Spinal Dural Arteriovenous Malformations Research Articles

Trans-radial spinal angiography: A single-center experience.

Spinal angiography (SpAn) is the gold standard for diagnosis of spinal dural fistulas and arteriovenous malformations. A complete spinal angiogram necessitates the interrogation of the segmental arteries arising from the aorta at every level as well, the internal iliac; and median sacral arteries at the caudal end; and the cervical vasculature at the cranial end. SpAn has traditionally been performed with transfemoral arterial access and could be challenging. Of late, transradial arterial access has emerged as a popular alternative for endovascular surgical Neuroradiology (ESN) procedures including SpAn. However, there is paucity of the literature regarding transradial access for spinal angiography. After IRB approval, records and imaging were reviewed in a series of patients who underwent SpAn at our institution. A total of nine spinal angiograms were performed via transradial access in a consecutive series of eight patients between July 2019 and December 2020 at our institution. Eight of these were diagnostic SpAn's, and one patient underwent SpAn with transradial approach for the treatment of a type I spinal dural arteriovenous fistula. No complications occurred during or subsequent to the procedures. SpAn can be successfully and safely accomplished via transradial access. This approach appears to provide a stable method for interventions, as well.

Acute Paraparesis Following Epidural Steroid Injection in a Patient with Spinal Dural Arteriovenous Malformation: Case Report and Review of Literature (P07.256)

Acute Paraparesis Following Epidural Steroid Injection in a Patient with Spinal Dural Arteriovenous Malformation: Case Report and Review of Literature (P07.256)

Standard of practice: embolization of spinal arteriovenous fistulae, spinal arteriovenous malformations, and tumors of the spinal axis

Spinal vascular malformations include a heterogeneous group of pathological/anatomical entities with congenital and acquired etiologies that induce spinal cord dysfunction, primarily through intradural extramedullary drainage and enlargement of the coronal...

Endovascular treatment for acute paraplegia after epidural steroid injection in a patient with spinal dural arteriovenous malformation

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations. Type 1 spinal arteriovenous malformations are defined by the presence of radiculomeningeal feeders that drain into intradural veins. Patients with these lesions frequently present with chronic myelopathy, which is most often caused by venous hypertension. The authors present the case of a 69-year-old man with acute paraparesis following a lumbar epidural injection, resulting from a previously undiagnosed SDAVF. The patient initially reported right lower-extremity weakness and paresthesias and was referred to an orthopedic practice. His pain and weakness were exacerbated with ambulation. Reevaluation at 4 months was remarkable for groin, mild low-back, and buttock pain. The patient received a right L5-S1 interlaminar epidural steroid injection and became acutely weak. He presented to the emergency department 3 hours after the injection. Once MRI of the lumbar and thoracic spine had been performed, the neurosurgery service was consulted, and it was decided to proceed with emergent spinal angiography with the intent to embolize the fistula. An emergent spinal angiogram was obtained, revealing 2 arterial pedicles emanating from the right T-5 and T-6 radicular arteries. Transarterial embolization was thought to be the most rapid way to potentially obliterate the fistula. The patient exhibited immediate improvement in neurological function, and by 6 hours postprocedure, his neurological function was near normal. He was ambulatory and released to home 3 days after the embolization procedure.

Spinal dural arteriovenous fistulas: outcome and prognostic factors

The aim of this study is to review the clinical outcome of patients treated for spinal dural arteriovenous malformations and investigate the presence of pretreatment indicators of outcome after short- and midterm follow-up. The authors retrospectively reviewed the records of 65 consecutive patients treated either surgically or endovascularly in 3 neurosurgery departments between 1989 and 2009. After treatment, 80% of patients reported improvement of at least 1 symptom. Motor symptoms improved more than sensory disorders, pain, or sphincter impairment. Spinal dural arteriovenous fistulas at the thoracic level, and in particular at the lower level, responded better than those in other spinal areas. Spinal dural arteriovenous fistula is a rare pathology with a malignant course that should be treated aggressively. This study appears to confirm that neurological status before treatment, anatomical location of the fistula, and symptoms at presentation are all factors that can predict outcome. Early diagnosis of spinal dural arteriovenous malformations in the lower thoracic area in patients with an Aminoff scale score < 3 was associated with the most favorable outcome.

Engorged and tortuous intradural filum terminale vein as a sign of a sacral dural arteriovenous malformation

Sacral spinal dural arteriovenous (AV) malformation is rare and its clinical features are not specific to differentiate sacral dural AV malformation from the superiorly located ones. A sacral dural AV malformation, therefore, is usually diagnosed after negative thoracic and lumbar arteriograms. In this report, we propose a myelographic or magnetic resonance (MR) sign of engorged and tortuous intradural filum terminale vein as an indication of a sacral dural AV malformation. When this sign is seen, pelvic arteriography should be performed first.

Radical excision of intramedullary cavernous angiomas.

