Dural arteriovenous fistula of the lumbar spine presenting with subarachnoid hemorrhage

2004 ◽  
Vol 100 (4) ◽  
pp. 385-391 ◽  
Author(s):  
Christoph Koch ◽  
Stefan Gottschalk ◽  
Alf Giese
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Craniocervical Junction ◽  
Type I ◽  
Spinal Dural Arteriovenous Fistula ◽  
Content Type ◽  
Spinal Arteriovenous Malformation ◽  
First Case ◽  
Imaging Results

✓ The authors report on a patient presenting with subarachnoid hemorrhage (SAH) that was initially attributed to an aneurysm of the right internal carotid artery. During surgical exploration and placement of a clip, however, it was observed that the aneurysm had not ruptured. Diagnostic workup including spinal magnetic resonance imaging revealed a vascular malformation of the lumbar spinal canal within a subarachnoid hematoma. Spinal angiography demonstrated a spinal dural arteriovenous fistula (DAVF) (Type I spinal arteriovenous malformation) with a feeding vessel arising from the L-4 radicular artery. In the literature, SAH due to spinal DAVFs is rare; only cases of dural fistulas of the craniocervical junction and the cervical spine have been reported. This is the first case of SAH that can be attributed to a lumbar DAVF. Although unusual even in cases of cervical DAVF, SAH as a presenting symptom may occur in spinal DAVF of any location. Nontraumatic SAH should not be prematurely attributed to the rupture of an intracranial aneurysm if the clinical findings and imaging results are inconclusive.

scholarly journals Multiple aneurysms on the subarcuate artery arising from the anterior inferior cerebellar artery in a patient with a Borden type I transverse-sigmoid dural arteriovenous fistula manifesting as subarachnoid hemorrhage: A case report

2018 ◽  
Vol 25 (1) ◽  
pp. 90-96 ◽  
Author(s):  
Tomoaki Suzuki ◽  
Kouichirou Okamoto ◽  
Nobuyuki Genkai ◽  
Yasushi Ito ◽  
Hiroshi Abe
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Anterior Inferior Cerebellar Artery ◽  
Type I ◽  
Feeding Artery ◽  
Multiple Aneurysms ◽  
Arteriovenous Shunts ◽  
Cerebellar Artery ◽  
Subarcuate Artery

Background Peripheral anterior inferior cerebellar artery (AICA) aneurysms are rare and commonly associated with vascular malformations, such as cerebellar arteriovenous malformations (AVMs). We present a case wherein multiple AICA feeding aneurysms on the subarcuate artery as a feeding artery of a Borden type I transverse-sigmoid dural arteriovenous fistula (dAVF) manifested as subarachnoid hemorrhage. Case description A 67-year-old woman presented with acute severe headache. Brain computed tomography (CT) demonstrated subarachnoid hemorrhage mainly in the posterior fossa. A transverse-sigmoid dAVF was detected on magnetic resonance angiography (MRA) and three-dimensional-CT angiography (3D-CTA), with no cortical venous reflex. The patient underwent conventional angiography, which showed multiple aneurysms on a small branch of the AICA, feeding a transverse-sigmoid dAVF (Borden type I). The AICA aneurysms seemed flow dependent and ruptured owing to high-flow arteriovenous shunts through the dAVF. Based on the source images of the MRA, the small artery arising from the AICA was considered the subarcuate artery, and it was confirmed on 3D-CTA after the artery was successfully embolized with Onyx without any complications. Multiple aneurysms on the subarcuate artery are extremely rare, and the artery has not been identified as a feeding artery of the transverse-sigmoid dAVF. Conclusion A rare case of multiple ruptured aneurysms on the subarcuate artery was reported in a patient with a Borden type I dAVF at the transverse-sigmoid sinuses manifesting as subarachnoid hemorrhage. Onyx embolization of the parent artery occlusion was feasible and useful in treating this type of feeding artery aneurysm of the AICA with a dAVF.

