The Long and Winding Road: Thoracic Myelopathy Associated With Occipitocervical Dural Arteriovenous Fistula

Sao-Mai, Angelique; Kapurch, Joseph; Kumar, Ravi; Port, John D.; Miller, Jeffrey W.; Gompel, Jamie J. Van

doi:10.1016/j.wneu.2017.09.073

Cited by 14 publications

(9 citation statements)

References 32 publications

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“…13 Table 1 summarizes the reported literature on the epidemiologic and clinical characteristics and presenting symptoms of DI-AVFs by the involved spine region. 4,6,7,10,12,[15][16][17][18]20,21,25,26,[28][29][30][31][32][33][34] Figure 2 demonstrates the prevalence of DI-AVFs over spinal regions 35 ; data are for 59 cases, obtained as part of a retrospective analysis of 146 surgically managed intramedullary spinal cord cavernous malformations treated at our institution. 4,6,7,10,12,[15][16][17][18]20,21,26,[28][29][30][31][32][33][34]…”

Section: Thoracic and Lumbosacral Di-avfsmentioning

confidence: 99%

“…In some lumbosacral DI-AVF cases, endovascular access to the tiny feeders might not be feasible, and microsurgical resection would be the sole curative treatment. Female sex, % 26-34 10,18 Predominantly male 15 6.3 6 44.4 0 20 Cases at T7-T9 31 Multiple cases 25 ICH % 10 15 NR 0 0…”

Section: Thoracic and Upper Lumbar Di-avfsmentioning

confidence: 99%

“…Other, % Tinnitus, 9 18 Intramedullary hemorrhage, 7.2 10 Brainstem dysfunction, 6 18 Stroke, 5 18 CN palsy, 3 18 Seizures, 1 18 NA 2 cases with chest pain 32 NA Asymptomatic/subacute, % 8-50 10,18,20 50 20 7 cases 17 20 26 7 cases 17 6 cases 17 Abbreviations: CCJ = craniocervical junction; CN = cranial nerve; DI-AVF = dorsal intradural arteriovenous fistula; ICH = intracranial hemorrhage, NA = not available; NR = not reported; SAH = subarachnoid hemorrhage. a Values are percentage unless otherwise indicated.…”

Section: Thoracic and Upper Lumbar Di-avfsmentioning

confidence: 99%

“…Common index symptoms include motor weakness, sensory deficits, bowel and bladder dysfunction, neuropathic pain, and reflex abnormalities; rare presentations include respiratory failure or spinal subarachnoid hemorrhage (SAH). 18 Spinal cord infarction is also an underlying cause of presenting symptoms of DI-AVFs. Zalewski et al 19 identified DI-AVFs as the most common cause of spinal cord infarction, accounting for 30% of 280 patients.…”

Section: Natural History and Pathophysiologymentioning

confidence: 99%

“…4,6,7,10,12,15-18,20,21,25,26,28-34 Figure 2 demonstrates the prevalence of DI-AVFs over spinal regions 35 ; data are for 59 cases, obtained as part of a retrospective analysis of 146 surgically managed intramedullary spinal cord cavernous malformations treated at our institution. 4,6,7,10,12,15-18,20,21,26,28-34…”

Section: Natural History and Pathophysiologymentioning

confidence: 99%

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Spinal Dorsal Intradural Arteriovenous Fistulas

et al. 2023

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In this review, we describe the pathophysiology, diagnosis, and treatment of spinal dorsal intradural arteriovenous fistulae (DI-AVFs), focusing on novel research areas. DI-AVFs compose the most common subgroup of spinal arteriovenous lesions and most commonly involve the thoracic spine, followed by lumbar and sacral segments. The pathogenesis underlying DI-AVFs is an area of emerging understanding, thought to be attributable to venous congestion and hypertension that precipitate ascending myelopathy. Patients with DI-AVFs typically present with motor, sensory, or urinary dysfunction, although a wide swath of other less common symptoms has been reported. DI-AVFs can be subdivided by spinal region, which in turn is associated with 4 distinct clinical phenotypes: craniocervical junction (CCJ), subaxial cervical, thoracic, and lumbosacral. Patients with CCJ and lumbosacral DI-AVFs have particularly interesting presentations and treatment considerations. High-value diagnostic findings on magnetic resonance imaging include flow voids, missing-piece sign, and T2-weighted intramedullary hyperintensity. However, digital subtraction angiography is the gold standard for diagnosis and localization of DI-AVFs, as well as for definitive treatment planning. Surgical disconnection of DI-AVFs is almost universally curative and frontline treatment especially for CCJ and lumbosacral DI-AVFs. Endovascular techniques evolve in promising ways, such as improved visualization, distal access, and liquid embolic techniques. The pathophysiology of DI-AVFs is better understood using newly identified radiological diagnostic markers. Despite new techniques and devices introduced in the endovascular field, surgery remains the gold-standard treatment for DI-AVFs.

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