This is a retrospective study of patients with surgically treated, intramedullary cavernous malformations. We conducted the study to elucidate the outcomes of the patients, as well as potential pitfalls in their care. A series of 12 patients underwent radical excision of intramedullary cavernous malformations between 1986 and 1996. All lesions were diagnosed by magnetic resonance imaging. Although seven patients experienced recurrent episodes of pain and sensorimotor disturbances, the histories of the other five patients were relevant for slowly progressing deficits (mostly sensory). All cavernomas were completely resected. No deaths were recorded. In follow-up examinations (5-102 mo after discharge), there was no evidence of recurrence, either clinically or in control magnetic resonance imaging scans. In follow-up examinations, two patients demonstrated sensory deficits that were slightly more pronounced than the preoperative deficits. The postoperative neurological status of 3 of 12 patients was unchanged, compared with the preoperative status. The status of the remaining seven patients had improved. For four patients there was effective functional improvement, and for three others there was complete postoperative relief of pain. Deficits of the long tracts were less prone to recover. The clinical course of cavernous malformations may be difficult to distinguish from that of spinal dural arteriovenous malformations or focal demyelinating disease. In the latter case, even magnetic resonance imaging results could be deceptive. Radical resection of these malformations is feasible, with relatively low surgical morbidity, provided that the preoperative deficits of the patients are limited. Given the generally progressive course of the illness and the few acute catastrophic myelopathies, complete excision is advocated whenever malformations are symptomatic.

Radical Excision of Intramedullary Cavernous Angiomas

OBJECTIVE: This is a retrospective study of patients with surgically treated, intramedullary cavernous malformations. We conducted the study to elucidate the outcomes of the patients, as well as potential pitfalls in their care. METHODS: A series of 12 patients underwent radical excision of intramedullary cavernous malformations between 1986 and 1996. All lesions were diagnosed by magnetic resonance imaging. Although seven patients experienced recurrent episodes of pain and sensorimotor disturbances, the histories of the other five patients were relevant for slowly progressing deficits (mostly sensory). RESULTS: All cavernomas were completely resected. No deaths were recorded. In follow-up examinations (5-102 mo after discharge), there was no evidence of recurrence, either clinically or in control magnetic resonance imaging scans. In follow-up examinations, two patients demonstrated sensory deficits that were slightly more pronounced than the preoperative deficits. The postoperative neurological status of 3 of 12 patients was unchanged, compared with the preoperative status. The status of the remaining seven patients had improved. For four patients there was effective functional improvement, and for three others there was complete postoperative relief of pain. Deficits of the long tracts were less prone to recover. CONCLUSION: The clinical course of cavernous malformations may be difficult to distinguish from that of spinal dural arteriovenous malformations or focal demyelinating disease. In the latter case, even magnetic resonance imaging results could be deceptive. Radical resection of these malformations is feasible, with relatively low surgical morbidity, provided that the preoperative deficits of the patients are limited. Given the generally progressive course of the illness and the few acute catastrophic myelopathies, complete excision is advocated whenever malformations are symptomatic.

Motor Evoked Potentials Predicting Early Recovery from Paraparesis after Embolisation of a Spinal Dural Arteriovenous Fistula

Spinal dural arteriovenous malformation is an increasingly diagnosed cause of ischaemic myelopathy. Though routine intraoperative monitoring has been demonstrated to be of benefit in the endovascular treatment of these lesions, its predictive value has not been well documented. We present the case of an elderly woman with progressive spastic paraparesis who demonstrated marked improvement in limb muscle motor evoked potentials of the lower extremities immediately following endovascular occlusion of the lesion. The patient subsequently showed improvement in strength, sensation and sphincter control.

Microvascular anatomy of dural arteriovenous abnormalities of the spine: a microangiographic study

Although most vascular abnormalities of the spinal cord are now ascribed to an abnormal communication between a dural artery and a medullary vein on the dura near a sensory nerve root, these lesions are too small for their anatomy to be demonstrated directly by spinal arteriography. Thus, it is unknown whether the site of dural arteriovenous shunting is an arteriovenous malformation (AVM), implying a congenital origin, or is a direct arteriovenous fistula (AVF), implying an acquired etiology. The authors treated six patients by en bloc resection of the involved dural root sleeve, proximal nerve root, and adjacent spinal dura. All of the patients presented with myelopathy and their arteriograms were consistent with a spinal dural vascular malformation. The lesions occurred between T-6 and T-12, levels at which clinical deficits from such resection are minimal. The dural artery or medullary vein associated with the vascular malformation was cannulated and a dilute solution of barium sulfate was injected during sequential fine-grain radiography. In all of the lesions the artery split into daughter vessels that coalesced one to three times to form a skein of arterial loops in the dura that invariably emptied into a medullary vein without an intervening capillary plexus. Several medium-to-small collateral vessels arising from adjacent intercostal or lumbar arteries were commonly present in the dura and converged at the site of the AVF to join a single medullary vein. These results show that spinal dural AVMs are direct AVFs that link the dural branch of the radiculo-medullary-dural artery with the intradural medullary vein. They also provide an anatomical explanation for the presence of a multiple segmental arterial supply and a single draining medullary vein of spinal dural AVFs, and the propensity for reestablishment of flow through the arteriovenous shunt after embolic occlusion.

