Dural arteriovenous fistulae at the foramen magnum

Reinges, M. H. T.; Thron, A.; Mull, Michael; Huffmann, Beate C.; Gilsbach, Joachim M.

doi:10.1007/s004150170226

Cited by 69 publications

(50 citation statements)

References 33 publications

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“…We excluded DAVFs located in remote regions that drained into posterior fossa veins secondary to thrombosis of their "natural" outlets, in particular cavernous sinus or transversesigmoid lesions with venous occlusions. In the previously published literature, we found 30 cases of petrosal vein DAVFs 4,5,[7][8][9]13,16,21,30,33,[36][37][38]41,45,48,52,55,56,59,60 and 35 cases of medulla bridging vein DAVFs, 1,11,14,[17][18][19][20][22][23][24][25]31,32,35,39,40,43,46,50,51,53,58,61 all of which were well described with clinical and angiographic information. These previously reported cases were analyzed together, with special attention to their clinical characteristics.…”

Section: Methodsmentioning

confidence: 99%

Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas

Mitsuhashi

Aurboonyawat

Pereira

et al. 2009

JNS

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Object Dural arteriovenous fistulas (DAVFs) with leptomeningeal venous reflux generally pose a high risk of aggressive manifestations including hemorrhage. Among DAVFs, there is a peculiar type that demonstrates direct drainage into the bridging vein rather than the dural venous sinus. The purpose of this study was to investigate the characteristics of DAVFs that drain directly into the petrosal vein or the bridging vein of the medulla oblongata. Methods Eleven consecutive cases of DAVFs that drained directly into the petrosal vein and 6 that drained directly into the bridging vein of the medulla were retrospectively reviewed. These cases were evaluated and/or treated at Hospital de Bicêtre in Paris, France, over a 27-year period. A review of previously reported cases was also performed. Results Both of these “extrasinusal”-type DAVFs demonstrated very similar characteristics. There was a significant male predominance (p < 0.001) for this lesion, and a significantly higher incidence of aggressive neurological manifestations including hemorrhage or venous hypertension than in DAVFs of the transverse-sigmoid or cavernous sinus (p < 0.001). This finding was considered to be attributable to leptomeningeal venous reflux. Regarding treatment, endovascular embolization (either transarterial or transvenous) is frequently difficult, and surgery may be an effective therapeutic choice in many instances. Conclusions Embryologically, both the petrosal vein and the bridging vein of the medulla are cranial homologs of the spinal cord emissary bridging veins that drain the pial venous network. The authors believe that DAVFs in these locations may be included in a single category with spinal DAVFs because of their similar clinical characteristics.

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Section: Methodsmentioning

confidence: 99%

Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas

Mitsuhashi

Aurboonyawat

Pereira

et al. 2009

JNS

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“…Sacral lesions occur in approximately 4% of patients, 28 whereas high cervical lesions (at the level of the foramen magnum) occur in 2% of patients. 29 Low cervical DAVFs (below C2 and above T1) are extremely rare. 30,31 In approximately 2% of patients, double spinal DAVFs or an association of a spinal dural with a spinal pial AV shunt may be present, raising the possibility of a potential etiologic connection.…”

