Management of spinal epidural arteriovenous fistulas: interventional techniques and results

Abstract

The diagnosis and treatment of SEDAVF can be challenging due to their rarity and intricate pathomechanics. Patients with severe pain or progression of symptoms or myelopathic symptoms need to be treated at the earliest opportunity, while asymptomatic patients can be closely monitored. Percutaneous embolization is an effective strategy to embolize SEDAVF associated venous pouch.

Spinal intraosseous epidural arteriovenous fistula with perimedullary drainage obliterated with Onyx embolization: case report

“…We attempted embolization via an arterial approach in our patient using the Onyx LES, which incorporates a new nonadhesive liquid embolic agent that can decrease the risk of gluing the catheter to anatomical structures and allows a more durable injection of greater volumes of agent delivered in a single session. This agent is mainly used for the treatment of cerebral dural fistulas, and some studies have used this agent for spinal dural AVFs, but only 3 reports 12,13,15 have described the application of this agent for spinal epidural AVFs. A study by Silva et al 15 documented 2 cases of epidural AVF treated using Onyx embolization, but treatment failed because of incomplete occlusion of the draining vein and the risk of agent migration into the spinal artery via anastomosis.…”

Spinal epidural arteriovenous fistulas

“…The therapeutic goal in treating epidural AVFs is to obliterate the fistulous communication between the feeding artery and the draining vein as well as the proximal venous drainage by means of surgery or endovascular embolization 2 32. Currently, endovascular treatment is the favored method of treatment, with about two-thirds of studies and case reports reporting the use of endovascular treatment 3.…”

“…The primary embolic agents used to treat SEDAVFs are Onyx and n-Butyl cyanoacrylate (n-BCA) glue 2 11 33–35. Each material has advantages and disadvantages, and there are no data to support the superiority of one embolic agent over the other 4.…”

“…In our practice, Onyx is the primary embolic agent used for treatment of spinal fistulas. During transarterial embolization, Onyx is able to permeate to the venous side of the AVF and can also fill other arterial feeding vessels in a retrograde fashion, thus facilitating complete closure of the AVF 2 11 33–35. In addition, Onyx can be delivered more slowly than n-BCA, allowing for a more controlled injection.…”

“…These lesions can present with compressive symptoms or congestive myelopathy,1 2 and can be difficult to distinguish from the more common and better described spinal dural arteriovenous fistulas (SDAVF). In this review, we describe the anatomy, physiology, clinical presentation, imaging, and treatment options for SEDAVFs.…”