A sacral dural arteriovenous fistula presenting with an intermittent myelopathy aggravated by menstruation

1991 ◽  
Vol 75 (6) ◽  
pp. 947-949 ◽  
Author(s):  
Dong-Ik Kim ◽  
In-Sup Choi ◽  
Alex Berenstein
Keyword(s):  
Arteriovenous Fistula ◽  
Clinical Manifestation ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Spinal Dural Arteriovenous Fistula ◽  
Content Type ◽  
Repeat Angiography ◽  
Fine Print

✓ The case is reported of a woman with a spinal dural arteriovenous fistula whose intermittent myelopathy became aggravated with menstruation. Her symptoms recurred in spite of successful acrylic embolization of the lateral sacral arteriovenous fistula. Repeat angiography showed venous drainage from the uterus toward the medullary vein. Total abdominal hysterectomy cured her symptoms. The pathophysiological basis for this peculiar clinical manifestation and its management are discussed.

Cervical Spine Dural Arteriovenous Fistula With Coexisting Spinal Radiculopial Artery Aneurysm Presenting as Subarachnoid Hemorrhage

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 259-263 ◽  
Author(s):  
Joshua W. Lucas ◽  
Jesse Jones ◽  
Azadeh Farin ◽  
Paul Kim ◽  
Steven L. Giannotta
Keyword(s):  
Native American ◽  
Cervical Spine ◽  
Subarachnoid Hemorrhage ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Sudden Onset ◽  
Spinal Dural Arteriovenous Fistula ◽  
The Right

Abstract BACKGROUND AND IMPORTANCE We present a patient with a cervical spine dural arteriovenous fistula associated with a radiculopial artery aneurysm at the same vertebral level presenting with subarachnoid hemorrhage. CLINICAL PRESENTATION A 45-year-old Native American man presented with sudden-onset severe headache, lethargy, and right hemiparesis. Computed tomography (CT) of the head showed subarachnoid hemorrhage and hydrocephalus. A subsequent CT of the neck showed an anterior spinal subdural hematoma from C2 to C4 causing mild cord compression. Carotid and vertebral angiography failed to demonstrate an intracranial aneurysm, but showed a spinal dural arteriovenous fistula originating from the right vertebral artery at the C5 neuroforamen. The severity of the patient's symptoms, atypical for rupture of a dural arteriovenous fistula, prompted more thorough angiographic evaluation. Thus, injection of the right thyrocervical trunk was performed, demonstrating a 4-mm spinal radiculopial artery aneurysm. Following ventriculostomy, a hemilaminectomy from C4 to C7 was performed with disconnection of the fistula from its drainage system. Subsequent resection of the aneurysm, which was determined to be the cause of the hemorrhage, was accomplished. The patient improved neurologically and was discharged to rehabilitation. CONCLUSION Spinal cord aneurysms from a separate vascular distribution may coexist with spinal dural arteriovenous fistulas. In the setting of spinal hemorrhage, especially in situations with an atypical clinical presentation, comprehensive imaging is indicated to rule out such lesions.

Angiographically occult spinal dural arteriovenous fistula located using selective computed tomography angiography

2007 ◽  
Vol 7 (2) ◽  
pp. 215-220 ◽  
Author(s):  
Taku Sugawara ◽  
Yoshitaka Hirano ◽  
Yasunobu Itoh ◽  
Hiroyuki Kinouchi ◽  
Satoshi Takahashi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Spinal Cord ◽  
Mr Imaging ◽  
Arteriovenous Fistula ◽  
Ct Angiography ◽  
Dural Arteriovenous Fistula ◽  
Low Flow ◽  
Spinal Dural Arteriovenous Fistula ◽  
Coronary Veins ◽  
Spinal Arteriovenous Malformation

✓Spinal dural arteriovenous fistula (DAVF) is the most common type of spinal arteriovenous malformation and may cause progressive myelopathy but is usually treatable in the early stages by direct surgery or intravascular embolization. Selective spinal angiography has been the gold standard for diagnosis, but angiographically occult DAVF is not uncommon. A 67-year-old man presented with a 2-year history of progressive paraparesis. Magnetic resonance (MR) imaging demonstrated segmental atrophy of the spinal cord and dilated coronary veins on the dorsal surface of the spinal cord. A DAVF was suspected, but repeated selective angiography failed to demonstrate the fistula. Findings from spoiled gradient echo MR imaging suggested that the draining vein flowed into the dilated venous plexus at the T-9 level. Selective computed tomography (CT) angiography of the right T-9 intercostal artery confirmed the location of the fistula. The authors successfully occluded the draining vein through surgery, and they observed that the fistula was low flow. The patient exhibited improvement in his symptoms, and postoperative MR imaging confirmed closure of the fistula. Selective CT angiography is useful in locating the draining vein of angiographically occult DAVF and therefore minimizing the extent of the surgical procedure.

