Clinical and Imaging Characteristics of Spinal Dural Arteriovenous Fistulas and Spinal Epidural Arteriovenous Fistulas

Brinjikji, Waleed; Colombo, Elisa; Cloft, Harry J.; Lanzino, Giuseppe

doi:10.1093/neuros/nyaa492

Cited by 15 publications

(4 citation statements)

References 17 publications

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“…Additionally, Adamkiewicz's artery must be identified to plan a safe treatment approach. As suggested by Brinjikji et al ( 10 ) dural and epidural spinal arteriovenous fistula share clinical and radiological findings including hyperintense T2 cord signal, and perimedullary flow-voids. The peculiarity of epidural fistulas consists of appearance on spinal MRI and DSA with a pouch of epidural contrast.…”

Section: Methodsmentioning

confidence: 81%

Spinal dural and epidural arteriovenous fistula: Recurrence rate after surgical and endovascular treatment

et al. 2023

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IntroductionSpinal dural arteriovenous fistula consist of an heterogenous group of vascular malformation often causing severe neurological deficit due to progressive myelopathy. This type of malformation could be associated with subarachnoid or subdural hemorrhage inside the spinal canal. In the English literature surgical treatment is regarded as the best option if compared to endovascular procedure, being the latter associated with an increased risk of relapse despite its less invasiveness.MethodsIn this study a retrospective analysis of 30 patients with spinal dural and epidural fistula associated with perimedullary venous congestion was undertaken. The radiological and clinical presentation of each patient is analyzed, and the grade of myelopathy is classified through the mJOA score.ResultsA total number of 31 out of 41 collected procedures (22 surgery vs. 19 endovascular) were dural fistulas while the remaining 10 were classified as epidural. A 46% recurrence rate for endovascular treatment against 0% for surgical (p-value 0.004) was described for dural fistulas, while in the epidural fistula group the rate of recurrence was 80% and 20% respectively for endovascular and surgery treatment (p-value 0.6).DiscussionAccording to the results, surgical treatment could be considered as first-line treatment for spinal dural arteriovenous fistulas. Endovascular embolization can be proposed in selected cases, as a less invasive technique, for elderly patients or with important comorbidities. In spinal epidural arteriovenous fistulas, in view of the greater invasiveness of the surgical treatment and the non-significant difference in terms of recurrence risk between the two techniques, endovascular treatment could be proposed as a first choice treatment; in the event of a recurrence, a surgical intervention will instead be proposed in a short time.

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Section: Methodsmentioning

confidence: 81%

Spinal dural and epidural arteriovenous fistula: Recurrence rate after surgical and endovascular treatment

et al. 2023

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“…The onset of these symptoms is progressive, with a gradual deterioration over a period of 6 months to 2 years, although rapid deterioration has also been reported [ 14 ]. The aim of treatment is to interrupt the fistulous arterial and venous points [ 15 , 16 , 17 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Magnetic Resonance Imaging Findings in Predicting Neurological Status Pre- and Post-Treatment of Spinal Dural Arteriovenous Fistulas: A 22-Year Experience in a Neurovascular and Spine Center

Filis,

Engellandt,

Romualdo

et al. 2024

Diagnostics

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Background: Successful treatment of spinal dural arteriovenous fistulas (SDAVF) requires prompt diagnosis with definitive fistula localization and non-delayed treatment. Magnetic resonance imaging (MRI) is used for the screening and follow-up of SDAVF, although the value of MRI signs such as myelopathy and flow voids is controversial. Therefore, we investigated the predictive value of MRI signs pre- and post-treatment and their correlation with the neurological status of SDAVF patients. Methods: We retrospectively analyzed the clinical records of 81 patients who underwent surgical or endovascular treatment for SDAVF at our hospital between 2002 and 2023. A total of 41 SDAVF patients with follow-up MRI of 4.6 [2.9–6.5] months (median [interquartile range]) post-treatment and clinical follow-up of 3, 6, and 12 months were included. Results: The extent of pretreatment myelopathy was seven [6–8] vertebral levels, with follow-up MRI showing no myelopathy in 70.7% of cases. The pretreatment flow voids extended over seven [4.5–10] vertebral levels and completely disappeared on follow-up MRI in 100% of cases. The modified Aminoff–Logue scale of disability (mALS) was four [2–7] pretreatment and two [0–4.5] at the third follow-up, with improvement in 65.9% of patients. The American Spinal Injury Association motor score (ASIA-MS) was 97 [88–100] pretreatment and 100 [95–100] at the third follow-up assessment, with 78% of patients improving. Pretreatment ASIA-MS correlated with the extent of myelopathy at admission (R2: 0.179; 95% CI: −0.185, −0.033; p = 0.006) but not with flow voids at admission, while pretreatment mALS showed no correlation with either MRI signs. The improvement in ASIA-MS and mALS between admission and the last follow-up showed no correlation with the extent of pretreatment myelopathy and flow voids or with pos-treatment MRI changes. The diagnostic sensitivity of magnetic resonance angiography (MRA) for localization of the fistula was 68.3% (28/41). Conclusions: The severity of the clinical condition in SDAVF patients has a multifactorial cause, whereby the ASIA-MS correlates with the extent of myelopathy pretreatment. MRI changes after treatment showed no correlation with the clinical outcome and cannot be used as a prognostic factor.

