Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas

Abstract

To establish if interruption of the intradural draining spinal vein or surgical excision are curative treatments for spinal dural arteriovenous fistulas (AVFs), the medical records and radiographic studies of 19 patients with spinal dural AVFs and progressive myelopathy were reviewed. Spinal arteriograms were obtained before and within 2 weeks after surgery in 19 patients, and after a delay of 4 months or more in 11 patients. The mean clinical and arteriographic follow up was at 37 and 35 months, respectively. In the 11 patients who underwent excision of the dural AVF there was no evidence of a residual lesion upon immediate or delayed postoperative arteriography. Surgery in eight patients consisted of simple interruption of the intradural draining vein as it entered the subarachnoid space. In six of these patients the vein draining the AVF intrathecally provided the only venous drainage of the AVF. In these six patients there was no immediate (six of six) or delayed (four of six) arteriographic evidence of residual or recurrent flow through the AVF. Two patients had an AVF with both intra- and extradural venous drainage; after intradural division of the draining vein there was residual flow through the AVF into the extradural venous system. In one of these two patients intrathecal venous drainage was reestablished, which required additional therapy. In the other patient the extradural AVF spontaneously thrombosed and was not evident on delayed follow-up arteriography. In patients with spinal dural AVFs with only intrathecal medullary venous drainage, which includes most patients with these lesions, surgical interruption of the intradural draining vein provides lasting and curative treatment. In patients with both intra- and extradural drainage of the AVF, complete excision of the fistula or interruption of the intra- and extradural venous drainage of the fistula is indicated. In patients in whom a common vessel supplies the spinal cord and the dural AVF, simple surgical interruption of the vein draining the AVF is the treatment of choice, as it provides lasting obliteration of the fistula and it is the only treatment that does not risk arterial occlusion and cord infarction. Simple interruption of the venous drainage of a spinal dural AVF provides lasting occlusion of the fistula, as it does for cranial dural AVFs, if all pathways of venous drainage are interrupted. This result provides further evidence that the venous approach to the treatment of dural AVFs can be used successfully.

Treatment and outcome of spinal dural arteriovenous fistulas

“…Successful treatment requires obliteration of the nidus [4]. Afshar et al [1] found that in most patients with dAVF and only intrathecal medullary venous drainage, surgical interruption of the intradural draining vein provides lasting and curative treatment. Only in patients with both intra-and extradural drainage is complete excision of the fistula or interruption of intra-and extradural venous drainage of the fistula indicated.…”

Intracranial subarachnoid hemorrhage resulting from cervical spine dural arteriovenous fistulas: literature review and case presentation

“…Patients characteristically present with progressive myelopathy, including spastic paraparesis and bladder dysfunction resulting from venous hypertension in the medullary veins and the pial coronary venous plexus of the spinal cord. 1,4,11,17,19 Cervical dAVFs represent only a minority of spinal dAVFs, but in contrast to their thoracolumbar counterparts, they may be associated with protean clinical manifestations such as SAH, vascular congestive myelopathy, radiculopathy, and cranial nerve dysfunction. 2,12 In 1987, Cahan et al 3 published the first report of an SAH occurring secondary to cervical dAVFs, and a number of small case series have been published subsequently.…”

Spinal Dural Arteriovenous Fistulas: Clinical and Radiological outcome of Endovascular Treatment

“…In this series investigators did not investigate micturition disability. 1,28 In our study, Endovascular treatment was successful in 20 out of 22 (90.9%), and failure occurred in 2 out of 22 patients, (9.1%) who were referred to surgery. We had only one patient (5%) out of 20 patients who had endovascular procedures, with procedure related complication in the form of worsening of symptoms post treatment that improved later on.…”