Section: Epidemiologymentioning

confidence: 99%

Spinal Dural Arteriovenous Fistulas

Krings¹,

Geibprasert²

2009

AJNR Am J Neuroradiol

368

376

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SUMMARY:Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive para-or tetraplegia. They most commonly affect elderly men and are classically found in the thoracolumbar region. The AV shunt is located inside the dura mater close to the spinal nerve root where the arterial blood from a radiculomeningeal artery enters a radicular vein. The increase in spinal venous pressure leads to decreased drainage of normal spinal veins, venous congestion, and the clinical findings of progressive myelopathy. On MR imaging, the combination of cord edema, perimedullary dilated vessels, and cord enhancement is characteristic. Therapy has to be aimed at occluding the shunting zone, either by superselective embolization with a liquid embolic agent or by a neurosurgical approach. Following occlusion of the fistula, the progression of the disease can be stopped and improvement of symptoms is typically observed. Despite being the most commonly encountered spinal vascular malformation, spinal dural arteriovenous fistulas (SDAVFs) are rare and still underdiagnosed entities, which, if not treated properly, can lead to considerable morbidity with progressive spinal cord symptoms. Because presenting clinical symptoms are unspecific, the neuroradiologist is often the first clinician to raise the possibility of this diagnosis, which initially rests mainly on MR imaging. For a thorough understanding of the disease and for planning the therapeutic strategy, however, selective spinal digital subtraction angiography (DSA) still is necessary. The aim of the following article is to review the epidemiology, etiology, clinical and imaging features, and therapeutic approaches of this type of spinal vascular malformation. Because an understanding of spinal vascular malformations both from an etiologic and pathophysiologic standpoint is based on the spinal vascular anatomy, we will start by briefly describing the salient features of the spine and spinal cord arterial supply and venous drainage followed by a classification of spinal vascular malformations in general and a classification of dural arteriovenous (AV) shunts in particular. Embryology and Anatomy of the Spinal VasculatureDevelopment of the neural plate starts during the third gestational week and is derived from the embryologic ectoderm. This process is induced by the underlying notochord and adjacent mesoderm, which regulate the development of the surrounding structures, including the nerves, blood vessels, and somites.1 In this stage, the angioblasts initially form small cell clusters (blood islands) within the embryonic and extraembryonic mesoderm.2 Formation of the neural tube begins early in the fourth week (days 22-23) with closure of the rostral and caudal neuropore during days 25-27, which coincides with the establishment of the intrinsic blood vascular circulation within the spinal cord.3 Two longitudinal collector systems form in the subarachnoid space at the dorsal and ventral surfac...

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“…Usually, the disease becomes symptomatic in elderly men (between 40-60 y). Most fistulae are found in the thoracolumbal region although they may be encountered from the sacral region to the level of the foramen magnum 10 . The arteriovenous shunt is located inside the dura mater close to the spinal nerve root where the arterial blood from a radiculomeningeal artery (i.e.…”

Section: Dural Av Fistulaementioning

confidence: 99%

Classification of Spinal Vascular Malformations

et al. 2009

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SUMMARY -Spinal vascular malformations are rare diseases with a wide variety of neurological presentations. Their classification depends on the differentiation of shunting versus non-shunting lesions, the latter being the spinal cord cavernomas. In the shunting lesions, the next step in the proposed classification scheme is related to the feeding artery which can subdivide the dural vascular shunts from the pial vascular malformations: while those shunts that are fed by radiculomeningeal arteries (i.e. the counterparts of meningeal arteries in the brain) constitute the dural arteriovenous fistulas, the shunts that are fed by arteries that would normally supply the spinal cord (i.e. the radiculomedullary and radiculopial arteries) are the pial cord arteriovenous malformations (whose cranial counterparts are the brain AVMs). Depending on the type of transition between artery and vein the latter pial AVMs can be further subdivided into glomerular (plexiforme or nidus-type) AVMs with a network of intervening vessels inbetween the artery and vein and the fistulous pial AVMs. The last step in the classification then describes whether the type of fistula has a high or a low shunting volume which will differentiate the "Macro-" from the "Micro-"fistulae. The proposed classification is therefore based on a stepwise analysis of the shunt including its arterial anatomy, its nidus-architecture and its flow-volume evaluation. The major advantage of this approach is that it leads to a subclassification with direct implications on the choice of treatment, thereby constituting a simple and practical approach to evaluate these rare diseases.

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Dural arteriovenous fistulae at the foramen magnum

Cited by 69 publications

References 33 publications

Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas

Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas

Spinal Dural Arteriovenous Fistulas

Classification of Spinal Vascular Malformations

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