Spinal Dural Arteriovenous Fistulas: An Underestimated Cause of Myelopathy

Bradac, Gianni Boris; Doro, Daniele; Riva, Anibal La; Bracchi, M.; Stura, G.; Riccio, Alexander R.; Pagni, C. A.

doi:10.1159/000117015

Cited by 23 publications

(10 citation statements)

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“…These findings have been corroborated in a series of intracranial dural AVFs [109]. In our patient, the rate of arteriovenous transit was faster than that of other patients presenting without hemorrhage (1 vs. 2-3 [29] 20 0 0 Blackburn et al [30] 17 0 0 Bl ehaut et al [31] 10 0 0 Bowen et al [32] 8 0 0 Bradac et al [33] 13 0 0 Burrows et al [34] 1 0 0 Cabrera et al [35] 1 0 0 Cenzato et al [36] 37 0 0 Cenzato et al [37] 1 0 0 Cordato et al [38] 1 0 0 Criscuolo et al [39] 1 0 0 Deen et al [40] 1 0 0 Eskandar et al [41] 18 0 0 Finsterer et al [42] 1 0 0 Foote et al [43] 1 0 0 Gilbertson et al [44] 55 0 0 Hage et al [45] 5 0 0 Hall et al [46] 3 0 0 Hanakita et al [47] 2 0 0 Hassler et al [48] 18 0 0 Hasuo et al [49] 2 0 0 Houdart et al [50] 1 0 0 Huffmann et al [51] 18 0 0 Hurst et al [ seconds), and the draining vein was associated with a venous varix (Figs. 2 and 3).…”

Section: Discussionsupporting

confidence: 78%

Intramedullary hemorrhage from a thoracolumbar dural arteriovenous fistula

Hamdan

Padmanabhan

2015

The Spine Journal

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Section: Discussionsupporting

confidence: 78%

Intramedullary hemorrhage from a thoracolumbar dural arteriovenous fistula

Hamdan

Padmanabhan

2015

The Spine Journal

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“…[7] Spinal dural arteriovenous fistula (SDAVF) constitutes 70–80% of all spinal vascular malformations with an annual incidence of 5-10 cases per million. [1] The vascular nidus is located on the dural sheath of a spinal nerve root and is supplied by a dural artery, usually a branch of radicular or intercostal artery[3] [Figure 1]. Intradural arteriovenous malformations (AVMs) and cavernous angiomas are less common types of vascular malformations of spinal cord.…”

Section: Introductionmentioning

confidence: 99%

“…[20] The pathophysiology is thought to be congestion of the spinal cord medullary venous plexus with edema and neuronal ischemia. [3] The clinical features include radicular or axial back pain, gait imbalance, weakness, numbness, and bladder or bowel disturbances. Aminoff and Logue in their seminal observations described the clinical features and postulated a disability score to classify the severity of SDAVF[39] (Aminoff and Logue Scale, ALS) [Table 1].…”

Section: Introductionmentioning

confidence: 99%

Comparison of surgical and endovascular approach in management of spinal dural arteriovenous fistulas: A single center experience of 27 patients

Gokhale¹,

Khan²,

McDonagh³

et al. 2014

Surg Neurol Int

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Background:Spinal dural arteriovenous fistula (SDAVF) is a rare spinal vascular malformation with an annual incidence of 5-10 cases per million. The data on efficacy, recurrence rates and complications of endovascular versus surgical treatment of SDAVF is limited.Methods:We conducted a retrospective chart review of 27 adult patients with a diagnosis of SDAVF and who underwent treatment at Duke University Hospital between January 1, 1993 and December 31, 2012. We compared the outcome measures by Aminoff–Logue score (ALS) in patients who underwent treatment with endovascular embolization versus surgical ligation of fistula. We compared complication rates, recurrence rates as well as data on long-term follow up in these patients.Results:Out of 27 patients in the study, 10 patients underwent endovascular embolization (Onyx was used in 5 patients and NBCA in 5 patients) as the first line therapy. Seventeen patients underwent surgical ligation as initial therapeutic modality. Patients in both groups showed significant improvement in clinical status (ALS) after treatment. One patient in endovascular group developed spinal infarction due to accidental embolization of medullary artery. Three patients in embolization group had recurrence of fistula during the course of follow up requiring surgical ligation. Two patients in surgical group developed local wound infection. None of the patients in surgical group had recurrence of fistula during the course of follow up.Conclusions:Endovascular embolization and surgical ligation are effective treatment strategies for SDAVF. Our observations show that surgical ligation may offer permanent cure without any recurrence. Endovascular approach is associated with higher incidence of recurrence, especially with use of onyx.

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“…The increase in spinal venous pressure diminishes the arteriovenous pressure gradient and leads to a decreased drainage of normal spinal veins and a venous congestion with intramedullary edema [9,10]. This in turn leads to chronic hypoxia and progressive myelopathy [11]. Clinical symptomatology of this congestive myelopathy is rather unspecific and might consist of hypo-and paraesthesias, paraparesis, back pain that might irradiate to the lower legs, impotence, and sphincter disturbances.…”

Section: Dural Av Fistulaementioning

confidence: 99%

Spinal Vascular Malformations

et al. 2006

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Spinal vascular malformations are rare diseases with a wide variety of neurological presentations. In this article spinal cavernomas, arteriovenous malformations (both from the fistulous and glomerular type), and spinal dural arteriovenous fistulae are described and an overview about their imaging features on magnetic resonance imaging (MRI) and digital subtraction angiography is given. Clinical differential diagnoses, the neurological symptomatology and the potential therapeutic approaches of these diseases which vary depending on the underlying pathology are given. Although MRI constitutes the diagnostic modality of first choice in suspected spinal vascular malformation, a definite diagnosis of the disease and therefore the choice of suited therapeutic approach rest on selective spinal angiography. Treatment in symptomatic patients offers an improvement in the prognosis. In most spinal vascular malformations except for spinal cavernomas, the endovascular approach is the method of first choice; in selected cases a combined or surgical therapy might be considered.

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Spinal Dural Arteriovenous Fistulas: An Underestimated Cause of Myelopathy

Cited by 23 publications

References 0 publications

Intramedullary hemorrhage from a thoracolumbar dural arteriovenous fistula

Intramedullary hemorrhage from a thoracolumbar dural arteriovenous fistula

Comparison of surgical and endovascular approach in management of spinal dural arteriovenous fistulas: A single center experience of 27 patients

Spinal Vascular Malformations

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