Abstract
Spinal epidural arteriovenous fistulas are rare vascular malformations. We present 13 patients with spinal epidural arteriovenous fistulas, noting the various presenting symptom patterns, imaging findings related to bone involvement, and outcomes. Among 111 patients with spinal vascular malformations in the institutional data base from 1993 to 2017, thirteen patients (11.7%) had spinal epidural arteriovenous fistulas. We evaluated presenting symptoms and imaging findings, including bone involvement and mode of treatment. To assess the treatment outcome, we compared initial and follow-up clinical status using the modified Aminoff and Logue Scale of Disability and the modified Rankin Scale. The presenting symptoms were lower back pain (n = 2), radiculopathy (n = 5), and myelopathy (n = 7). There is overlap of symptoms in 1 patient (No. 11). Distribution of spinal epidural arteriovenous fistulas was cervical (n = 3), thoracic (n = 2), lumbar (n = 6), and sacral (n = 2). Intradural venous reflux was identified in 7 patients with congestive venous myelopathy. The fistulas were successfully treated in all patients who underwent treatment (endovascular embolization, n = 10; operation, n = 1) except 2 patients who refused treatment due to tolerable symptoms. Transarterial glue (n = 7) was used in nonosseous types; and transvenous coils (n = 3), in osseous type. After 19 months of median follow-up, the patients showed symptom improvement after treatment. Although presenting symptoms were diverse, myelopathy caused by intradural venous reflux was the main target of treatment. Endovascular treatment was considered via an arterial approach in nonosseous types and via a venous approach in osseous types.
Highlights
BACKGROUND AND PURPOSESpinal epidural arteriovenous fistulas are rare vascular malformations
Spinal epidural arteriovenous fistula (SEDAVF) is a rare vascular disease of the spine that manifests with benign symptoms, such as radiculopathy
SEDAVFs are fistulas located in the epidural space between the branches of the radicular artery and the epidural venous plexus,4,5 whereas the typical location of more common spinal dural arteriovenous fistulas (SDAVFs) is within the dural sleeve between the radiculomeningeal artery and the radicular vein or bridging vein
Summary
Among 111 patients with spinal vascular malformations in the institutional data base from 1993 to 2017, thirteen patients (11.7%) had spinal epidural arteriovenous fistulas. To assess the treatment outcome, we compared initial and follow-up clinical status using the modified Aminoff and Logue Scale of Disability and the modified Rankin Scale. Patients We retrospectively reviewed a data base of our institution, a tertiary hospital, that was maintained prospectively since 1993 to identify all spinal vascular malformations (ie, spinal arteriovenous malformation, spinal dural/epidural arteriovenous fistula, and vertebrovertebral fistula). Patient information regarding the clinical history, neurologic symptoms and signs, and follow-up results was obtained from the data base connected to the electronic medical record. Patients’ symptoms were classified as myelopathy and radiculopathy according to the initial neurologic symptoms and signs. The scores were based on the records of the patients’ symptoms and neurologic examinations, which were described by neurologists not directly involved in treatment We evaluated the presence of functional disability using the modified Aminoff and Logue Scale of Disability (ALS) and the modified Rankin Scale. The scores were based on the records of the patients’ symptoms and neurologic examinations, which were described by neurologists not directly involved in treatment
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