Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Spinal epidural arteriovenous fistulas (SEDAVFs) constitute a rare but treatable cause of vascular myelopathy and are a different subtype from the more common Type I spinal dural AVFs. The purpose of this study was to review a consecutive series of SEDAVFs from a single institution and report on the clinical presentations, functional status, and treatment outcomes.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors identified all SEDAVFs treated at their institution from 2005 to 2015. SEDAVFs were defined as spinal AVFs in which the fistulous connection occurred in the epidural venous plexus. The clinical presentation, functional status, immediate treatment outcomes, and long-term neurological outcomes were analyzed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Twenty-four patients with SEDAVFs were included in this study. The patients' mean age at presentation was 66.9 years. The most common presenting symptoms were pain and numbness (22 patients, 91.7%), followed by lower-extremity weakness (21 patients, 87.5%). The mean duration of symptoms prior to diagnosis was 11.8 months. Eighteen patients (75.0%) were treated with endovascular therapy alone, 4 (16.7) with surgery, and 2 (8.3%) with a combination of techniques. There was 1 major treatment-related complication (4.2%). Fifteen patients (62.5%) had improvement in disability, and 12 patients (54.5%) had improvement in sensory symptoms.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>SEDAVFs often present with lower-extremity motor dysfunction and sensory symptoms. With the availability of newer liquid embolic agents, these lesions can be effectively treated with endovascular techniques. Surgery is also effective at treating these lesions, especially in situations where endovascular embolization fails or is not safe and in patients presenting with mass effect from compressive varices.</jats:p></jats:sec>

Angiographic and Clinical Characteristics of Thoracolumbar Spinal Epidural and Dural Arteriovenous Fistulas

“…On the contrary, primary surgical treatment is less frequently undergone for the SEAVFs. 15 Interruption of the intradural draining vein can cause remnant of epidural AVF, and recruitment of the retrograde intradural drainage may occur via radiculomedullary vein at another spinal level. 16 Surgical approach to the arterized venous pouch has a risk of massive bleeding, and it is difficult because the venous pouch is usually located at ventral epidural space.…”

“…Therefore, endovascular technique is preferred to use for the treatment of SEAVFs in resent reports. 9 , 10 , 15 Nasr et al 15 recently reported a case series of SEAVF at a single center. In their series, 18 of 24 patients (75%) were treated by endovascular technique, 4 (16.7%) by open surgery, and 2 (8.3%) by combination of both.…”

Dilated Vein of the Filum Terminale on MRI: A Marker for Deep Lumbar and Sacral Dural and Epidural Arteriovenous Fistulas

“…These lesions can result in considerable morbidity from congestive myelopathy secondary to chronic venous hypertension. [1][2][3][4][5][6] Delay in the identification of spinal vascular malformations has been shown to result in high rates of irreversible morbidity due to the natural history of the disease, unnecessary surgeries including spinal cord biopsies and laminectomies, costly-yet-ineffective medical interventions including intravenous immunoglobulin therapy, and substantial costs from unnecessary serologic and imaging investigations. 7 Once the imaging findings suggestive of a spinal vascular malformation are properly identified, further investigations are required to characterize the angioarchitecture and location of the dominant arterial feeders to the lesion.…”

Comparison between Spinal Dural Arteriovenous Fistula and Spinal Epidural Arteriovenous Fistula

“…According to previous studies, TAE was more frequently selected for SEAVF patients compared with direct surgery, and favorable results were obtained by sufficiently injecting liquid embolic materials, such as NBCA or Onyx, into the intradural vein via the venous pouch. 1,[4][5][6] In particular, Kiyosue et al reviewed TAE of SEAVFs and reported that the occlusion rate of TAE was low when drainage involved epidural outflow, whereas it was 90% in patients with intradural reflux alone. 4) These studies indicated that a shunt was present on the ventral side of the spinal canal in many patients with SEAVFs, making direct surgery to the shunt difficult and that shunts remained after blockage of a vein with intradural reflux alone, inducing recurrent intradural drainage.…”