Positional vomiting due to a thoracic spinal dural arteriovenous fistula

2004 ◽  
Vol 1 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Dennis J. Cordato ◽  
Mark A. Davies ◽  
Lynette T. Masters ◽  
Phillip D. Cremer ◽  
Raymond S. Schwartz ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Hypertension ◽  
High Signal ◽  
Spinal Dural Arteriovenous Fistula ◽  
Content Type ◽  
Signal Abnormality ◽  
Thoracic Spinal ◽  
The Brain

✓ The authors report the unique case of a patient with a thoracic spinal dural arteriovenous fistula (DAVF) causing remote brainstem symptoms of positional vomiting and minimal vertigo. Magnetic resonance (MR) imaging of the brain demonstrated high signal abnormality in the medulla, presumably related to venous hypertension, and spinal MR imaging revealed markedly dilated veins along the dorsal aspect of the cord. Spinal angiography confirmed the presence of a thoracic spinal DAVF. Disconnection of the DAVF from the spine resulted in a marked improvement in symptoms and resolution of the preoperative MR imaging—documented abnormalities. The authors highlight the rare syndrome of positional vomiting as a brainstem symptom and conclude that spinal DAVFs should be considered in the differential diagnosis of high signal MR imaging abnormalities localized to the brainstem.

Outcome after the Treatment of Spinal Dural Arteriovenous Fistulae: A Contemporary Single-institution Series and Meta-analysis

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 77-88 ◽  
Author(s):  
Michael P. Steinmetz ◽  
Michael M. Chow ◽  
Ajit A. Krishnaney ◽  
Doreen Andrews-Hinders ◽  
Edward C. Benzel ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Retrospective Review ◽  
Initial Treatment ◽  
Dural Arteriovenous Fistula ◽  
Meta Analysis ◽  
Type I ◽  
Single Institution ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulae

Abstract OBJECTIVE: Spinal dural arteriovenous fistulae (Type I spinal AVMs) are the most common type of spinal vascular malformations. The optimal treatment strategy has yet to be defined, and endovascular embolization is being offered with increasing frequency. A 7-year single-institution retrospective review of outcome with surgical management of Type I spinal AVMs is presented along with a meta-analysis of existing literature. METHODS: For the institutional analysis, a retrospective review of all patients who underwent treatment at our institution for Type I spinal AVMs was performed. Between 1995 and the present (the time frame during which endovascular treatments were available), 19 consecutive patients were treated. Follow-up was performed by clinical examination or telephone interview, and functional status was measured by use of the Aminoff-Logue score. For the meta-analysis, a MEDLINE search between 1966 and the present was performed for surgical, endovascular, or combined treatment of spinal dural arteriovenous fistula. These series were included in a meta-analysis to evaluate success and failure rates, complications, and functional outcome. Specifically, embolization and microsurgery were compared. RESULTS: For the institutional analysis, 18 of 19 patients were available for long-term follow-up after surgery. There were no surgical failures, but one complication was seen. Patients demonstrated a statistically significant improvement in gait and bladder function after surgery. For the meta-analysis, 98% of those patients treated with microsurgery had their dural arteriovenous fistulae successfully obliterated after the initial treatment, compared with only 46% with embolization, as judged by radiographic or clinical follow-up. 89% percent of patients demonstrated improvement or stabilization in neurological symptoms after surgical treatment. Few complications were demonstrated with either surgery or embolization. CONCLUSION: At this point, surgery seems to be superior to embolization for the management of spinal dural arteriovenous fistula. The fistula is usually obliterated after the initial treatment, with few clinical or radiographic recurrences. The majority of patients either improve or stabilize after treatment. Few worsen, and the morbidity is minimal. It is reasonable to attempt initial embolization, especially at the time of the initial diagnostic spinal angiogram. The treating physicians and patients should be aware of the high chance of recurrence, and patients may ultimately require surgery or repeat embolization. After endovascular therapy, patients are committed to repeat angiography and probably embolization. For these reasons, it is the authors' opinion that surgery should be used as the first-line therapy for spinal dural arteriovenous fistulae.

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