Spinal epidural angiomatous malformations draining into intrathecal veins

Kendall, B. E.; Logue, Valentine

doi:10.1007/bf00344211

Cited by 394 publications

(125 citation statements)

References 8 publications

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“…26 The most common of these, spinal dural arteriovenous fistula, as well as the less frequently encountered perimedullary and epidural fistula all can cause a progressive myelopathy. 2,30 Intramedullary fistulas, which are rare, often present with hemorrhage. 12 The underlying pathophysiologic mechanism of the myelopathy induced by arteriovenous fistulas is now believed to involve passive venous congestion of the cord, [1][2][3][4]31 because arterial blood originating from the fistula enters the perimedullary venous plexus, a valveless system, increasing pressure and impairing normal drainage from the cord parenchyma.…”

Section: Discussionmentioning

confidence: 99%

“…7 It was not until the 1970s, with continuous improvement in radiologic imaging, that the etiology of the majority of the cases was ascribed to a spinal dural arteriovenous fistula draining into intradural medullary veins. 1,2 Large series of patients with this condition have been reported in recent decades. 11,12,23 and their clinicoradiologic characteristics and therapeutic approaches have been well studied.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] The primary vascular pathology often lies outside the spinal cord. The secondary changes occurring in the spinal parenchyma, however, histologically can mimic an intraspinal vascular malformation or even a neoplasm.…”

mentioning

confidence: 99%

“…[11][12][13] In the typical spinal dural arteriovenous fistula, engorged tortuous vascular channels are identified in the subarachnoid space predominantly on the dorsal aspect of the cord, a consequence of the impaired spinal venous drainage. 2,11,12 Venous congestive myelopathy can also be caused by arteriovenous fistulas occurring intradurally and involving the perimedullary space, or rarely extradurally. 2 Similar pathologic changes have also been rarely reported in the absence of a demonstrable fistula or of abnormal spinal surface vessels.…”

mentioning

confidence: 99%

“…2,11,12 Venous congestive myelopathy can also be caused by arteriovenous fistulas occurring intradurally and involving the perimedullary space, or rarely extradurally. 2 Similar pathologic changes have also been rarely reported in the absence of a demonstrable fistula or of abnormal spinal surface vessels. [13][14][15] Magnetic resonance imaging (MRI), by demonstrating the presence of enlarged, contrast-enhancing tortuous vessels in the subarachnoid space, spinal cord swelling and enhancement, and increased spinal cord signal on T2-weighted images may prompt consideration of the diagnosis of venous congestive myelopathy.…”

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confidence: 99%

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Venous congestive myelopathy: a mimic of neoplasia

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Venous congestive myelopathy: a mimic of neoplasia

et al. 2005

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Antireflux mechanisms in veins draining the upper territory of the vertebral column and spinal cord in man

Scapinelli

2000

Clin. Anat.

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Phase‐contrast MR angiography of vascular malformations of the spinal cord at 0.5 T

Gelbert

Guichard

Mourier

et al. 1992

Magnetic Resonance Imaging

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Preliminary experience with phase-contrast magnetic resonance (MR) angiography at 0.5 T applied in 12 cases of vascular malformations of the spinal cord is reported. There were six intramedullary arteriovenous malformations (AVMs), four perimedullary fistulas. and two dural arteriovenous fistulas with perimedullary drainage, all proved with x-ray angiography. The small size of the vessels and their location within a bony structure presented a technical challenge. Serpentine vascular signal patterns were identified within the spinal canal in all cases, showing good correlation with the x-ray angiographic pattern. Relative to spin-echo images, MR angiograms allowed better visualization of the venous drainage. The nidus of intramedullary AVMs was more difficult to recognize. The ability to manipulate the velocity-encoding value allows better characterization of flow speed. The results underline the two dimensions of the phase-contrast technique, which provides both anatomic images and dynamic information about vascular malformations. MR angiography does not replace selective x-ray angiography, which is indispensable for therapeutic strategy (endovascular procedure or surgery), but it can be considered a valuable alternative to x-ray angiography during follow-up. These malformations can be classified according to the type of feeding artery (radiculomedullary or meningeal) and vascular architecture (fistula or nidus). This classification commonly recognizes three types of malformations (4): (a) arteriovenous malformations (AVMs) issuing from a spinal artery, with a completely or partially intramedullary nidus (5); ( b ) direct perimedullary fistulas between a spinal artery and the perimedullary veins (three types-I, 11, and 111-have been identified, according to the size of the fistula and vessels); and ( c ) dural arteriovenous fistulas (AVFs) between a meningeal branch of a radicular artery and the perimedullary veins (6.7).AVMs and types I1 and 111 perimedullary fistulas are high-flow malformations; type I perimedullary fistulas and dural AVFs are slow-flow malformations.We discuss and give examples of our initial experience with phase-contrast MR angiography of vascular malformations of the spinal cord. We also attempt to determine the clinical protocols and technical parameters for the future application of this method. MATERIALS AND METHODSTwelve patients with proven vascular malformations of the spinal cord were referred for phase-contrast MR angiography. There were six intramedullary AVMs, four perimedullary fistulas, and two dural AVFs with perimedullary drainage. All MR imaging was performed with a 0.5-T magnet (MR Max; GE Medical Systems, Milwaukee).They included sagittal-and axial-plane T 1-weighted (TR msec/TE msec = 500/50) and T2-weighted (2.000/60, 120) spin-echo images. MR angiography was performed in a sagittal orientation with a twodimensional gradient-echo sequence ( 160/25, 20" flip angle) and a section thickness of 20 mm. The image matrix was 160 x 160. The number of signals averaged was 10, with...

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Spinal epidural angiomatous malformations draining into intrathecal veins

Cited by 394 publications

References 8 publications

Venous congestive myelopathy: a mimic of neoplasia

Venous congestive myelopathy: a mimic of neoplasia

Antireflux mechanisms in veins draining the upper territory of the vertebral column and spinal cord in man

Phase‐contrast MR angiography of vascular malformations of the spinal cord at 0.5 T

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