Intradural perimedullary arteriovenous fistulas (Type IV spinal cord arteriovenous malformations)

Barrow, Daniel L.; Colohan, Austin R. T.; Dawson, Robert C.

doi:10.3171/jns.1994.81.2.0221

Cited by 154 publications

(73 citation statements)

References 17 publications

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“…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. His symptoms (back and radicular pain) and abnormal MRI findings resolved after complete closure of the fistula.…”

Section: 19supporting

confidence: 80%

Filum terminale arteriovenous fistulas: the role of endovascular treatment

Chanthanaphak

Pongpech

Jiarakongmun

et al. 2013

SPI

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Object The authors describe the clinical presentation, imaging features, and management of patients presenting with filum terminale arteriovenous fistulas (FTAVFs) and the role of transarterial treatment in their management. Methods The authors retrospectively reviewed data obtained in 10 patients with FTAVFs diagnosed between January 1990 and December 2011. Results Most patients (70%) were male, and the age of the population ranged from 31 to 72 years (mean 58.2 years). Clinical presentation was progressive paraparesis and sensory loss in the lower extremities in 9 cases, back pain in 7, radicular pain in 3, bowel/bladder disturbance in 5, and impotence in 1. The duration of symptoms varied between 2 and 24 months. Initial MRI studies showed intramedullary increased T2 signal, swollen cord, and dilated perimedullary veins in all patients. One patient had syringomyelia, presumably caused by venous hypertension transmitted by the perimedullary venous system. Embolization was attempted in 7 patients and was curative in 6 patients. Surgery was performed in the other 4 patients in whom embolization was unsuccessful or deemed not feasible. There was no treatment-related complication in either group. Symptoms, venous congestion in the cord, and syringomyelia improved on follow-up in all patients. Conclusions Embolization should be considered the treatment of choice for FTAVFs and can effectively treat the majority of patients presenting with an FTAVF. In a smaller group of patients in whom the angioarchitecture is unfavorable, open surgery is recommended.

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Section: 19supporting

confidence: 80%

Filum terminale arteriovenous fistulas: the role of endovascular treatment

Chanthanaphak

Pongpech

Jiarakongmun

et al. 2013

SPI

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“…Perimedullary AVFs were treated initially with clipping, 5) but recently with embolization 1,2,5,7,8,[19][20][21] and combined embolization and surgery. 1,7,8,14,15,[18][19][20][21]23) The presence of small pial artery networks around the spinal cord 11) hinder complete isolation of the AVF by clipping of the large feeding arteries.…”

Section: Discussionmentioning

confidence: 99%

“…Spinal arteriovenous malformations (AVMs) have recently been classified into four types 1,2,5,10,15,17) : long dorsal or dural spinal AVM; compact or glomus lesion, usually intramedullary with multiple feeding vessels; large juvenile malformation; and direct arteriovenous fistula (AVF) on the surface of the spinal cord, without an intervening network of abnormal vessels (nidus). The last type of AVM is also known as intradural perimedullary AVF, and has been further classified into three subtypes 7,13) : Type I is a small and single AVF fed by the terminal portion of a thin anterior spinal artery and drained by the slowly ascending perimedullary venous system; type II is a medium AVF fed by several arterial pedicles and drained by the slowly ascending perimedullary venous system; and type III is a single, giant AVF with giant venous ectasia and rapid metameric venous drainage.…”

Section: Introductionmentioning

confidence: 99%

Cervical Perimedullary Arteriovenous Fistula in an Infant Presenting With Subarachnoid Hemorrhage -Case Report-

Sasamori

Hida

Yano

et al. 2008

Neurol. Med. Chir.(Tokyo)

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A 9-month-old boy was transferred to our institute after suffering sudden seizure and loss of consciousness followed by cardiopulmonary arrest. Neurological examination on admission revealed deep coma and tetraparesis. Brain computed tomography revealed diffuse intracranial subarachnoid hemorrhage (SAH), whereas brain magnetic resonance (MR) angiography showed no intracranial abnormalities. MR imaging of the spine demonstrated a remarkable flow void extending from C3 to T1. Digital subtraction angiography revealed a perimedullary arteriovenous fistula (AVF) fed by the left thyrocervical trunk, associated with a varix and a dilated perimedullary vein. He had hypoxic encephalopathy due to transient cardiopulmonary arrest, and remained in the intensive care unit for 2 months. Thereafter, he was transferred to the pediatric ward, where his general condition improved, and after 7 months underwent embolization of the AVF to prevent further SAH. The perimedullary AVF was successfully interrupted by transarterial embolization with n-butyl-2-cyanoacrylate and platinum coils, and no additional neurological deficits developed. Post-embolization MR imaging showed loss of the flow void. The favorable outcome demonstrates the importance of spinal cord imaging in infants with SAH without other intracranial abnormalities to detect the presence of perimedullary AVF. Perimedullary AVFs in children are often associated with huge fistulas and varices, so are good candidates for endovascular surgery.

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“…Therefore, surgery is usually preferred. 4,6,8,23 Conversely, the endovascular approach is recommended in Type IVc lesions because the large and tortuous patho- * Clinical outcomes were evaluated using the modified McCormick scale at each period and were compared with pretreatment grades. † One patient with a perimedullary AVF was lost to follow-up after treatment.…”

Section: Perimedullary Avfsmentioning

confidence: 99%

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

Cho

Kim

Kwon

et al. 2013

SPI

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Object 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. Methods 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. Results 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%). Conclusions 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.

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Intradural perimedullary arteriovenous fistulas (Type IV spinal cord arteriovenous malformations)

Cited by 154 publications

References 17 publications

Filum terminale arteriovenous fistulas: the role of endovascular treatment

Filum terminale arteriovenous fistulas: the role of endovascular treatment

Cervical Perimedullary Arteriovenous Fistula in an Infant Presenting With Subarachnoid Hemorrhage -Case Report-

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

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