Spinal extradural arteriovenous fistulas: a clinical and radiological description of different types and their novel treatment with Onyx

Rangel-Castilla, Leonardo; Holman, Paul J.; Krishna, Chandan; Trask, Todd; Klucznik, Richard P.; Diaz, Orlando M.

doi:10.3171/2011.6.spine10695

Cited by 105 publications

(94 citation statements)

References 8 publications

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“…[2][3][4][5][6][7][8][9][10]12,13,[15][16][17][19][20][21][22][23]25,27,[29][30][31][32] These cases were divided into 2 groups: those with and those without intradural venous drainage, 22 and 23 cases respectively (Tables 1 and 2). …”

Section: Resultsmentioning

confidence: 99%

“…3,6,7,9,10,13,16,[21][22][23]25 Venous congestion is presumed to be a primary cause of myelopathy in these patients, which is similar to cases of dural AVFs.…”

Section: Type A: Extradural Spinal Avf With Intradural Venous Drainagementioning

confidence: 99%

“…2,4,5,8,10,12,15,17,19,20,22,27,[29][30][31][32] Therefore, patients with these lesions should be treated with decompression of the spinal cord by shrinking the enlarged extradural venous plexus to reduce mass effect, although no intradural procedure is required. These lesions, which are fed by vertebral, ascending cervical, and deep cervical arteries and exhibit high flow, are seen mainly in the cervical and upper thoracic regions.…”

Section: Type B: Extradural Spinal Avf Without Intradural Venous Draimentioning

confidence: 99%

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Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: a systematic literature review

Takai¹,

Taniguchi²

2012

FOC

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Object Spinal arteriovenous malformations (AVMs) are classified into types according to anatomical characteristics: dural arteriovenous fistulas (AVFs), intramedullary AVMs, perimedullary AVFs, and extradural AVFs. Spinal extradural AVFs are much rarer than other types of spinal AVMs, and the available literature on this clinical entity has been based only on case reports or small case series. To investigate the clinical characteristics of patients with spinal extradural AVFs, the authors systematically reviewed the associated literature in the MRI era. Methods The PubMed database was searched for all relevant English-language case reports and case series published from 1990 to 2011. The clinical differences between Type A with and Type B without intradural venous drainage were statistically compared, especially regarding clinical features and angiographic and MRI findings. Results Forty-five cases of spinal extradural AVFs were found. Type A spinal extradural AVFs were diagnosed in patients with a significantly older age (mean 63.5 years) as compared with Type B AVFs (mean 34.3 years, p < 0.0001). Most cases of Type A spinal extradural AVFs exhibited a diffuse high signal intensity of the spinal cord on T2-weighted MR images and no mass effect (p < 0.0001), and they commonly occurred in the thoracolumbar and lumbar regions (p < 0.0001). On the other hand, cases of Type B lesions exhibited a normal signal intensity of the cord with severe mass effect due to an enlarged extradural venous plexus, and they commonly occurred in the cervical and upper thoracic regions (p < 0.0001), frequently in patients with neurofibromatosis Type 1 (p = 0.049). Because Type B AVFs consisted of high-flow, multiple complex anastomoses between arteries and the epidural venous plexus, patients with these lesions tended to undergo multisession treatments, and the rate of partial AVF occlusion was significantly higher than for Type A AVFs (p = 0.018), although there was no difference in symptom outcomes between the 2 groups. Conclusions To the best of the authors' knowledge, a comparative analysis of the clinical differences in patients with extradural AVFs with or without intradural venous drainage has yet to be described in the literature. They concluded that in the diagnosis of spinal extradural AVF, evaluation of intradural venous drainage is important because the cause of myelopathy determines the treatment goals.

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Section: Resultsmentioning

confidence: 99%

“…3,6,7,9,10,13,16,[21][22][23]25 Venous congestion is presumed to be a primary cause of myelopathy in these patients, which is similar to cases of dural AVFs.…”

Section: Type A: Extradural Spinal Avf With Intradural Venous Drainagementioning

confidence: 99%

Section: Type B: Extradural Spinal Avf Without Intradural Venous Draimentioning

confidence: 99%

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Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: a systematic literature review

Takai¹,

Taniguchi²

2012

FOC

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“…We attempted embolization via an arterial approach in our patient using the Onyx LES, which incorporates a new nonadhesive liquid embolic agent that can decrease the risk of gluing the catheter to anatomical structures and allows a more durable injection of greater volumes of agent delivered in a single session. This agent is mainly used for the treatment of cerebral dural fistulas, and some studies have used this agent for spinal dural AVFs, but only 3 reports 12,13,15 have described the application of this agent for spinal epidural AVFs. A study by Silva et al 15 documented 2 cases of epidural AVF treated using Onyx embolization, but treatment failed because of incomplete occlusion of the draining vein and the risk of agent migration into the spinal artery via anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…This lesion is very rare, and only a limited number of cases have been reported in the literature to date. [1][2][3][4]8,13,15,18 Here we describe an extremely rare case of intraosseous spinal epidural AVF with perimedullary vein reflux causing symptoms of myelopathy. The intraosseous fistula was located in a fractured vertebral body and was totally obliterated using Onyx embolization.…”

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confidence: 99%

Spinal intraosseous epidural arteriovenous fistula with perimedullary drainage obliterated with Onyx embolization: case report

Ou¹,

Wang

Yang

et al. 2015

SPI

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The authors report an extremely rare case of spinal intraosseous epidural arteriovenous fistula (AVF) with perimedullary vein reflux causing symptoms of myelopathy. The intraosseous fistula tracts were completely obliterated with Onyx embolic agent, resulting in a total resolution of symptoms. The unique features of this case include the rare location of the fistula in the vertebral body and the association of the fistula with a compressive fracture. Imaging studies confirmed these hemodynamic findings and provided clarity and direct evidence regarding the association of epidural AVF formation with the vertebral compressive fracture. The authors also propose a possible disease evolution based on the previously adduced reflux-impending mechanism.

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Thoracic epidural arteriovenous malformation causing rapidly progressive myelopathy and mimicking an acute transverse myelitis: A case report

Yuan

Zhou

et al. 2022

Ibrain

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Clinical symptoms of spinal arteriovenous malformations (AVMs) combined with acute spontaneous hemorrhage lack specificity, which leads to misdiagnosis and delays treatment. The current study aimed to analyze the causes of misdiagnosis and review the key points of diagnosis and treatment.We presented an extremely rare case of a 25-year-old man whose clinical characteristics mimicked acute transverse myelitis, suffering from rapidly and repeatedly progressive myelopathy with a mass. The pathological diagnosis of the mass was AVM; symptom-based surgical treatment with posterior decompression and the removal of epidural AVMs during the postoperative 12-month follow-up period were performed. The manual muscle testing grade score of the proximal and distal muscles in both lower limbs improved from 1 to 5, and the American Spinal Injury Association motor and sensation grade score improved from B to E. In the case of sudden or progressive spinal cord injury of unknown cause and acute spinal cord dysfunction, there might be a misdiagnosis. The key to a differential diagnosis is to take into account AVMs, and spontaneous hemorrhages and hematomas should also be suspected.Angiography and magnetic resonance imaging are very important for the

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Spinal extradural arteriovenous fistulas: a clinical and radiological description of different types and their novel treatment with Onyx

Cited by 105 publications

References 8 publications

Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: a systematic literature review

Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: a systematic literature review

Spinal intraosseous epidural arteriovenous fistula with perimedullary drainage obliterated with Onyx embolization: case report

Thoracic epidural arteriovenous malformation causing rapidly progressive myelopathy and mimicking an acute transverse myelitis: A case report

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