Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM's in 81 patients

1987 ◽  
Vol 67 (6) ◽  
pp. 795-802 ◽  
Author(s):  
Bruce Rosenblum ◽  
Edward H. Oldfield ◽  
John L. Doppman ◽  
Giovanni Di Chiro
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Initial Symptom ◽  
Lumbar Region ◽  
Radiographic Findings ◽  
Content Type ◽  
Spinal Arteriovenous Malformations ◽  
Av Fistulas ◽  
Av Shunt ◽  
Fine Print

✓ The medical records and arteriograms of 81 patients with spinal arteriovenous malformations (AVM's) were reviewed, and the vascular lesions were classified as dural arteriovenous (AV) fistulas or intradural AVM's. Intradural AVM's were further classified as intramedullary AVM's (juvenile and glomus types) and direct AV fistulas, which were extramedullary or intramedullary in location. Dural AV fistulas were defined as being supplied by a dural artery and draining into spinal veins via an AV shunt in the intervertebral foramen. Intramedullary AVM's were defined as having the AV shunt contained at least partially within the cord or pia and receiving arterial supply by medullary arteries. Of the 81 patients, 27 (33%) had dural AV fistulas and 54 (67%) had intradural AVM's. Several dissimilarities in clinical and radiographic findings of the two subgroups were evident. The patients with intramedullary AVM's were younger; the age at onset of symptoms averaged 27 years compared to 49 years for dural AV fistulas. The most common initial symptom associated with dural AV fistulas was steadily progressive paresis, whereas hemorrhage was the most common presenting symptom in cases of intramedullary lesions. No patients with dural AV fistulas had subarachnoid hemorrhage. Activity exacerbated symptoms more frequently in patients with dural lesions. Associated vascular anomalies occurred only in cases of intradural AVM's. In 96% of the dural lesions the AV nidus was in the low thoracic or lumbar region; in only 15% did the intercostal or lumbar arteries supplying the AVM also provide a medullary artery which supplied the spinal cord. In contrast, most intradural AVM's (84%) were in the cervical or thoracic segments of the spinal cord and all of them were supplied by medullary arteries. Transit of contrast medium through the intradural AVM's was rapid in 80% of cases, suggesting high-flow lesions. Forty-four percent of the patients with AVM's of the spinal cord had associated saccular arterial or venous spinal aneurysms. No dural AV fistulas displayed these characteristics. A good outcome occurred in 88% of patients with dural AV fistulas after nidus obliteration, while 49% of patients with intramedullary AVM's did well after surgery or embolization. These findings suggest that dural and intradural AVM's differ in etiology (acquired vs. congenital) and that they have different pathophysiology, radiographic findings, clinical presentation, and response to treatment.

Magnetic resonance imaging of spinal arteriovenous malformations

1987 ◽  
Vol 66 (6) ◽  
pp. 830-834 ◽  
Author(s):  
John L. Doppman ◽  
Giovanni Di Chiro ◽  
Andrew J. Dwyer ◽  
Joseph L. Frank ◽  
Edward H. Oldfield
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
High Signal ◽  
Resonance Imaging ◽  
Content Type ◽  
Spinal Arteriovenous Malformations ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Avm ◽  
Fine Print

✓ Magnetic resonance imaging (MRI) was performed on 12 patients with spinal arteriovenous malformations (AVM's). Six lesions were intramedullary, five were dural, and one was in a posterior extramedullary location. Serpentine filling defects similar to the classic myelographic findings were demonstrated within the high-signal cerebrospinal fluid on T2-weighted coronal scans. The intramedullary nidus was identified by MRI as an area of low-signal intensity within the cord in all six intramedullary AVM's. Neither the dural nor the posterior extramedullary lesions showed intramedullary components. It is concluded that MRI may noninvasively provide the initial diagnosis of a spinal AVM and distinguish intramedullary from dural and extramedullary lesions.

