Spinal ventral epidural arteriovenous fistulas of the lumbar spine: angioarchitecture and endovascular treatment

Abstract

IntroductionSpinal ventral epidural arteriovenous fistulas (EDAVFs) are relatively rare spinal vascular lesions. We investigated the angioarchitecture of spinal ventral EDAVFs and show the results of endovascular treatment.MethodsWe reviewed six consecutive patients (four males and two females; mean age, 67.3 years) with spinal ventral EDAVFs treated at our institutions from May 2011 to October 2012. All patients presented with progressive myelopathy. The findings of angiography, including 3D/2D reformatted images, treatments, and outcomes, were investigated. A literature review focused on the angioarchitecture and treatment of spinal ventral EDAVFs is also presented.ResultsThe EDAVFs were located in the ventral epidural space at the L1–L5 levels. All EDAVFs were supplied by the dorsal somatic branches from multiple segmental arteries. The ventral somatic branches and the radiculomeningeal arteries also supplied the AVFs in two patients. The AVFs drained via an epidural venous pouch into the perimedullary vein in four patients and into both the perimedullary vein and paravertebral veins in two patients. Four cases without paravertebral drainage were treated by transarterial embolization with diluted glue, and two cases with perimedullary and paravertebral drainages were treated by transvenous embolization alone or in combination with transarterial embolization. An angiographic cure was obtained in all patients. Clinical symptoms resolved in two patients, markedly improved in three patients, and minimally improved in one patient.ConclusionIn our limited experience, spinal ventral EDAVFs were primarily fed by somatic branches. EDAVFs can be successfully treated by endovascular techniques selected based on the drainage type of the AVF.

Shunted pouches of cavernous sinus dural AVFs: evaluation by 3D rotational angiography

“…In their report, CSdAVFs are classified into the ventral epidural group, which is essentially located at the ventral epidural plexus of the primary drainage system of the vertebral body (osseous structure) [14]. Regarding feeding arteries, spinal ventral epidural AVFs were mainly fed by the dorsal somatic branches (retrocorporeal artery) [15]. Similarly, "posteromedial" shunted pouches of the CSdAVFs were mainly fed by the medial clival and carotid branches of the ascending pharyngeal arteries, which are homologues of the dorsal somatic branches of the spinal arterial system.…”

Cervical Spinal Epidural Arteriovenous Fistula with Coexisting Spinal Anterior Spinal Artery Aneurysm Presenting as Subarachnoid Hemorrhage—Case Report

“…[1][2][3] In some cases, spinal epidural AVF can cause acute paraplegia due to reflux into medullary veins with venous congestion. [4][5][6][7] In patients with craniocervical dural AVF, subarachnoid hemorrhage has been reported to occur because of a direct venous drainage pattern in an intracranially or intramedullary fashion. [8][9][10][11][12] However, hemorrhagic presentation of cervical spinal epidural AVF without intramedullary venous drainage is very rare.…”

Large spinal intraosseous arteriovenous fistula: case report

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caSe report T he occurrence of epidural or paraspinal arteriovenous fistula (AVF) is rare, 3 and that of spinal intraosseous AVF is extremely rare. Only 2 cases of spinal intraosseous AVF associated with a fracture of the vertebral body have been reported in the English literature.

1,2 One of the 2 cases 1 had a fracture of the L-3 vertebral body with a large flow void.

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