Spinal epidural arteriovenous fistula with perimedullary drainage

2006 ◽  
Vol 5 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Timo Krings ◽  
Michael Mull ◽  
Azize Bostroem ◽  
Juergen Otto ◽  
Franz J. Hans ◽  
...  
Keyword(s):  
Venous Congestion ◽  
Resonance Imaging ◽  
Rare Type ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Shunts ◽  
Dural Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Spinal Epidural

✓ The classic angiographically demonstrated features of spinal dural arteriovenous fistulas are shunts of radiculomeningeal branches with radicular veins draining exclusively in the direction of perimedullary veins and thereby causing venous congestion. These shunts are located at the point where the radicular vein passes the dura mater. Spinal epidural arteriovenous shunts, however, normally do not drain into the perimedullary veins and are, therefore, asymptomatic, presumably because of a postulated reflux-impeding mechanism between the dural sleeves. The authors report on a patient in whom an epidural arteriovenous shunt showed delayed retrograde drainage into perimedullary veins, leading to the classic clinical (and magnetic resonance imaging–based) findings of venous congestion. Intraoperatively the angiographically established diagnosis was confirmed. Coagulation of both the epidural shunt zone and the radicular vein resulted in complete obliteration of the fistula, as confirmed on repeated angiography. This rare type of fistula should stimulate considerations on the role of valvelike mechanisms normally impeding retrograde flow from the epidural plexus to perimedullary veins and suggest that, in certain pathological circumstances, epidural fistulas can drain retrogradely into perimedullary veins as an infrequent variant of spinal arteriovenous shunts.

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.

scholarly journals Overview of the current role of endovascular and surgical treatment in spinal dural arteriovenous fistulas

2009 ◽  
Vol 26 (1) ◽  
pp. E8 ◽  
Author(s):  
Amir R. Dehdashti ◽  
Leodante B. Da Costa ◽  
Karel G. terBrugge ◽  
Robert A. Willinsky ◽  
Michael Tymianski ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Vascular Lesions ◽  
Current Role ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Spinal Dural Arteriovenous Fistulas

Dural arteriovenous fistulas are the most common vascular malformations of the spinal cord. These benign vascular lesions are considered straightforward targets of surgical treatment and possibly endovascular embolization, but the outcome in these cases depends mainly on the extent of clinical dysfunction at the time of the diagnosis. A timely diagnosis is an equally important factor, with early treatment regardless of the type more likely to yield significant improvements in neurological functioning. The outcomes after surgical and endovascular treatment are similar if complete obliteration of the fistulous site is obtained. In the present study, the authors evaluated the current role of each modality in the management of these interesting lesions.

Volumetric myelographic magnetic resonance imaging to localize difficult-to-find spinal dural arteriovenous fistulas

2011 ◽  
Vol 14 (3) ◽  
pp. 398-404 ◽  
Author(s):  
Jonathan M. Morris ◽  
Timothy J. Kaufmann ◽  
Norbert G. Campeau ◽  
Harry J. Cloft ◽  
Giuseppe Lanzino
Keyword(s):  
Magnetic Resonance Imaging ◽  
Steady State ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Mr Angiography ◽  
Three Dimensional ◽  
Resonance Imaging ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Although more prevalent in males in the 6th and 7th decade of life, spinal dural arteriovenous fistulas (SDAVFs) are an uncommon cause of progressive myelopathy. Magnetic resonance imaging and more recently Gd bolus MR angiography have been used to diagnose, radiographically define, and preprocedurally localize the contributing lumbar artery. Three-dimensional myelographic MR imaging sequences have recently been developed for anatomical evaluation of the spinal canal. The authors describe 3 recent cases in which volumetric myelographic MR imaging with a 3D phase-cycled fast imaging employing steady state acquisition (PC-FIESTA) and a 3D constructive interference steady state (CISS) technique were particularly useful not only for documenting an SDAVF, but also for providing localization when CT angiography, MR imaging, MR angiography, and spinal angiography failed to localize the fistula. In a patient harboring an SDAVF at T-4, surgical exploration was performed based on the constellation of findings on the PC-FIESTA images as well as the fact that the spinal segments leading to T-4 were the only ones that the authors were unable to catheterize. In a second patient, who harbored an SDAVF at T-6, after 2 separate angiograms failed to demonstrate the fistula, careful assessment of the CISS images led the authors to focus a third angiogram on the left T-6 intercostal artery and to perform superselective microcatheterization. In a third patient with an SDAVF originating from the lateral sacral branch, the PC-FIESTA sequence demonstrated the arterialized vein extending into the S-1 foramen, leading to a second angiogram and superselective internal iliac injections. The authors concluded that myelographic MR imaging sequences can be useful not only as an aid to diagnosis but also for localization of an SDAVF in complex cases.

scholarly journals Spinal Epidural Arteriovenous Fistula: A Unique Pathway into the Perimedullary Vein

2009 ◽  
Vol 15 (4) ◽  
pp. 466-469 ◽  
Author(s):  
S.M. Lim ◽  
I.S. Choi
Keyword(s):  
Epidural Space ◽  
Clinical Symptoms ◽  
Vascular Malformations ◽  
Venous Pressure ◽  
Venous Plexus ◽  
Previous Surgery ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Spinal Epidural

Spinal dural arteriovenous fistulas (AVFs) are rare vascular malformations in the spinal dura, fed by dural branches of the radicular arteries, and drain primarily into intradural venous plexuses. They may cause elevated medullary venous pressure and produce a progressive myelopathy. We describe a case of AVF in the epidural space of the previous surgery site of L3 and it showed a unique complex venous pathway into the perimedullary vein, leading to classic clinical symptoms of venous congestion in the spinal cord. The shunt was draining into bilateral epidural venous plexus and then to the paravertebral veins at the level of L2. The venous outflow entered to the epidural space again and finally refluxed into the intradural perimedullary vein.

scholarly journals Spinal Dural AVFs: Classifications and Advanced Imaging

2021 ◽  
pp. 129-135
Author(s):  
Michihiro Tanaka
Keyword(s):  
Spinal Cord ◽  
Imaging Modality ◽  
Thoracolumbar Spine ◽  
Venous Congestion ◽  
Advanced Imaging ◽  
Imaging Technology ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

AbstractSpinal dural arteriovenous fistulas (SDAVFs) are the most common vascular shunts of the spine. They occur predominantly in men (more than 80%), commonly involve the thoracolumbar spine, and usually cause progressive myelopathy because of venous congestion of the spinal cord. Recent advanced imaging technology can visualize the detailed angioarchitecture of the spinal cord, and this provides more information of the regional microanatomy related with the shunt disease. We retrospectively analyzed the location of the shunt with adjacent vasculatures and assessed the efficacy and the sensitivity of each imaging modality. Based on these data, a new concept of classification for SDAVFs was reviewed.

Sign in / Sign up

Export Citation Format

Share Document