Dural Arteriovenous Malformations

Dural Arteriovenous Malformations. Issam A. Awad, Daniel L. Barrow (Editors). Park Ridge, AANS Publications Committee, 1993. Pages: 253. Price: '90.00, List; '80, AANS Members; '70.00, Residents. This new publication, issued by the AANS Publications Committee, synthesizes current thinking about cranial and spinal dural arteriovenous malformations (AVMs). This multiauthored book of 15 chapters covers the topics of definition and classification, pathophysiology and animal models, etiology, hemodynamics, prognostic factors, endovascular and surgical therapy, and dural AVMs at specific locations. The final chapter presents an enlightening overview of a complex subject. The text is easily readable and comprehensible. Most illustrations are uncluttered anatomic line drawings. Angiograms, magnetic resonance (MR) images, and computed tomographic (CT) scans are abundantly used and are of excellent quality. References are current and relevant and vary between 20 and 100 per chapter. The index is comprehensive. Dural AVM is a rare disorder, with a prevalence of 10 to...

Case report: Spontaneous thrombosis of a spinal dural AVM (Foix-Alajouanine syndrome) — Magnetic resonance appearance

We describe a patient with a classical presentation of a spinal dural arteriovenous malformation which probably underwent spontaneous thrombosis. This is known as the Foix-Alajouanine syndrome. The diagnosis was not made in this patient until after cord infarction had occurred. The clinical and radiological features of spinal vascular malformations are reviewed because prompt treatment may halt or even reverse their neurological manifestations.

In situ photocoagulation of spinal dural arteriovenous malformations using the Nd:YAG laser.

Spinal dural arteriovenous malformations (AVM's) are the most common type of AVM involving the spinal cord in adults. Direct obliteration of the fistula nidus located in the dura is the preferred method of treatment. Five cases of spinal dural AVM were treated by open surgical exposure, microsurgical disconnection of the dural nidus from the coronal venous plexus, and in situ obliteration of the nidus using the Nd:YAG laser. Use of the Nd:YAG laser reduced nidus obliteration to a simple 10-minute technical exercise. All patients improved neurologically following surgery, and complete obliteration of all lesions was verified by delayed angiography. There were no permanent complications related to either the surgical exposure or the use of the Nd:YAG laser. Open surgical treatment of spinal dural AVM's using the Nd:YAG laser appears to be a safe, effective, and durable method of treating these lesions. Photocoagulation is discussed in the context of the other treatment modalities available.

Spinal dural arteriovenous malformations--a treatable cause of progressive paraparesis in elderly people.

Spinal dural arteriovenous malformations (SDAVMs) were first described in 1977. They present with a progressive paraparesis, principally in men aged 60 years and over. They are usually dorsolumbar in situation and are thought to be acquired lesions which produce symptoms by obstructing the venous drainage of the spinal cord. There are no pathognomonic clinical features and diagnosis depends on a high level of clinical suspicion and myelography extended into the dorsal region. The condition is probably underdiagnosed and may be quite a common cause of progressive leg weakness in elderly people. Surgical treatment is relatively simple, safe, and if carried at an early stage can lead to dramatic neurological recovery. This paper reports nine cases seen over a period of 7 years. All the patients showed marked neurological improvement after surgery.

Magnetic resonance imaging in cases of spinal dural arteriovenous malformation

Two patients with spinal dural arteriovenous malformations associated with intramedullary changes confirmed by the T2-weighted magnetic resonance imaging (MRI) scans are reported. The characteristics of the MRI findings for these 2 patients were as follows. 1) In the T2-weighted spin-echo image, intramedullary changes observed by MRI were visualized as a high signal intensity area at the level where delay in venous circulation of the spinal cord was revealed by the angiography of the spinal cord. 2) After the obliteration of the arteriovenous shunt by surgical management, intramedullary changes remarkably decreased and disappeared with the disappearance of swelling of the spinal cord observed preoperatively. After that, the atrophy of the spinal cord was shown. 3) The level, extent, and severity of intramedullary changes remarkably decided by the condition of the level where the radiculospinal vein, as the flowing vein, refluxes into the coronal venous plexus and venous flow occurs through the radiculospinal vein into the epidural veins. We suspect that intramedullary changes shown by the T2-weighted MRI scan chiefly represent edema of the spinal cord, caused by an increase in venous pressure due to venous congestion of the spinal cord. MRI is a very useful diagnostic aid to detect intramedullary changes associated with a spinal dural arteriovenous malformation and to evaluate therapeutic results after surgery. (Neurosurgery 24:919-923, 1989)