Spinal epidural arteriovenous fistulas

Brinjikji, Waleed; Yin, Rong; Nasr, Deena M.; Lanzino, Giuseppe

doi:10.1136/neurintsurg-2015-012181

Cited by 49 publications

(39 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2 A SEAVF with perimedullary venous reflux has been thought to present with nonspecific myelopathic symptoms comparable with those of a typical SDAVF. 3,4 However, their precise angiographic and clinical presentations have not yet been investigated in a large number of patients and might still be unfamiliar to most neurologic and radiologic physicians.…”

mentioning

confidence: 99%

Spinal Epidural Arteriovenous Fistula with Perimedullary Venous Reflux: Clinical and Neuroradiologic Features of an Underestimated Vascular Disorder

Mull¹,

Othman²,

Dafotakis

et al. 2018

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: The purpose of this study was to discuss the clinical and radiologic characteristics of spinal epidural arteriovenous fistulas (SEAVF) and demonstrate their specific angiomorphology in a single-center series. MATERIALS AND METHODS: Thirteen consecutive patients were diagnosed with SEAVF at RWTH Aachen University Hospital between 2006 and 2018 and were included in this study. All patients had MR imaging and DSA before treatment; 10 of these 13 patients received contrast-enhanced MRA (CE-MRA). RESULTS: The mean patient age was 72 Ϯ 8 years. Paraparesis was present in 12 (92%) patients. Sphincter dysfunction and sensory symptoms were observed in 7 (54%) and 6 (46%) patients, respectively. The mean duration of symptoms was 6 Ϯ 8 months. Congestive myelopathy on MR imaging was present in all patients. Prominent arterialized perimedullary veins were demonstrated in only 3 cases. CE-MRA revealed arterialized perimedullary veins and an arterialized epidural pouch in 9/10 (90%) patients, mostly located ventrolaterally. DSA demonstrated a multisegmental extension of the arterialized ventrolateral epidural pouch in 6 (46%) cases. An intradural radicular drainage vein was localized distant from the original fistula point in 3 (23%) patients. CONCLUSIONS: Congestive myelopathy with an acute/subacute clinical course was the dominant finding in spinal epidural arteriovenous fistulas. CE-MRA is a powerful diagnostic tool for identifying arterialized perimedullary veins as well as an arterialized epidural pouch. While arterialized perimedullary veins frequently present with only mild enlargement and elongation in spinal epidural arteriovenous fistulas, the arterialized epidural pouch is frequently located ventrolaterally and may extend over several vertebral levels. DSA remains the criterion standard to precisely visualize a spinal epidural arteriovenous fistula and its intradural radicular drainage vein, which may be located distant from the fistulous point. ABBREVIATIONS: AV ϭ arteriovenous; CE-MRA ϭ contrast-enhanced MRA; SDAVF ϭ spinal dural arteriovenous fistula; SEAVF ϭ spinal epidural arteriovenous fistula

show abstract

mentioning

confidence: 99%

Spinal Epidural Arteriovenous Fistula with Perimedullary Venous Reflux: Clinical and Neuroradiologic Features of an Underestimated Vascular Disorder

Mull¹,

Othman²,

Dafotakis

et al. 2018

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…These lesions can result in considerable morbidity from congestive myelopathy secondary to chronic venous hypertension. [1][2][3][4][5][6] Delay in the identification of spinal vascular malformations has been shown to result in high rates of irreversible morbidity due to the natural history of the disease, unnecessary surgeries including spinal cord biopsies and laminectomies, costly-yet-ineffective medical interventions including intravenous immunoglobulin therapy, and substantial costs from unnecessary serologic and imaging investigations. 7 Once the imaging findings suggestive of a spinal vascular malformation are properly identified, further investigations are required to characterize the angioarchitecture and location of the dominant arterial feeders to the lesion.…”

mentioning

confidence: 99%

Dilated Vein of the Filum Terminale on MRI: A Marker for Deep Lumbar and Sacral Dural and Epidural Arteriovenous Fistulas

