Spinal epidural arteriovenous fistula with perimedullary drainage

Abstract

<jats:p>✓ The classic angiographically demonstrated features of spinal dural arteriovenous fistulas are shunts of radiculomeningeal branches with radicular veins draining exclusively in the direction of perimedullary veins and thereby causing venous congestion. These shunts are located at the point where the radicular vein passes the dura mater. Spinal epidural arteriovenous shunts, however, normally do not drain into the perimedullary veins and are, therefore, asymptomatic, presumably because of a postulated reflux-impeding mechanism between the dural sleeves. The authors report on a patient in whom an epidural arteriovenous shunt showed delayed retrograde drainage into perimedullary veins, leading to the classic clinical (and magnetic resonance imaging–based) findings of venous congestion. Intraoperatively the angiographically established diagnosis was confirmed. Coagulation of both the epidural shunt zone and the radicular vein resulted in complete obliteration of the fistula, as confirmed on repeated angiography.</jats:p> <jats:p>This rare type of fistula should stimulate considerations on the role of valvelike mechanisms normally impeding retrograde flow from the epidural plexus to perimedullary veins and suggest that, in certain pathological circumstances, epidural fistulas can drain retrogradely into perimedullary veins as an infrequent variant of spinal arteriovenous shunts.</jats:p>

Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: a systematic literature review

“…[2][3][4][5][6][7][8][9][10]12,13,[15][16][17][19][20][21][22][23]25,27,[29][30][31][32] These cases were divided into 2 groups: those with and those without intradural venous drainage, 22 and 23 cases respectively (Tables 1 and 2). …”

Spinal Epidural Arteriovenous Fistula with Double Perimedullary Reflux

“…Cognard et al 6 , were able to show retrograde filling of intradural veins in a patient with a high-flow lesion. Whereas venous congestion was absent and paraspinal shunts were present in these two patients, the other two patients described in the literature had a spinal epidural AVF that showed secondary reflux into perimedullary veins and clinical signs of spinal venous hypertension 2,7 . In the third case, the lateral sacral artery shunted into the epidural plexus and a retrograde filling of …”

“…These have been recently classified as "lateral epidural" shunts given their location along the lateral nerve root sleeves 1 . According to this classification, the ventral epidural AV shunts that drain into the ventrally located epidural venous plexus are usually asymptomatic, which has been previously attributed to the presence of an anti-reflux mechanism within the dural sleeves that prevents retrograde flow of the arterialized blood into radicular or perimedullary veins 2 .…”

Paraspinal Arteriovenous Fistula Presenting With Subarachnoid Hemorrhage and Acute Progressive Myelopathy -Case Report-

“…A few cases of paraspinal AVFs have been reported, 1,2,6,8,[10][11][12] but cases with acute onset and symptoms developing within hours to days are very rare. Spinal AVFs usually present with slowly progressive myelopathy.…”

“…A case of paraspinal AVF with progressive myelopathy was treated with surgery, both the epidural fistula zone and radicular vein were coagulated, and complete obliteration of the fistula was confirmed on angiography. 10) Only one report has described a combined endovascular and surgical approach for such fistulas, using arterial glue injection followed by direct surgery to treat a sacral paraspinal AVF fed by the sacral lateral artery that drained into the epidural venous plexus. 11) Surgery may be considered as a therapeutic option for spinal AVFs with complex angioarchitecture.…”