Study and therapeutic progress on spinal cord perimedullary arteriovenous fistulas

Ji, Tiefeng; Guo, Yunbao; Shi, Lei; Yu, Jinlu

doi:10.3892/br.2017.951

Cited by 11 publications

(14 citation statements)

References 74 publications

(80 reference statements)

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“…[ 17 ] Endovascular treatment should be considered as second-line choice because of the difficulty in navigating a microcatheter through the long and tortuous course of the thin ASA; the possibility of reflux of the liquid embolic material into the ASA; the risk or tearing, dissecting, thrombosis, or vasospasm of the ASA during embolization; concerning about recanalization of the fistula; and requiring expertise and experience in neurointerventional procedure. [ 9 10 11 ] According to a review about treatment on spinal cord PMAVFs by Ji et al .,[ 18 ] they found that endovascular treatment is more effective in high-flow PMAVFs, leading to a good outcome.…”

Section: Discussionmentioning

confidence: 99%

Remote intramedullary hemorrhage in the thoracic spinal cord secondary to a perimedullary arteriovenous fistula of the distal end of conus medullaris mimicking filum terminale arteriovenous fistula

et al. 2021

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Perimedullary arteriovenous fistulas (PMAVFs) of the conus medullaris are rare and usually manifest with progressive myelopathy secondary to venous congestion resulting from retrograde arterialization of the draining vein into the spinal cord. We present a rare case of conus PMAVF presenting with remote intramedullary spinal cord hemorrhage in the thoracic cord. A 37-year-old woman was transferred to our institute due to sudden severe pain in the left lower leg and weakness of the lower extremities following progressive paresthesia of the lower extremities. Magnetic resonance imaging of the thoracic and lumbosacral spine revealed spinal cord congestion extending from the conus medullaris to the level of T6 with intramedullary hemorrhage at the level of T8–9 on the left side of the spinal cord. There were abnormal serpiginous intradural flow voids along the anterior surface of the spinal cord extending from the level of L2 to the lower cervical with venous varix at the level of T8–9, probably being the source of hemorrhage. Spinal angiography confirmed conus PMAVF at the distal end of the conus medullaris supplied by the sulco-commissural artery arising from the enlarged anterior spinal artery originating from the left T11 intercostal artery with cranial drainage through the dilated anterior spinal vein into the tortuous perimedullary veins up to the lower cervical level. The patient underwent successful endovascular treatment with N-butyl cyanoacrylate and had gradually improved until being ability to walk independently without residual pain of the left lower leg. We speculated that an increased venous flow into a varix may be considered an important risk factor of hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Remote intramedullary hemorrhage in the thoracic spinal cord secondary to a perimedullary arteriovenous fistula of the distal end of conus medullaris mimicking filum terminale arteriovenous fistula

et al. 2021

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“…When the first symptoms appear, there is a 50% probability of progression to a bed-ridden state (Aminoff 5) within 3 years [ 7 ]. Therefore, timely recognition of the sAVF is essential to allow therapy to meet a narrow window of opportunity [ 3 ]. Less frequently, the symptoms of PMAVF may be caused by rupture and hemorrhage either in the intramedullary or in the subarachnoid space [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, intramedullary hemorrhage or subarachnoid hemorrhage (SAH) may occur as well [ 1 ]. Magnetic resonance imaging (MRI) of the spine and spinal angiography may elucidate the type of lesion and the proper treatment modality can be selected [ 2 , 3 , 4 ]. However, the initial clinical manifestation can be nonspecific and may mislead the initial diagnosis; the exact diagnosis may become apparent only after more severe and specific clinical manifestation transpire [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Ruptured Thoracolumbar Perimedullary Arteriovenous Fistula during Pregnancy Complicated by Cerebral Subarachnoid Hemorrhage and Brainstem Hematoma: A Case Report

