Congestive myelopathy due to craniocervical junction arteriovenous fistulas mimicking transverse myelitis: a multicenter study on 27 cases

Takai, Keisuke; Endo, Toshiki; Seki, Takahiro; Inoue, Tomoo

doi:10.1007/s00415-022-11536-7

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…Besides rarely "true" intramedullary AVMs (▶ Fig. 8a-e), well-treatable DAVFs also cause volume and pressure overload of the venous drainage system resulting in so-called congestive myelopathy [99,101]. MRI shows T2 hyperintense signal changes, possible spinal cord swelling, and inhomogeneous patchy enhancement on pc T1WI [99,101].…”

Section: Vascular Spinal Cord Diseasesmentioning

confidence: 99%

“…8a-e), well-treatable DAVFs also cause volume and pressure overload of the venous drainage system resulting in so-called congestive myelopathy [99,101]. MRI shows T2 hyperintense signal changes, possible spinal cord swelling, and inhomogeneous patchy enhancement on pc T1WI [99,101]. However, intracranial DAVFs with drainage into the perimedullary veins of the cervical spine, i. e., classified as Cognard type V, should be considered (▶ Fig.…”

Section: Vascular Spinal Cord Diseasesmentioning

confidence: 99%

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Cervical myelitis: a practical approach to its differential diagnosis on MR imaging

Weidauer

Hattingen

Arendt

2023

Rofo

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Background Differential diagnosis of non-compressive cervical myelopathy encompasses a broad spectrum of inflammatory, infectious, vascular, neoplastic, neurodegenerative, and metabolic etiologies. Although the speed of symptom onset and clinical course seem to be specific for certain neurological diseases, lesion pattern on MR imaging is a key player to confirm diagnostic considerations. Methods The differentiation between acute complete transverse myelitis and acute partial transverse myelitis makes it possible to distinguish between certain entities, with the latter often being the onset of multiple sclerosis. Typical medullary MRI lesion patterns include a) longitudinal extensive transverse myelitis, b) short-range ovoid and peripheral lesions, c) polio-like appearance with involvement of the anterior horns, and d) granulomatous nodular enhancement prototypes. Results and Conclusion Cerebrospinal fluid analysis, blood culture tests, and autoimmune antibody testing are crucial for the correct interpretation of imaging findings. The combination of neuroradiological features and neurological and laboratory findings including cerebrospinal fluid analysis improves diagnostic accuracy. Key Points:

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Section: Vascular Spinal Cord Diseasesmentioning

confidence: 99%

Section: Vascular Spinal Cord Diseasesmentioning

confidence: 99%

Cervical myelitis: a practical approach to its differential diagnosis on MR imaging

Weidauer

Hattingen

Arendt

2023

Rofo

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“…High cervical CCJ AVFs can be located on the inner or outer surface of the dura mater, on the spinal nerves, or on the spinal cord surface and can be divided into the following four types: DAVFs, radicular AVFs (RAVFs), epidural AVFs (EAVFs), and perimedullary AVFs (PAVFs) (Figures 4, 5), in which DAVFs and RAVFs tend to occur at the C1 level and EAVFs and PAVFs tend to occur at the C2 level (10,33,53,54). High cervical CCJ AVFs may be single or multiple AVFs, and less than 10% of AVFs are multiple AVFs (4,7,55).…”

Section: Classification and Angioarchitecturementioning

confidence: 99%

“…High cervical CCJ AVFs also had upward intradural drainage. Even the draining veins can reflux upward into the intracranial venous system due to rich anastomosis ( 3 , 4 , 10 , 36 , 44 , 55 , 58 , 61 , 64 ). Due to the overload of the draining vein, drainage may involve multiple veins or multiple pathways ( Figure 7 ) ( 33 ).…”

Section: Angioarchitecture Of High Cervical Ccj Avfsmentioning

confidence: 99%

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Treatment of high cervical arteriovenous fistulas in the craniocervical junction region

2023

Front. Neurol.