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“…The development of high-resolution DSA has improved the assessment of the exact location of SDAVF fistulous point ( 11 – 14 ). The aim of treatment is to interrupt the fistulous arterial and venous point ( 2 , 12 , 13 , 15 , 16 ). Even though surgery represents the gold standard of treatment, endovascular treatment has become an essential alternative treatment option ( 17 , 18 ).…”

Section: Introductionmentioning

confidence: 99%

“…Spinal digital subtraction angiography (DSA) is considered to be the gold standard for the diagnosis of SDAVF (6). The development of high-resolution DSA has improved the assessment of the exact location of SDAVF fistulous point (11)(12)(13)(14). The aim of treatment is to interrupt the fistulous arterial and venous point (2,12,13,15,16).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic, clinical management, and outcomes in patients with spinal dural arteriovenous fistula

Filis,

Romualdo,

Engellandt

et al. 2024

Front. Surg.

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BackgroundSpinal dural arteriovenous fistulas (SDAVFs) are rare spinal vascular malformations, but account for 70 to 80% of all spinal arteriovenous malformations. SDAVFs can be treated either surgically or endovascularly, with surgical treatment appearing to lead to higher closure rates. Our aim was to analyze the demographic data, diagnostic history, treatment characteristics and clinical short- and long-term outcomes.MethodsThe medical records of 81 patients who underwent surgical (n = 70, 86.4%) and endovascular (n = 11, 13.6%) treatment for SDAVF at a university hospital between 2002 and 2023 were retrospectively analyzed.ResultsSDAVF was observed more frequently in men than women (61, 75.3% vs. 20, 24.7%) with a mean age of 63.5 ± 12.7 years and a mean duration of symptoms to diagnosis of 12.0 ± 12.8 months. The most common first symptom was gait disturbance (36, 44.4%), followed by sensory disturbance (24, 29.6%). The location of the fistula point was most common in the lower thoracic region (36, 44.5%), followed by the lumbar region (23, 28.4%). Incomplete or failed occlusion of the fistula occurred in 8 patients (9.9%), with 6 patients (7.4%) undergoing further treatment either surgically or endovascularly. Treatment- or hospital-related complications were observed in 16 patients (19.8%). A single-level laminectomy was the most common approach (31, 44.3%), followed by single-level hemilaminectomy (28, 40.0%), and unilateral interlaminar fenestration (11, 15.7%). Back pain or radiculopathy was observed in 58% of patients (47/81) pre-treatment and had already decreased to 24.7% at hospital discharge (p < 0.001). No significant differences were observed in sensory disturbances (p = 0.681). The median of American Spinal Injury Association motor score (ASIA-MS) was 94 [82.5–100] at admission, 98 [86.5–100] at hospital discharge, 100 [90–100] at the first, second, and third follow-up (p = 0.019). The median modified Aminoff-Logue scale (mALS) was 5 [2–7] at admission, 3 [1–6] at hospital discharge, 2 [1–5] at the first follow-up, 2 [0.5–5] at the second follow-up and 2 [1–7] at the third follow-up (p = 0.006).ConclusionsSDAVF occurs predominantly in men in the 6th decade of life and can be safely and effectively treated surgically and endovascularly, improving symptoms such as pain and motor deficits, gait disturbances as well as bowel and bladder dysfunction, but not sensory disturbances.

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Clinical and Imaging Characteristics of Spinal Dural Arteriovenous Fistulas and Spinal Epidural Arteriovenous Fistulas

Cited by 15 publications

References 17 publications

Spinal dural and epidural arteriovenous fistula: Recurrence rate after surgical and endovascular treatment

Spinal dural and epidural arteriovenous fistula: Recurrence rate after surgical and endovascular treatment

The Impact of Magnetic Resonance Imaging Findings in Predicting Neurological Status Pre- and Post-Treatment of Spinal Dural Arteriovenous Fistulas: A 22-Year Experience in a Neurovascular and Spine Center

Diagnostic, clinical management, and outcomes in patients with spinal dural arteriovenous fistula

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