Endovascular Treatment of Spinal Arteriovenous Lesions: Beyond the Dural Fistula

Abstract

SUMMARY:During the past few decades, there have been significant advances in the understanding of spinal vascular lesions, mainly because of the evolution of imaging technology and selective spinal angiography techniques. In this article, we discuss the classification, pathophysiology, and clinical manifestations of spinal vascular lesions other than DAVFs and provide a review of the endovascular approach to treat these lesions. ABBREVIATIONS:ASA ϭ anterior spinal artery; AVF ϭ arteriovenous fistula; AVM ϭ arteriovenous malformation; DAVF ϭ dural arteriovenous fistula; MMA ϭ middle meningeal artery; n-BCA ϭ n-butyl 2-cyanoacrylate; PSA ϭ posterior spinal artery; PVA ϭ polyvinyl alcohol; SAH ϭ subarachnoid hemorrhage; SVM ϭ spinal vascular malformation S pinal arteriovenous lesions are rare entities, with severe consequences if untreated. During the past few decades, there have been significant advances in the understanding of these lesions, mainly because of selective spinal angiography. Increased knowledge of the angioarchitecture and pathophysiology of SVMs has lead to the development of endovascular embolization for these lesions, first described by Dr Djindjian in France and Drs DiChiro and Doppman in the United States. Further evolution in imaging technology and interventional and surgical techniques allows us to manage these lesions more efficiently, in the context of a multidisciplinary approach. In this article, we present the classification and pathophysiology of spinal arteriovenous lesions and the approach to endovascular treatment. This article does not discuss the pathophysiology and management of spinal DAVFs, which was discussed in a prior review article in this journal.

Filum terminale arteriovenous fistulas: the role of endovascular treatment

“…1,17 Our patients had symptoms similar to those reported in previous studies. 1,12,26 Interestingly, one patient (Case 2) had no neurological deficit despite obvious increased T2 signal within the lower thoracic cord on MRI.…”

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

“…[4][5][6][7] In patients with craniocervical dural AVF, subarachnoid hemorrhage has been reported to occur because of a direct venous drainage pattern in an intracranially or intramedullary fashion. [8][9][10][11][12] However, hemorrhagic presentation of cervical spinal epidural AVF without intramedullary venous drainage is very rare. The present report describes a case of a patient with cervical spine epidural AVFs associated with anterior spinal artery aneurysm at the same vertebral level who presented with subarachnoid hemorrhage.…”

High cervical arteriovenous fistulas fed by dural and spinal arteries and draining into a single medullary vein

“…19,30,34,38 However, surgery continues to play a key role, and a multidisciplinary approach is essential. 30 In the treatment of spinal dural AVFs, or Type I AVMs, tentative embolization is adopted by many centers if the anterior spinal artery does not arise from the same pedicle as the shunt feeder. 18,19,34 If a liquid embolic agent does not reach the venous site, early surgical intervention is strongly advocated.…”

“…15 Embolization plays an important role in the management of Type II and Type III AVMs, either as a primary treatment or as an adjunct to surgery. 1,19,28,30,38 The indications for endovascular treatment of Type IV AVMs vary according to the subtype. 1,9,10,19,23,25,28,30,38 Because Type IV-A fistulas are small, they are usually inaccessible for embolization.…”