Surgical Treatment of Spinal Extradural Arteriovenous Fistula with Parenchymal Drainage

Niizuma, Kuniyasu; Endo, Toshiki; Sato, K.; Takada, Shihomi; Sugawara, Takayuki; Mikawa, Shigeki; Tominaga, Teiji

doi:10.1227/neu.0b013e31828d97fd

Cited by 4 publications

(3 citation statements)

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“…Similarly with microsurgical treatment, new bridging intradural veins could be recruited if the initial draining vein was occluded without obliteration of the entire fistulous pouch. Such a phenomenon has been previously reported10 and will lead to symptom recurrence.…”

Section: Discussionsupporting

confidence: 59%

Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas: a systematic review and meta-analysis

Byun

Tsang

Hilditch

et al. 2018

J NeuroIntervent Surg

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Section: Discussionsupporting

confidence: 59%

Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas: a systematic review and meta-analysis

Byun

Tsang

Hilditch

et al. 2018

J NeuroIntervent Surg

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“…However, in one recently published series of four patients, Niizuma et al reported complete obliteration of three of four SEDAVFs treated with disconnection of the intradural draining vein without manipulation of the venous lake itself. In the one unsuccessful case of isolated draining vein ligation, there were multiple intradural draining veins, suggesting that the fistula was more complex 39. Surgical treatment is not always straightforward due to the often anterior location of these lesions which can make adequate exposure from a posterolateral approach difficult.…”

Section: Treatmentmentioning

confidence: 99%

Spinal epidural arteriovenous fistulas

Brinjikji

Yin

Nasr

et al. 2016

J NeuroIntervent Surg

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Spinal epidural arteriovenous fistulas (SEDAVFs) are rare complex lesions often presenting with protean clinical manifestations secondary to compressive symptoms or congestive myelopathy. The imaging manifestations of SEDAVFs on MR angiography/MRI include high T2 signal in the spinal cord, vascular engorgement of the epidural space, and prominent intradural vascular flow voids. Given the complexity of these lesions, they are best characterized anatomically on catheter angiography where careful inspection of arterial feeders and venous drainage patterns can be performed. The imaging hallmark of an SEDAVF on angiography is the presence of a dilated epidural venous pouch through which spinal and paraspinal veins are secondarily opacified. In the lower thoracic and lumbar spine, SEDAVFs are usually located in the ventral epidural space and fed mainly by the anteriorly coursing epidural arteries. In the cervical and upper thoracic spine, SEDAVFs and their feeding arteries are more typically located laterally in the spinal canal. Current treatment options include transarterial or transvenous endovascular embolization with liquid embolic agents or coils, and surgical resection/disconnection of the fistula. Further research is needed to better characterize how and why these lesions form and to identify the best treatment modalities.

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“…The key step to achieve curative embolization is that the embolic agent be cast in the proximal part of the draining veins; therefore, the tip of the microcatheter should be as close as possible to the shunt points. 19 We preferred to choose Onyx over N-butyl 2-cyanoacrylate glue because its superior penetration properties would facilitate the delivery of embolic agent to the venous side of the shunts. 20,21 If the lesion had extremely high flow and expanded drainage channels, coils may be used to reduce blood flow, which could facilitate the molding of the liquid embolic agent.…”

Section: Discussionmentioning

confidence: 99%

Natural History and Clinical Outcomes of Paravertebral Arteriovenous Shunts

Feng

et al. 2021

Stroke

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Background and Purpose: Paravertebral arteriovenous shunts (PVAVSs) are rare. Whether the intradural venous system is involved in drainage may lead to differences in clinical characteristics through specific pathophysiological mechanisms. This study aims to comprehensively evaluate the natural history and clinical outcomes of PVAVSs with or without intradural drainage. Methods: Sixty-four consecutive patients with PVAVSs from 2 institutes were retrospectively reviewed. Lesions were classified as type A (n=28) if the intradural veins were involved in drainage; otherwise, they were classified as type B (n=36). The clinical course from initial presentation to the last follow-up was analyzed. Results: The patients with type A shunts were older at presentation (52.5 versus 35.5 years, P <0.0001) and more likely to have lower spinal segments affected than patients with type B PVAVSs (67.8% versus 13.9%, P =0.00006). After presentation, the deterioration rates related to gait and sphincter dysfunction were significantly higher in patients with type A than type B shunts (gait dysfunction: 71.8%/y versus 17.0%/y, P =0.0006; sphincter dysfunction: 63.7%/y versus 11.3%/y, P =0.0002). According to the angiogram at the end of the latest treatment, 79% of type A and 75% of type B PVAVSs were completely obliterated. If the lesions were partially obliterated, a significantly higher clinical deterioration rate was observed in patients with type A shunts than those with type B shunts (69.9%/y versus 3.2%/y, P =0.0253). Conclusions: Type A PVAVSs feature rapid progressive neurological deficits; therefore, early clinical intervention is necessary. For complex lesions that cannot be completely obliterated, surgical disconnection of all refluxed radicular veins is suggested.

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Surgical Treatment of Spinal Extradural Arteriovenous Fistula with Parenchymal Drainage

Cited by 4 publications

References 0 publications

Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas: a systematic review and meta-analysis

Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas: a systematic review and meta-analysis

Spinal epidural arteriovenous fistulas

Natural History and Clinical Outcomes of Paravertebral Arteriovenous Shunts

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