Spinal and Paraspinal Arteriovenous Lesions

Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm

“…Open surgery has been reported as the optimal treatment of CCJ dural AVFs because of their high complete obliteration rates, 2,3 but some authors contend epidural AVFs are better treated with endovascular techniques. 8,9 In fact, for high-flow epidural AVFs with paravertebral venous drainage as in our case, exposure of the shunted pouch could cause brisk epidural bleeding. In cervical levels, the venous plexus extends medially over multiple spinal levels because bilateral dorsolateral longitudinal channels are dominant in venous drainage, unlike lumbosacral levels in which ventral retrocorporeal veins are dominant.…”

Spinal arteriovenous malformation without endovascular arterial access: is a combined neurosurgical approach and direct venous puncture an option?

“…All approaches can be acceptable in this kind of vascular malformation, but the presence of small feeders of the ASA and posterolateral artery in a conus medullaris AVM, as in our case, indicates that using either of the two techniques (neurosurgical or endovascular) separately could be dangerous. As Lenck et al recently described, safe surgical resection of spinal AVMs is feasible in some anatomical presentations 8. In this case, three previous endovascular treatments had been carried out without complete cure and a combined approach was indicated after an interdisciplinary discussion.…”

“…Endovascular treatment is the initial therapeutic choice for almost all spinal cord AVMs,6 7 but when arterial feeders are small, its use is to be avoided 7. There are rare cases when both approaches (endovascular and neurosurgical) are difficult due to complicated access (for example, when feeders come from the ASA and posterolateral spinal artery),8 and when the angioarchitecture9 of the spinal vascular malformations is very complex, a surgical approach becomes dangerous. Here we present treatment of a conus medullaris AVM in an angiography suite using the combination of a neurosurgical approach and direct puncture of the posterior medullary vein.…”

Intracranial Subarachnoid Haemorrhage Caused by Cervical Spinal Dural Arteriovenous Fistulas: Case Report

“…Most recently in 2019, Lenck et al ( 14 ) suggested the Toronto Classification of AVM/AVF of spine based on the anatomic feature and the topography of the shunting site. Under this system, the spinal vascular lesions were divided into the following: (a) spinal cord AVM—glomus intramedullary lesions; (b) pial AVF—shunts located superficial to the cord in the subpial space; (c) dural AVF—lesion located intradural but extrapial; (d) epidural AVF—lesions located outside dura but within the spinal canal; (e) paraspinal AVF—lesion pushing through to the outside of spinal canal and drain into para spinal venous plexuses; and (f) spinal arteriovenous metameric syndrome (SAMS)—lesions that involve multiple tissue layers (e.g., spinal cord, bone, paraspinal musculature, subcutaneous tissues, and skin) in one or several metameric segments.…”