Cervical Spinal Epidural Arteriovenous Fistula with Coexisting Spinal Anterior Spinal Artery Aneurysm Presenting as Subarachnoid Hemorrhage—Case Report

Nakagawa, Ichiro; Park, HunSoo; Hironaka, Yasuo; Wada, Takeshi; Kichikawa, Kimihiko; Nakase, Hiroyuki

doi:10.1016/j.jstrokecerebrovasdis.2014.07.012

Cited by 25 publications

(21 citation statements)

References 15 publications

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“…SEDAVF with intradural perimedullary venous drainage causes congestive myelopathy by prolonged chronic high pressure, and if left unrecognized, it can also trigger spinal cord infarction or hemorrhage, 5 ) 9 ) 17 ) and even subarachnoid hemorrhage at high cervical location. 13 ) 18 ) High-flow SEDAVF with direct shunting of VA uniquely causes cerebellar symptoms by vertebrobasilar insufficiency as well as pulsatile bruit or tinnitus, 7 ) 16 ) 19 ) 20 ) 28 ) but our patient did not show such a distinctive symptom. Therefore, although SEDAVF is rare, this pathology should be considered in the differential diagnosis of spinal radiculopathy or myelopathy and other mentioned symptoms.…”

Section: Discussioncontrasting

confidence: 55%

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Cervical spinal extradural arteriovenous fistula successfully treated using transarterial balloon-assisted coil embolization

Park

Kwon

Lee

2020

J Cerebrovasc Endovasc Neurosurg

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We present the case of a patient who developed compressive radiculopathy that was found to be associated with a spinal extradural arteriovenous fistula. The fistula was successfully obliterated with transarteiral balloon-assisted coiling, after which the patient was symptom-free. Although spinal extradural arteriovenous fistula is rare, this pathology should be considered in the differential diagnosis of spinal radiculopathy or myelopathy. Endovascular treatment appears to have been successful in resolving the symptoms associated with this pathology.

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Section: Discussioncontrasting

confidence: 55%

“…In addition, some reported cases involving venous hypertension in the spinal cord have led to irreversible results within a short period, with patients suffering permanent disability. 5 ) 9 ) 13 ) 17 ) 18 ) Thus, early detection and evaluation are the first key to achieving favorable outcome.…”

Section: Discussionmentioning

confidence: 99%

Cervical spinal extradural arteriovenous fistula successfully treated using transarterial balloon-assisted coil embolization

Park

Kwon

Lee

2020

J Cerebrovasc Endovasc Neurosurg

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“…The therapeutic goal in treating epidural AVFs is to obliterate the fistulous communication between the feeding artery and the draining vein as well as the proximal venous drainage by means of surgery or endovascular embolization 2 32. Currently, endovascular treatment is the favored method of treatment, with about two-thirds of studies and case reports reporting the use of endovascular treatment 3.…”

Section: Treatmentmentioning

confidence: 99%

Spinal epidural arteriovenous fistulas

Brinjikji

Yin

Nasr

et al. 2016

J NeuroIntervent Surg

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Spinal epidural arteriovenous fistulas (SEDAVFs) are rare complex lesions often presenting with protean clinical manifestations secondary to compressive symptoms or congestive myelopathy. The imaging manifestations of SEDAVFs on MR angiography/MRI include high T2 signal in the spinal cord, vascular engorgement of the epidural space, and prominent intradural vascular flow voids. Given the complexity of these lesions, they are best characterized anatomically on catheter angiography where careful inspection of arterial feeders and venous drainage patterns can be performed. The imaging hallmark of an SEDAVF on angiography is the presence of a dilated epidural venous pouch through which spinal and paraspinal veins are secondarily opacified. In the lower thoracic and lumbar spine, SEDAVFs are usually located in the ventral epidural space and fed mainly by the anteriorly coursing epidural arteries. In the cervical and upper thoracic spine, SEDAVFs and their feeding arteries are more typically located laterally in the spinal canal. Current treatment options include transarterial or transvenous endovascular embolization with liquid embolic agents or coils, and surgical resection/disconnection of the fistula. Further research is needed to better characterize how and why these lesions form and to identify the best treatment modalities.

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“…There exists a case report of epidural AVF at CCJ with a ruptured pial feeder aneurysm, treated by TAE with partial obliteration of the shunt without embolizing the aneurysm. 6 However, our case demonstrates partial obliteration of the shunt leaves a risk of recurrence of the aneurysm.…”

Section: Discussionmentioning

confidence: 57%

“…2,3 However, there are increasing reports of CCJ AVFs with pial feeder aneurysms. 4–6 Furthermore, a recent study by Hiramatsu et al. 1 showed pial feeder aneurysms are more likely to be associated with hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm

et al. 2019

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Arteriovenous fistulas at the craniocervical junction are rare vascular malformations with frequent hemorrhagic presentations, which may have a concurrent pial feeder aneurysm. A 65-year-old man presented with subarachnoid hemorrhage and angiography showed an epidural arteriovenous fistula at the C-2 level with an anterior spinal feeder aneurysm without perimedullary venous drainage. Transarterial coil embolization of the ruptured aneurysm and partial Onyx embolization of the shunt led to thrombosis of the aneurysm. However, three years later angiography showed an increased shunt flow and recurrence of the aneurysm. Transvenous embolization of the shunt using coils and Onyx yielded complete obliteration of the shunt, thus leading to occlusion of the aneurysm. This case demonstrates that partial transarterial embolization of arteriovenous fistula leaves a risk of rebleeding, whereas complete obliteration of the shunt with a transvenous approach can lead to disappearance of the flow-related aneurysm without embolization of the aneurysm itself.

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Cervical Spinal Epidural Arteriovenous Fistula with Coexisting Spinal Anterior Spinal Artery Aneurysm Presenting as Subarachnoid Hemorrhage—Case Report

Cited by 25 publications

References 15 publications

Cervical spinal extradural arteriovenous fistula successfully treated using transarterial balloon-assisted coil embolization

Cervical spinal extradural arteriovenous fistula successfully treated using transarterial balloon-assisted coil embolization

Spinal epidural arteriovenous fistulas

Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm

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