Clinical Presentations ◽  
Wide Range ◽  
Brainstem Dysfunction ◽  
Microsurgical Techniques

Spinal dural arteriovenous fistula (dAVF) is an acquired abnormal arterial-to-venous connection within the spinal dura with a wide range of clinical presentations and natural history. Spinal dAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dura of the nerve root sleeve. Cervical dAVF is a rare entity as the majority of spinal dAVFs present within the thoracolumbar segment with myelopathy. Only a small number of cervical lesions have been described, and only one presented with brainstem dysfunction. Herein we present one patient with brainstem dysfunction secondary to a spinal dAVF. The fistula was located within the C-3 nerve root sleeve. The details of microsurgical techniques to disconnect the fistula will be discussed. Although the option of endovascular disconnection of the fistula is reasonable, the author elected to proceed with microsurgical disconnection after discussion regarding the risks of such an endovascular route for the cervical spinal cord. The video can be found here: http://youtu.be/t8rUnZ8qVfY.

Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Nur Setiawan Suroto
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Vascular Malformation ◽  
Dural Arteriovenous Fistula ◽  
Motor Symptoms ◽  
Elderly Men ◽  
Spinal Dural Arteriovenous Fistula ◽  
Sensory Disturbances ◽  
Av Fistulas ◽  
Low Rate

Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region.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.

Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF)

2016 ◽  
Vol 9 (4) ◽  
pp. 405-410 ◽  
Author(s):  
Yudhi Adrianto ◽  
Ku Hyun Yang ◽  
Hae-Won Koo ◽  
Wonhyoung Park ◽  
Sung Chul Jung ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Arteriovenous Fistula ◽  
Open Surgery ◽  
Dural Arteriovenous Fistula ◽  
Spinal Dural Arteriovenous Fistula ◽  
Posterior Spinal Artery ◽  
Lumbar Level ◽  
Scale Scores ◽  
Complete Obliteration ◽  
Endovascular Approach

Background/objectiveThe concomitant origin of the anterior spinal artery (ASA) or the posterior spinal artery (PSA) from the feeder of a spinal dural arteriovenous fistula (SDAVF) is rare and the exact incidence is not known. We present our experience with the management of SDAVFs in such cases.MethodsIn 63 patients with SDAVF between 1993 and 2015, the feeder origin of the SDAVF was evaluated to determine whether it was concomitant with the origin of the ASA or PSA. Embolization was attempted when the patient did not want open surgery and an endovascular approach was regarded as safe and possible. The outcome of the procedure was evaluated as complete, partial, or no obliteration. The clinical outcome was evaluated by Aminoff–Logue (ALS) gait and micturition scale scores.ResultsNine patients (14%) had a concomitant origin of the ASA or PSA with the feeder. There were two cervical, five thoracic, and two lumbar level SDAVFs. A concomitant origin of the feeder was identified with the ASA (n=7) and PSA (n=2). Embolization was performed in four patients and open surgery was performed in five. Embolization resulted in complete obliteration in three patients and partial obliteration in one. Using the ALS gait and micturition scale, the final outcome improved in six while three cases remained in an unchanged condition over 2–148 months.ConclusionsThe concomitant origin of the ASA or PSA with the feeder occurs occasionally. Complete obliteration of the fistula can be achieved either by embolization or open surgery. Embolization can be carefully performed in selected patients who are in a poor condition and do not want to undergo open surgery.

Impact of non-contrast enhanced volumetric MRI-based feeder localization in the treatment of spinal dural arteriovenous fistula

2016 ◽  
Vol 9 (2) ◽  
pp. 178-182 ◽  
Author(s):  
Santhosh Kumar Kannath ◽  
Bejoy Thomas ◽  
P Sankara Sarma ◽  
Jayadevan Enakshy Rajan
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Definitive Treatment ◽  
Spinal Angiography ◽  
Vertebral Level ◽  
Spinal Dural Arteriovenous Fistula ◽  
Historical Cohort ◽  
Contrast Enhanced ◽  
The Impact

BackgroundThe preoperative localization of the feeder of spinal dural arteriovenous fistula (SDAVF) could simplify the diagnostic spinal angiographic procedure. Localization by non-contrast-enhanced MRI-based techniques is an attractive option. However, the usefulness of such an approach for evaluation of SDAVF has not yet been reported.ObjectiveTo study the impact of non-contrast MRI-based feeder localization, followed by targeted spinal angiography, in the evaluation of SDAVF before endovascular intervention.Materials and methodsProspectively collected data were analyzed and the level of the feeder was localized preoperatively. The procedural time for targeted spinal angiography was calculated and compared with that of a historical cohort, who underwent routine spinal angiographic examination before the study period. Follow-up MRI was carried out to assess the reliability of this model for detection of occasional metachronous lesions that might be missed with this approach.ResultsSeven patients underwent targeted spinal angiography during the study. The feeder level was accurately identified in five patients and was localized to one vertebral level in six patients. The correlation between MRI and DSA was statistically significant. The number of spinal levels assessed was fewer and overall procedure time was significantly shorter compared to historical cohort (58 min vs 162 min, respectively; p<0.001). Intervention was coupled with targeted angiography in two patients. Follow-up MRI demonstrated flow voids in one patient, who had recurrent fistula at one vertebral level below the previously embolized feeder.ConclusionsThe non-contrast MRI-based localization technique can reliably detect the level of feeder and help in therapeutic planning of SDAVF. The localization techniques potentially shorten the angiographic procedure and may facilitate simultaneous endovascular definitive treatment. Inclusion of follow-up MRI may be useful for detection of synchronous or metachronous lesions if a targeted approach is adopted. Additionally, this helps to identify failed endovascular therapy.

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