Abstract
Spinal vascular shunts, including fistulas and malformations, are rare and complex vascular lesions for which multiple classification schemes have been proposed. The most widely adopted scheme consists of 4 types: type I, dural AVFs; type II, intramedullary glomus AVMs; type III, juvenile/metameric AVMs; and type IV, intradural perimedullary AVFs. MR imaging and angiography techniques permit detailed assessment of spinal arteriovenous shunts, though DSA is the criterion standard for delineating vascular anatomy and treatment planning. Diagnosis is almost exclusively based on imaging, and features often mimic more common pathologies. The radiologist's recognition of spinal vascular shunts may improve outcomes because patients may benefit from early intervention.
Highlights
T2-weighted MR imaging depicts serpiginous perimedullary flow voids, typically overlying the dorconsisting of 6 lesion types proposed by Zozulya et al[9] and a type V extradural arteriovenous fistulas (AVFs) proposed by Takai.[10] sal cord and conus, without an intramedullary nidus (Fig 3 and Table 2)
Symptoms are related to cord edema and ischemia cord.[14,39,40,41] resulting from arterialized intravenous pressure competing with cord
The relatively infrequent and anatomically complex nature of spinal vascular shunts can present diagnostic and therapeutic challenges to radiologic and surgical teams. Assessment of these lesions can be further complicated by the lack of a universally accepted classification scheme
Summary
AVF types (and subtypes): Extradural found subtype IVa to be more common in males (male/female ratio 1⁄4 1.4:1), with a mean age of 46.9 years. Zozulya et al[9] or multiple (B) feeders) AVM types (and subtypes): Extradural-intradural Intradural (intramedullary, intramedullaryextramedullary, or conus medullaris). 34.3 and 18.7 years, both without sex predilection. Type I: Intramedullary ing Osler-Weber-Rendu, Proteus, Type II: Intradural or perimedullary Type III: Dural Type IV: Epidural
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