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The craniocervical junction (CCJ) is a complex region. Rarely, arteriovenous fistulas (AVFs) can occur in the CCJ region. Currently, it is accepted that CCJ AVFs should only refer to AVFs at the C1-C2 levels. It is reasonable to assume that high cervical CCJ AVFs are being referred to when discussing CCJ AVFs. High cervical CCJ AVFs can be divided into the following four types: dural AVF, radicular AVF, epidural AVF and perimedullary AVF. Until now, it was difficult to understand high cervical CCJ AVFs and provide a proper treatment for them. Therefore, an updated review of high cervical CCJ AVFs is necessary. In this review, the following issues are discussed: the definition of high cervical CCJ AVFs, vessel anatomy of the CCJ region, angioarchitecture of high cervical CCJ AVFs, treatment options, prognoses and complications. Based on the review and our experience, we found that the four types of high cervical CCJ AVFs share similar clinical and imaging characteristics. Patients may present with intracranial hemorrhage or congestive myelopathy. Treatment, including open surgery and endovascular treatment (EVT), can be used for symptomatic AVFs. Most high cervical CCJ AVFs can be effectively treated with open surgery. EVT remains challenging due to a high rate of incomplete obliteration and complications, and it can only be performed in superselective AVFs with simple angioarchitecture. Appropriate treatment can lead to a good prognosis.

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Classification, angioarchitecture and treatment outcomes of medullary bridging vein-draining dural arteriovenous fistulas in the foramen magnum region: a multicenter study

Ozaki,

Hiramatsu,

Nakamura

et al. 2024

Neuroradiology

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Purpose This study aimed to classify medullary bridging vein-draining dural arteriovenous fistulas (MBV-DAVFs) located around the foramen magnum (FM) according to their location and characterize their angioarchitecture and treatment outcomes. Methods Patients with MBV-DAVFs diagnosed between January 2013 and October 2022 were included. MBV-DAVFs were classified into four groups. Jugular vein-bridging vein (JV-BV) DAVF: located in proximity to jugular fossa, Anterior condylar vein (ACV)-BV DAVF: proximity to anterior condylar canal, Marginal sinus (MS)-BV DAVF: lateral surface of FM and Suboccipital cavernous sinus (SCS)-BV DAVF: proximity to dural penetration of vertebral artery. Results Twenty patients were included, three JV-BV, four ACV-BV, three MS-BV and ten SCS-BV DAVFs, respectively. All groups showed male predominance. There were significant differences in main feeders between JV (jugular branch of ascending pharyngeal artery) and SCS group (C1 dural branch). Pial feeders from anterior spinal artery (ASA) or lateral spinal artery (LSA) were visualized in four SCS and one MS group. Drainage pattern did not differ between groups. Transarterial embolization (TAE) was performed in three, two, one and two cases and complete obliteration was obtained in 100%, 50%, 100% and 0% in JV, ACS, MS and SCS group, respectively. Successful interventions without major complications were finally obtained in 100%, 75%, 100%, and 40% in JV, ACS, MS and SCS group, respectively. Conclusion JV-BV DAVFs were successfully treated using TAE alone. SCS-BV DAVFs were mainly fed by small C1 dural branches of vertebral artery often with pial feeders from ASA or LSA, and difficultly treated by TAE alone.

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Congestive myelopathy due to craniocervical junction arteriovenous fistulas mimicking transverse myelitis: a multicenter study on 27 cases

Cited by 9 publications

References 23 publications

Cervical myelitis: a practical approach to its differential diagnosis on MR imaging

Cervical myelitis: a practical approach to its differential diagnosis on MR imaging

Treatment of high cervical arteriovenous fistulas in the craniocervical junction region

Classification, angioarchitecture and treatment outcomes of medullary bridging vein-draining dural arteriovenous fistulas in the foramen magnum region: a multicenter study

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