Clinical features and treatment outcomes of the spinal arteriovenous fistulas and malformations

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Spinal vascular diseases, such as spinal dural arteriovenous fistulas (DAVFs), perimedullary arteriovenous fistulas (AVFs), and spinal arteriovenous malformations (AVMs), are very rare. The authors analyzed the features and treatment outcomes of these conditions.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Data from 64 patients were retrospectively reviewed. There were 33 spinal DAVFs (1 patient had 2 lesions), 20 perimedullary AVFs, and 12 spinal AVMs. Clinical features, radiological findings, treatment results, and clinical outcomes were evaluated according to the diseases, subtypes, and treatment modalities. The median duration of follow-up was 20, 42, and 56 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Spinal DAVFs showed faster progression of symptoms (median 5, 12, and 36 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively) and worse neurological status at diagnosis (poor neurological status in 56%, 65%, and 33%, respectively). On MRI, signal voids were demonstrated in all except 1 spinal DAVF. At the last follow-up, 94% of spinal DAVFs, 68% of perimedullary AVFs, and 50% of spinal AVMs were completely obliterated. Favorable clinical outcomes were achieved in 91%, 95%, and 58%, respectively. In detail, the majority (78%) of spinal DAVFs were embolized, resulting in complete obliteration in 92% and favorable clinical outcomes in 92%. Most Type IVa and IVb perimedullary AVFs were surgically treated (71% and 88%), with complete obliterations of 86% and 71%, and favorable clinical outcomes in 100% and 86%, respectively. All Type IVc lesions were embolized with a low cure rate of 40%; however, clinical outcomes were satisfactory. Spinal AVMs were generally embolized (67%), and only glomus-type lesions attained a satisfactory cure rate (80%) and clinical outcome (100%).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Embolization produced satisfactory outcomes in spinal DAVFs and glomus-type spinal AVMs. Surgery is advantageous in Type IVa and IVb perimedullary AVFs. Palliative embolization can be effective in Type IVc perimedullary AVFs and juvenile spinal AVMs.</jats:p></jats:sec>

Intramedullary hemorrhage from a thoracolumbar dural arteriovenous fistula

“…In cases with no hemorrhage, the outcome of spinal dural AVFs after timely intervention is generally considered to be very good, with 90% of patients demonstrating stabilization or improvement of symptoms [13,73,110]. There is currently limited data on the outcome of cases with hemorrhage caused by thoracolumbar dural AVFs, which probably reflects the rarity of this presentation.…”

Spinal epidural venous angioma presenting symtomps of lumbar disc herniation: a case report

“…Extradural spinal angiomas are most commonly observed in the dorsal and lumbar regions with solitary forms located particularly in the lower lumbar and lumbosacral regions (9). Even with angiography and MRI, the clinical diagnosis of extradural and intradural angiomas remains difficult (1, 3,4,5,10,13,14). Extradural angiomas are most often confused with disc hernias and spinal tumors (3).…”

Pediatric Dilemma: Endovascular versus Surgical Intervention for Spinal Vascular Malformations

“…In this regard, the pediatric population seems to have more easily treated vessels with endo- vascular therapy, but have a more complex structure of the lesion and more often than not are ineligible for endovascular treatment [47,48]. And finally, endovascular therapy in children should be considered in all details, because of the radiation doses and the utilization of contrast agents [7].…”