Modified classification of spinal cord vascular lesions

2002 ◽  
Vol 96 (2) ◽  
pp. 145-156 ◽  
Author(s):  
Robert F. Spetzler ◽  
Paul W. Detwiler ◽  
Howard A. Riina ◽  
Randall W. Porter
Keyword(s):  
Spinal Cord ◽  
Classification System ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Relevant Literature ◽  
Vascular Lesions ◽  
Cavernous Malformations ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Fine Print

The literature on spinal vascular malformations contains a great deal of confusing terminology. Some of the nomenclature is inconsistent with the lesions described. Based on the experience of the senior author (R.F.S.) in the treatment of more than 130 spinal cord vascular lesions and based on a thorough review of the relevant literature, the authors propose a modified classification system for spinal cord vascular lesions. Lesions are divided into three primary or broad categories: neoplasms, aneurysms, and arteriovenous lesions. Neoplastic vascular lesions include hemangioblastomas and cavernous malformations, both of which occur sporadically and familially. The second category consists of spinal aneurysms, which are rare. The third category, spinal cord arteriovenous lesions, is divided into arteriovenous fistulas and arteriovenous malformations (AVMs). Arteriovenous fistulas are subdivided into those that are extradural and those that are intradural, with intradural lesions categorized as either dorsal or ventral. Arteriovenous malformations are subdivided into extradural-intradural and intradural malformations. Intradural lesions are further divided into intramedullary, intramedullary-extramedullary, and conus medullaris, a new category of AVM. This modified classification system for vascular lesions of the spinal cord, based on pathophysiology, neuroimaging features, intraoperative observations, and neuroanatomy, offers several advantages. First, it includes all surgical vascular lesions that affect the spinal cord. Second, it guides treatment by classifying lesions based on location and pathophysiology. Finally, it eliminates the confusion produced by the multitude of unrelated nomenclatural terms found in the literature.

Rapid arteriovenous shunting in a spinal cord ependymoma

1976 ◽  
Vol 44 (6) ◽  
pp. 744-747 ◽  
Author(s):  
Eric T. Yuhl ◽  
John R. Bentson
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Arteriovenous Shunting ◽  
Content Type ◽  
Spinal Cord Ependymoma ◽  
Fine Print

✓ A case of ependymoma of the conus medullaris and cauda equina is described in which spinal angiography demonstrated rapid arteriovenous shunting, an angiographic sign which is typical of arteriovenous malformations and which has not been previously reported to occur with ependymomas.

Concurrent intracranial and spinal cord arteriovenous malformations

1975 ◽  
Vol 43 (1) ◽  
pp. 104-107 ◽  
Author(s):  
Cecil J. Hash ◽  
Charles B. Grossman ◽  
Henry A. Shenkin
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Hemorrhage ◽  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Dural Arteriovenous Malformation ◽  
Content Type ◽  
Spinal Arteriovenous Malformation ◽  
Fine Print

✓ The authors report the case of a patient with subarachnoid hemorrhage in whom an intracranial dural arteriovenous malformation coexisted with a spinal arteriovenous malformation. The latter was considered to be the source of the hemorrhage by clinical and radiographic criteria. It is concluded that patients with subarachnoid hemorrhage who show no suitable intracranial source for their bleed in some instances should be investigated for a spinal origin of hemorrhage.

Arteriovenous fistulas of the brain and the spinal cord

1993 ◽  
Vol 79 (1) ◽  
pp. 16-27 ◽  
Author(s):  
Francis H. Tomlinson ◽  
Daniel A. Rüfenacht ◽  
Thoralf M. Sundt ◽  
Douglas A. Nichols ◽  
Nicolee C. Fode
Keyword(s):  
Spinal Cord ◽  
Imaging Techniques ◽  
Neurological Dysfunction ◽  
Arterial Aneurysm ◽  
Cerebral Lesions ◽  
Content Type ◽  
Satisfactory Outcome ◽  
Ultrasound Study ◽  
Av Fistulas ◽  
Fine Print

