Direct spinal arteriovenous fistula: a new type of spinal AVM

Heros, Roberto C.; Debrun, Gérard; Ojemann, Robert G.; Lasjaunias, P.; Naessens, Pierre J.

doi:10.3171/jns.1986.64.1.0134

Cited by 199 publications

(82 citation statements)

References 23 publications

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“…Type IV-C lesions have giant dilated venous conduits. 5,22,27 Whereas both Type IV-A and Type IV-C spinal DAVFs can lead to the development of spinal cord ischemia, this phenomenon can occur via varying mechanisms in each case. In smaller spinal DAVFs, such as Type IV-A lesions, congestion of the radial veins draining the spinal cord results from disproportionate arterial inflow and venous outflow.…”

Section: Classification and Pathophysiologymentioning

confidence: 99%

“…6 In contrast to dorsal spinal DAVFs, intradural ventral AVFs typically form high-flow fistulas between the ASA and proximally located, enlarged venous networks; in previous classification schemes, these lesions were referred to as Type IV AVFs. 5,27 Ventral intradural AVFs can be further categorized according to their size. Type IV-A lesions are typically the smallest with only a single feeder vessel.…”

Section: Classification and Pathophysiologymentioning

confidence: 99%

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Endovascular management of spinal dural arteriovenous fistulas

Sivakumar

Zada²,

Yashar³

et al. 2009

FOC

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Object Spinal dural arteriovenous fistulas (DAVFs) are the most common spinal vascular malformations and can be a significant cause of myelopathy, yet remain inefficiently diagnosed lesions. Over the last several decades, the treatment of spinal DAVFs has improved tremendously due to improvements in neuroimaging, microsurgical, and endovascular techniques. The aim of this paper was to review the existing literature regarding the clinical characteristics, classification, and endovascular management of spinal DAVFs. Methods A search of the PubMed database from the National Library of Medicine and reference lists of all relevant articles was conducted to identify all studies pertaining to spinal DAVFs, spinal dural fistulas, and spinal vascular malformations, with particular attention to endovascular management and outcomes. Results The ability to definitively treat spinal DAVFs using endovascular embolization has significantly improved over the last several decades. Overall rates of definitive embolization of spinal DAVFs have ranged between 25 and 100%, depending in part on the embolic agent used and the use of variable stiffness microcatheters. The majority of recent studies in which N-butyl cyanoacrylate or other liquid embolic agents were used have reported success rates of 70–90%. Surgical treatment remains the definitive option in cases of failed embolization, repeated recanalization, or lesions not amenable to embolization. Clinical outcomes have been comparable to surgical treatment when the fistula and draining vein remain persistently occluded. Improvements in gait and motor function are more likely following successful treatment, whereas micturition symptoms are less likely to improve. Conclusions Endovascular embolization is an increasingly effective therapy in the treatment of spinal DAVFs, and can be used as a definitive intervention in the majority of patients that undergo modern endovascular intervention. A multidisciplinary approach to the treatment of these lesions is required, as surgery is required for refractory cases or those not amenable to embolization. Newer embolic agents, such as Onyx, hold significant promise for future therapy, yet long-term follow-up studies are required.

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Section: Classification and Pathophysiologymentioning

confidence: 99%

Section: Classification and Pathophysiologymentioning

confidence: 99%

Endovascular management of spinal dural arteriovenous fistulas

Sivakumar

Zada²,

Yashar³

et al. 2009

FOC

View full text Add to dashboard Cite

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“…When the fistulas are ventral and directly fed by the anterior spinal artery, they are subpial in location, whereas those fed by the posterior spinal arteries, they are subarachnoid. However, because of the free communications between the anterior and posterolateral arterial supply to the spinal cord via transmedullary or circumferential anastomosis, the sole contribution of the radiculo-pial arteries without anterior spinal artery involvement is unusual (12)(13)(14)(15). The venous drainage of spinal cord PMAVFs includes the perimedullary veins over the anterior and posterior surfaces of the spinal cord, often extending over multiple levels, with pial venous reflux and congestion being the most frequently encountered features (16).…”

Section: Angioarchitecture and Classification Of Spinal Cord Pmavfsmentioning

confidence: 99%

Study and therapeutic progress on spinal cord perimedullary arteriovenous fistulas

Guo

Shi

et al. 2017

Biomedical Reports

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Abstract. Spinal cord perimedullary arteriovenous fistulas (PMAVFs) are rare and belong to type IV spinal cord arteriovenous malformations (AVMs). Little is known regarding the treatment and prognosis of spinal cord PMAVFs. In the present study the relevant literature from PubMed was reviewed, and it was found that these fistulas can occur at all ages but are more common in children. In children, most spinal cord PMAVFs are large and with high flow, begin with bleeding and are frequently associated with hereditary hemorrhagic telangiectasia. However, in adults, most spinal cord PMAVFs are small and with low flow and begin with progressive spinal cord dysfunction. The early diagnosis of spinal cord PMAVFs is generally difficult, and symptoms can be very severe at the time of diagnosis. Digital subtraction angiography remains the gold standard; however, computed tomography angiography and magnetic resonance angiography are also promising. Spinal cord PMAVFs can be treated by endovascular embolization, surgical removal or a combination of the two methods. Most spinal cord PMAVFs show good outcomes after the appropriate treatment, and the prognosis is primarily associated with the blood flow of the PMAVF. For high-flow spinal cord PMAVFs, endovascular embolization is more effective and can lead to a good outcome; however, for low-flow spinal cord PMAVFs, surgical removal or the combination with endovascular embolization is the optimal choice. The prognosis for low-flow types is slightly worse than for high-flow spinal cord PMAVFs in children, but the outcome is acceptable.

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“…Several classifications have been proposed, 7,26,29,42,51 dividing the AVMs into subgroups based on morphological data. Based on angiographic interpretations that can be subjective and the relationship of the shunt with anatomical compartments of the vertebral column and spinal cord, these classifications lump together dural fistulas and true spinal cord AVMs, and sometimes even spinal tumors.…”

Section: Spinal Cord Avmsmentioning

confidence: 99%

Spinal cord vascular shunts: spinal cord vascular malformations and dural arteriovenous fistulas

Costa

Dehdashti²,

terBrugge

2009

FOC

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Object Spinal cord vascular malformations are rare, fascinating lesions. In this paper, the authors' goal was to demonstrate how these lesions, more specifically spinal cord arteriovenous malformations and dural arteriovenous fistulas, are assessed, classified, and managed at their institution. They also highlight some aspects of classification and management that may be different from the views of others. Methods The authors reviewed the 20-year experience at the senior author's institution regarding the management of spinal cord vascular malformations. They discuss the management, surgical and endovascular treatment results, and the classification that resulted from the combined experience of 3 major reference centers. Results The accumulated knowledge on embryological and pathophysiological aspects in such a rare disease resulted in a more global, patient-oriented (and not radiologically oriented) approach to spinal cord shunts. Conclusions The multiple classifications proposed for spinal cord vascular malformations reflect the continuous advancement of the authors' understanding. They adopt a classification based on new physiological and genetic data that treats these lesions as expressions of more complex disease processes and not simply a morphological target, with direct impact on therapeutic options.

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Direct spinal arteriovenous fistula: a new type of spinal AVM

Cited by 199 publications

References 23 publications

Endovascular management of spinal dural arteriovenous fistulas

Endovascular management of spinal dural arteriovenous fistulas

Study and therapeutic progress on spinal cord perimedullary arteriovenous fistulas

Spinal cord vascular shunts: spinal cord vascular malformations and dural arteriovenous fistulas

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