Brinjikji¹,

Hilditch²,

Morris³

et al. 2018

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: Conventional MR imaging can provide important clues regarding the location of a spinal vascular malformation. We hypothesized that a dilated vein of the filum terminale, identified as a curvilinear flow void on T2WI, could be an imaging marker for a lower lumbar (L3-L5) or sacral fistula. MATERIALS AND METHODS: We retrospectively identified all spinal dural and spinal epidural arteriovenous fistulas from 2 large tertiary referral centers from 2005 to 2018. All patients had a lumbar spinal MR imaging and a conventional spinal angiography. Images were reviewed by 2 neuroradiologists who categorized the level of the arterial feeder to the fistula and the presence or absence of a dilated vein of the filum terminale on T2WI and T1 postcontrast images. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula. RESULTS: One hundred sixty-two patients were included. An enlarged filum terminale vein was identified in 39 patients. Sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula were 86%, 98.3%, 94.9%, and 95.1%, respectively. CONCLUSIONS: The presence of a dilated vein of the filum terminale can accurately localize a spinal dural arteriovenous fistula/spinal epidural arteriovenous fistula to the lower lumbar or sacral spine in patients being evaluated for such lesions. This finding can be used to facilitate both noninvasive and conventional spinal angiography. ABBREVIATIONS: SDAVF ϭ spinal dural arteriovenous fistula; SEDAVF ϭ spinal epidural arteriovenous fistula; VFT ϭ vein of the filum terminale

show abstract

“…vague symptoms, such as leg dysesthesias and exertional leg weakness, that slowly progresses to severe myelopathy with paraplegia and sphincter dysfunction. 3 However, differentiation between SEDAVFs and the more common and well-established Type I SDAVFs is very important, as therapeutic choices may differ; some authors contend that SDAVFs are better treated surgically while SEDAVFs are better treated with endovascular techniques. 20 Since SEDAVFs are rare, few studies have sought to systematically investigate the clinical presentation, imaging characteristics, and treatment outcomes.…”

mentioning

confidence: 99%

Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas

Nasr¹,

Brinjikji

Clarke

et al. 2017

Journal of Neurosurgery: Spine

Self Cite

View full text Add to dashboard Cite

OBJECTIVESpinal epidural arteriovenous fistulas (SEDAVFs) constitute a rare but treatable cause of vascular myelopathy and are a different subtype from the more common Type I spinal dural AVFs. The purpose of this study was to review a consecutive series of SEDAVFs from a single institution and report on the clinical presentations, functional status, and treatment outcomes.METHODSThe authors identified all SEDAVFs treated at their institution from 2005 to 2015. SEDAVFs were defined as spinal AVFs in which the fistulous connection occurred in the epidural venous plexus. The clinical presentation, functional status, immediate treatment outcomes, and long-term neurological outcomes were analyzed.RESULTSTwenty-four patients with SEDAVFs were included in this study. The patients' mean age at presentation was 66.9 years. The most common presenting symptoms were pain and numbness (22 patients, 91.7%), followed by lower-extremity weakness (21 patients, 87.5%). The mean duration of symptoms prior to diagnosis was 11.8 months. Eighteen patients (75.0%) were treated with endovascular therapy alone, 4 (16.7) with surgery, and 2 (8.3%) with a combination of techniques. There was 1 major treatment-related complication (4.2%). Fifteen patients (62.5%) had improvement in disability, and 12 patients (54.5%) had improvement in sensory symptoms.CONCLUSIONSSEDAVFs often present with lower-extremity motor dysfunction and sensory symptoms. With the availability of newer liquid embolic agents, these lesions can be effectively treated with endovascular techniques. Surgery is also effective at treating these lesions, especially in situations where endovascular embolization fails or is not safe and in patients presenting with mass effect from compressive varices.

show abstract

Spinal epidural arteriovenous fistulas

Cited by 49 publications

References 37 publications

Spinal Epidural Arteriovenous Fistula with Perimedullary Venous Reflux: Clinical and Neuroradiologic Features of an Underestimated Vascular Disorder

Spinal Epidural Arteriovenous Fistula with Perimedullary Venous Reflux: Clinical and Neuroradiologic Features of an Underestimated Vascular Disorder

Dilated Vein of the Filum Terminale on MRI: A Marker for Deep Lumbar and Sacral Dural and Epidural Arteriovenous Fistulas

Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas

Contact Info

Product

Resources

About