Successful embolization of an upper cervical spinal dural fistula despite anterior spinal artery anastomosis

Nguyen, Anthony; Maynard, Ken; Coggins, William S.; Raghuram, Karthikram

doi:10.1080/02688697.2019.1694136

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…Fistulas lead to the direct diversion of blood from the arterial system to the venous plexus, reducing vascular resistance and, importantly, not including a capillary network to regulate unidirectional blood ow. 4 The result of this abnormal blood ow is "arterialization" of the venous plexus, followed by impaired venous drainage, usually resulting in venous congestion, venous hypertension, intramedullary edema, and local nerve cell hypoxia. 16 If this particular clinical phenotype is not recognized and left untreated, SDAVF may lead to severe disease.…”

Section: Discussionmentioning

confidence: 99%

“…Spinal cord perimedullary arteriovenous stulas (PMAVFs) are rare and belong to type V. SDAVF tends to occur in the middle and lower thoracic vertebrae, followed by the lumbar vertebrae and upper thoracic vertebrae, and it is very rare to occur above C2 and T1. 4 After embolization or surgical treatment, a good therapeutic effect has been achieved. 1,5 The clinical symptoms are progressive myelopathies, such as spastic paraplegia, sensory disorders, bladder dysfunction, and intestinal dysfunction, and the upper limb is not often involved.…”

Section: Introductionmentioning

confidence: 99%

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PNF technique combined with extracorporeal shock wave in the treatment of hemiplegia caused by upper cervical perimedullary arteriovenous fistula embolization:clinical experience and review of literature

Lin

Lee

et al. 2023

Preprint

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Purpose-Research of rehabilitation for postoperative dysfunction of Spinal dural arteriovenous fistula, especially perimedullary arteriovenous fistula, are still rare. This literature is a young patient with hemiplegia after embolization regained limb motor function by using extracorporeal shock wave to reduce muscle tension and PNF technique to enhance muscle strength and strengthen neural control. Methods-A 3-year and 11 months old girl fell down while riding a scooter and accidentally detected cervical spinal canal vascular malformation by brain MRI. The final diagnosis was perimedullary arteriovenous fistula with subarachnoid hemorrhage, C3-4 level. Total cerebrovascular angiography + spinal angiography + aortic arch angiography +C3-4 level perimedullary arteriovenous fistula interventional embolization was completed. The muscle strength of the right limb decreased after surgery, and the muscle strength of the right limb improved after dilation, vasodilation, and hormone shock therapy. At our initial assessment, we found that the patient could not lift the upper limb to hold a cup and could not stand. After 2 weeks of PNF technique combined with extracorporeal shock wave therapy, Manual Muscle Testing was used to evaluate the progress of muscle strength, modified Ashworh scale was used to evaluate muscle tension, and Barthel index was used to evaluate the dependence degree of daily life. The Time Up and Go Test and the Gaitwatch 3D Gait Analysis and Evaluation System are used to evaluate gait. Results-After 2 weeks of treatment, her motor function has been greatly recovered, she can lift the upper limbs, and walk independently. the score of the modified Ashworth scale(MAS) on Triceps Surae decreased from 2/5 to 1/5. Barthel index increased from 25/100 to 85/100. Deltoid strength increased from 1/5 to 3/5, Triceps strength increased from 1/5 to 4/5, Iliopsoas strength increased from 2/5 to 3/5, Quadriceps strength increased from 2/5 to 4/5, and tibialis anterior strength increased from 0/5 to 2/5. In gait, the hip joint and pelvis have almost the same movement trajectory as the left side in the stance phase and swing phase, but the ankle joint still has foot drop at the beginning and end of gait. Conclusions-PNF technique combined with extracorporeal shock wave could effectively improve the muscle tone, muscle strength, and gait of hemiplegia patients after upper cervical perimedullary arteriovenous fistula embolization. This literature reports a very rare case of hemiplegia after upper cervical perimedullary arteriovenous fistula embolization, which was able to walk independently after 2 weeks of rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

PNF technique combined with extracorporeal shock wave in the treatment of hemiplegia caused by upper cervical perimedullary arteriovenous fistula embolization:clinical experience and review of literature

Lin

Lee

et al. 2023

Preprint

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“…Cervical DAVFs occur in <6% of spinal DAVFs ( 30 – 33 ). In most cervical DAVFs, the ASA acts as a bystander ( 34 – 36 ). Rarely, the ASA can be an accomplice.…”

Section: Cervical Spinal Avfsmentioning

confidence: 99%

“…During EVT, liquid embolic materials can be chosen, and they should penetrate the vein beyond the fistula without disturbing the ASA. Therefore, the microcatheter should be in a wedged position to ensure no contrast reflux into the ASA ( 36 ). In EVTs for other AVFs and AVMs, the microcatheter should be in the wedged position.…”

Section: Cervical Spinal Avfsmentioning

confidence: 99%

Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend?

Zhang

Hou

et al. 2021

Front. Neurol.

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The cervical anterior spinal artery (ASA) is a very important artery arising from the intracranial vertebral artery (VA). It can play different roles in endovascular treatment (EVT) of spinal vascular diseases. The current understanding of these roles is incomplete; therefore, we performed this review. We found that cervical ASA can be involved in many spinal vascular diseases, such as arteriovenous fistula (AVF), arteriovenous malformation (AVM), and aneurysm, and can serve as a collateral channel in proximal VA occlusion. In AVF and AVM, when the cervical ASA is involved, it often plays the role of an accomplice or victim because it acts as the feeder or as a bystander that does not provide blood flow to the AVF and AVM. In cervical ASA aneurysm, the ASA is a victim. During EVT of VA aneurysms or stenoses, the cervical ASA ostia can be covered or occluded, resulting in ASA ischemia. In this situation, the ASA is a victim. In VA occlusion or the subclavian steal phenomenon, the cervical ASA can serve as a collateral channel to provide blood flow to the posterior circulation. In this case, the ASA plays the role of a friend. According to the role of the cervical ASA in spinal vascular diseases, EVT should be determined “case by case.” Most importantly, when EVT is performed to treat these diseases, the cervical ASA axis must be preserved. Therefore, understanding the role of the cervical ASA in spinal vascular diseases is crucial.

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Treatment of Dural Arteriovenous Fistula with Intradural Draining Vein at the Craniocervical Junction: Case Series with Special Reference to the Anatomical Considerations

et al. 2023

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Successful embolization of an upper cervical spinal dural fistula despite anterior spinal artery anastomosis

Cited by 3 publications

References 8 publications

PNF technique combined with extracorporeal shock wave in the treatment of hemiplegia caused by upper cervical perimedullary arteriovenous fistula embolization:clinical experience and review of literature

PNF technique combined with extracorporeal shock wave in the treatment of hemiplegia caused by upper cervical perimedullary arteriovenous fistula embolization:clinical experience and review of literature

Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend?

Treatment of Dural Arteriovenous Fistula with Intradural Draining Vein at the Craniocervical Junction: Case Series with Special Reference to the Anatomical Considerations

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