✓ Arteriovenous (AV) fistulas of cerebral and spinal arteries are characterized angiographically by an immediate AV transition without a capillary bed or “nidus” as occurs in AV malformations (AVM's). The clinical presentation, morphology, radiology, and treatment of 12 patients with cerebral AV fistulas and of 12 patients with spinal AV fistulas are reviewed. In the patients with cerebral lesions, headache and seizure disorders were the most common presentations followed by subarachnoid hemorrhage, cardiac failure, progressive neurological dysfunction, and incidental detection on prenatal ultrasound study. In patients with spinal AV fistulas, weakness and sensory disturbance in the lower extremities were the most frequent clinical presentations followed by back pain, disturbances of micturition, and grand mal seizure. The etiology of the symptom complex produced by AV fistulas in each of these locations differed, with venous hypertension being important in spinal cord lesions. Of the patients with cerebral lesions, nine had a single AV fistula, one had two fistulas, and two had multiple fistulas. An AVM was observed in five patients with fistulas (two large, three small). Nine patients exhibited extramedullary AV fistulas of the spine, of whom eight had a single fistula and one had three fistulas; three patients had intramedullary spinal AV fistulas. An arterial aneurysm was found in association with two fistulas, one cerebral and one spinal. Venous ectasias or varices, frequently exhibiting mural calcification, were observed to be prominent in all AV fistulas involving cerebral arteries and in two involving spinal arteries. The location and size of the venous complexes reflected the diameter of the fistula. In addition to conventional imaging techniques (cerebral angiography, computerized tomography, and magnetic resonance (MR) imaging), MR angiography was a helpful adjunct in the evaluation of fistulas. Treatment strategies employed for AV fistulas in both locations included open surgical and endovascular procedures, frequently used in combination. A satisfactory outcome was observed in all patients.

Transient postprandial paresis associated with arteriovenous malformations of the spinal cord

1973 ◽  
Vol 39 (5) ◽  
pp. 652-655 ◽  
Author(s):  
Anthony D. Oliver ◽  
Charles B. Wilson ◽  
Edwin B. Boldrey
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
The Body ◽  
Neurological Deficits ◽  
Clinical Feature ◽  
Content Type ◽  
Spinal Arteriovenous Malformation ◽  
Low Resistance ◽  
Fine Print

✓ Two cases of spinal arteriovenous malformation (AVM) are reported because of a previously unobserved clinical feature: recurrent transient postprandial paresis of the legs. The authors believe the paresis was caused by chronic shunting of blood away from the cord and into the low-resistance AVM. Symptomatic cord ischemia might then be precipitated by vasodilatation in other areas of the body such as the splanchnic, brachial, or uterine vessels. We believe that in some instances this mechanism should be considered as an explanation for episodic neurological deficits seen in association with spinal AVM's.

Spinal cord arteriovenous malformations with significant intramedullary components

1983 ◽  
Vol 59 (3) ◽  
pp. 471-478 ◽  
Author(s):  
Philip Cogen ◽  
Bennett M. Stein
Keyword(s):  
Arteriovenous Malformations ◽  
The Other ◽  
Neurological Deficits ◽  
Content Type ◽  
Postoperative Course ◽  
Microsurgical Techniques ◽  
Spinal Arteriovenous Malformations ◽  
High Degree ◽  
Fine Print

✓ Few neurosurgeons have stressed the occurrence, manifestations, and resectability of intramedullary spinal arteriovenous malformations (AVM's). In six of 17 patients in the authors' series of operable spinal AVM's, the lesions had major intramedullary components. Three of these six patients presented with subarachnoid hemorrhage, and all had catastrophic neurological deficits which gradually improved. The hemorrhages appeared to originate from large venous varices lying adjacent to the intramedullary portion of the AVM. The mechanism explaining the sudden neurological deficit in the other three patients was presumed to be thrombosis within the venous varices associated with their AVM's. The reliability of the various radiographic procedures in identifying the intramedullary components of these AVM's is discussed. These malformations may be removed totally with a high degree of safety using microsurgical techniques. The postoperative course in this series of patients was gratifying in terms of improvement of neurological deficits. Postoperative angiography was not performed on all of these patients. However, the follow-up period averaged 5 years.

Dural arteriovenous malformations of the spine

1984 ◽  
Vol 60 (2) ◽  
pp. 238-247 ◽  
Author(s):  
Lindsay Symon ◽  
Hideyuki Kuyama ◽  
Brian Kendall
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Dural Arteriovenous Malformation ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Results Of Surgery ◽  
Dural Avm ◽  
Angiographic Findings ◽  
Progressive Course ◽  
Fine Print

✓ The clinical and angiographic findings of 55 patients with a spinal dural arteriovenous malformation (AVM) are reviewed, and the results of surgery assessed. The symptoms of dural AVM are usually gradual in onset, and hemorrhage from this type of AVM is less common than in true spinal cord angiomas. Other clinical features and the myelographic findings are similar to those of spinal cord angiomas. On angiography, the nidus of dural AVM's usually projected lateral to the spinal cord. Clipping of communicating vessels between the AVM and the coronal plexus was carried out in 50 patients, and decompressive laminectomy only in five cases. Surgery led to improvement of disturbed gait or arrest of a previously progressive course in 85% of those managed by clipping communicating vessels. The pathophysiology and surgical treatment of dural AVM's are discussed.

Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula

1983 ◽  
Vol 59 (6) ◽  
pp. 1019-1030 ◽  
Author(s):  
Edward H. Oldfield ◽  
Giovanni Di Chiro ◽  
Eugene A. Quindlen ◽  
Kenneth G. Rieth ◽  
John L. Doppman
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Arteriovenous Malformations ◽  
Venous Hypertension ◽  
Current Therapy ◽  
Type I ◽  
Content Type ◽  
Symptoms And Signs ◽  
Extensive Surgery ◽  
Fine Print

✓ As demonstrated by selective spinal cord arteriography, over 80% of spinal cord arteriovenous malformations (AVM's) occupy a predominantly extramedullary position. Current therapy frequently requires surgical stripping of the long dorsal intradural vessel(s) from the underlying spinal cord over many cord segments. The authors report six patients with a dural arteriovenous fistula fed by a cluster of abnormal epidural arteries. These vessels, which surrounded and were embedded into the dural covering of a thoracic nerve root, drained into a long sinuous intrathecal paramedullary vein(s). The angiographic and surgical appearance of the intradural component of these lesions was identical to that of lesions previously classified as Type I AVM's of the spinal cord. All patients had symptoms and signs of myelopathy. In five patients, surgery was limited to coagulation and excision of the extradural vessels and division of the intradural arterialized vein. Progressive improvement began within days following surgery. No residual abnormality was demonstrated by postoperative selective spinal cord arteriography, which was performed in all five patients. The findings support those of Kendall and Logue, that surgery restricted to elimination of the arteriovenous fistula at the intervertebral foramen is curative, and that more extensive surgery is unnecessary for this subgroup of AVM's of the spinal cord. These lesions comprise a sizable percent of all spinal AVM's. Resolution of myelopathy in these patients supports the hypothesis that venous hypertension causes chronic progressive myelopathy.

The “filum intermedium” sign: focal in utero spinal cord infarct and extraspinal thecal sac

1994 ◽  
Vol 81 (6) ◽  
pp. 941-946 ◽  
Author(s):  
Adam N. Mamelak ◽  
Philip H. Cogen ◽  
A. James Barkovich
Keyword(s):  
Spinal Cord ◽  
Spinal Canal ◽  
Spinal Column ◽  
In Utero ◽  
Magnetic Resonance Images ◽  
Radiographic Appearance ◽  
Radiographic Findings ◽  
Content Type ◽  
And Migration ◽  
Fine Print

✓ This report describes the unique case of a child born with paraplegia and a neurogenic bladder who was found to have a dysplastic, nonossified T-12 vertebral body, midline fusion of the T-12 neural arches, obliteration of the spinal canal at T-12, and an extraspinal thecal sac in the T11—L1 region. Neural tissue was focally absent from T9–12, but neural structures above and below were preserved. Narrowing of the thecal sac on myelograms and sagittal magnetic resonance images signifies in utero focal infarction of the spinal cord after neurulation but before formation of the posterior half of the spinal canal. The infarction resulted in severe focal narrowing of the thecal sac from T10—L1, resembling a premature and duplicated filum terminale; to denote the radiographic appearance of these anomalies, the authors have coined the term “filum intermedium” sign. The extremely unusual radiographic findings in this child illustrate the important interactions between neural tube, neural crest, and somite in the development of the spinal cord and spinal column. Correlation of the radiographic findings with the embryological differentiation and migration of these structures suggests that the spinal anomalies were caused by a focal insult, probably vascular in origin, occurring between the sixth and eighth weeks of gestation. The identification of a focally narrowed thecal sac and spinal cord (the “filum intermedium” sign) localizes the time of the insult to between the first and third month of gestation, and therefore is a useful marker in understanding developmental malformation of the spinal cord.

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