2020

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Intradural spinal arteriovenous fistulas (sAVF) are spinal vascular lesions that usually manifest due to myelopathy or local symptoms caused by venous congestion and ischemia. In addition, perimedullary arteriovenous fistulas (PMAVF) in particular may rupture and cause subarachnoid or intramedullary hemorrhage along with relevant symptoms. Subarachnoid hemorrhage (SAH) can propagate into cranial space with clinically dominant symptoms and signs of typical aneurysmal intracranial SAH. The standard workup for cerebral SAH, after excluding an intracranial source of hemorrhage, is usually limited to a cervical spine MRI; therefore, thoracolumbar sources of hemorrhage can be missed, or their diagnosis may be delayed. Here we present a case of a pregnant patient who presented with cerebral SAH. The source of hemorrhage was not initially identified, leading to a presumptive diagnosis of benign pretruncal non-aneurysmal SAH. The correct diagnosis of spinal thoracolumbar PMAVF was revealed 2.5 months later due to the progression of local symptoms. While the diagnosis was being refined and endovascular treatment was being planned (but delayed due to pregnancy), there was a recurrence of intraconal hemorrhage followed by brainstem hemorrhage. This led to significant clinical deterioration. The PMAVF was then treated microsurgically and the patient experienced partial recovery.

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“…PAVFs result from direct communication between feeding arteries and enlarged draining veins without the intervening nidus; they are intradural but extramedullary, and in the cervical region, they are usually located on the anterior or lateral surface of the spinal cord ( 56 ). The shunting points can be single or multiple ( 57 ). Cervical PAVFs are not uncommon; in the Mizutani et al, study, PAVFs in the cervical region accounted for 22.4% of all PAVFs ( 2 ).…”

Section: Cervical Spinal Avfsmentioning

confidence: 99%

“…Not all PAVFs are appropriate for EVT. For Type A PAVFs, EVT is difficult because ASA catheterization is problematic; for Types B and C PAVFs, transarterial EVT via the ASA may be a safe and effective choice ( 57 , 63 ). Certainly, if the ASA is a bystander in PAVFs, EVT is easy ( Figure 3 ).…”

Section: Cervical Spinal Avfsmentioning

confidence: 99%

Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend?

Zhang

Hou

et al. 2021

Front. Neurol.

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The cervical anterior spinal artery (ASA) is a very important artery arising from the intracranial vertebral artery (VA). It can play different roles in endovascular treatment (EVT) of spinal vascular diseases. The current understanding of these roles is incomplete; therefore, we performed this review. We found that cervical ASA can be involved in many spinal vascular diseases, such as arteriovenous fistula (AVF), arteriovenous malformation (AVM), and aneurysm, and can serve as a collateral channel in proximal VA occlusion. In AVF and AVM, when the cervical ASA is involved, it often plays the role of an accomplice or victim because it acts as the feeder or as a bystander that does not provide blood flow to the AVF and AVM. In cervical ASA aneurysm, the ASA is a victim. During EVT of VA aneurysms or stenoses, the cervical ASA ostia can be covered or occluded, resulting in ASA ischemia. In this situation, the ASA is a victim. In VA occlusion or the subclavian steal phenomenon, the cervical ASA can serve as a collateral channel to provide blood flow to the posterior circulation. In this case, the ASA plays the role of a friend. According to the role of the cervical ASA in spinal vascular diseases, EVT should be determined “case by case.” Most importantly, when EVT is performed to treat these diseases, the cervical ASA axis must be preserved. Therefore, understanding the role of the cervical ASA in spinal vascular diseases is crucial.

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Study and therapeutic progress on spinal cord perimedullary arteriovenous fistulas

Cited by 11 publications

References 74 publications

Remote intramedullary hemorrhage in the thoracic spinal cord secondary to a perimedullary arteriovenous fistula of the distal end of conus medullaris mimicking filum terminale arteriovenous fistula

Remote intramedullary hemorrhage in the thoracic spinal cord secondary to a perimedullary arteriovenous fistula of the distal end of conus medullaris mimicking filum terminale arteriovenous fistula

Ruptured Thoracolumbar Perimedullary Arteriovenous Fistula during Pregnancy Complicated by Cerebral Subarachnoid Hemorrhage and Brainstem Hematoma: A Case Report

Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend?

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