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Andrea L. Halliday, Christopher S. Ogilvy, and Robert M. Crowell

showing the surgical approach to the arteriovenous fistula on the lateral aspect of the brain stem and exposure of the fistula. A 5-mm straight aneurysm clip was placed adjacent to the vertebral artery on the fistulous component. After the clip was placed, the previously red arterialized vein turned blue. Fig. 3. Postoperative angiograms, anteroposterior (left) and lateral (right) views, demonstrating complete obliteration of the arteriovenous shunt on the lateral aspect of the brain stem. The arterialized veins do not appear. Postoperative Course

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Wendy Huang, Bradley A. Gross, and Rose Du

S pinal extradural arteriovenous fistulas (eAVFs), at times referred to as “epidural AVFs,” are typically supplied by radicular branches, with drainage into the epidural venous plexus. 25 , 53 , 60 , 61 They can be a source of neurological morbidity as a result of venous engorgement and mass effect or venous hypertension due to recruitment of intradural perimedullary veins. 25 , 53 , 60 , 61 Spinal hemorrhage, although uncommon, can occur. 9 , 13 Because of the lesion's rarity, our understanding of its demographics, natural history, and treatment

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Farhad Pirouzmand, M. Christopher Wallace, and Robert Willinsky

S pinal dural arteriovenous fistulas (AVFs) comprise 80 to 85% of spinal arteriovenous malformations. 18 Typically these lesions are located in the dura mater around the sensory ganglion of the proximal nerve root. These fistulas usually represent an abnormal connection between the segmental dural arterial supply of the root sleeve and the underlying medullary vein. Clinical symptoms relate to the reversal of flow in the perimedullary veins, resulting in “venous hypertension.” 2 The venous drainage of symptomatic spinal dural AVFs is usually exclusively

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Paul A. LaHaye and Pablo M. Lawner

. J Neurosurg 46: 795–803, 1977 3. Bitoh S , Hasegawa H , Fujiwara M , et al : Traumatic arteriovenous fistula between the middle meningeal artery and cortical vein. Surg Neurol 14 : 355 – 358 , 1980 Bitoh S, Hasegawa H, Fujiwara M, et al: Traumatic arteriovenous fistula between the middle meningeal artery and cortical vein. Surg Neurol 14: 355–358, 1980 4. Burton C , Velasco F , Dorman J : Traumatic aneurysm of a peripheral cerebral artery. Review and case report. J Neurosurg

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Alim P. Mitha, Erin E. Murphy, and Christopher S. Ogilvy

spinal dural arteriovenous malformations . BNI Quarterly 12 : 23 – 32 , 1996 5 Djindjian M , Ayache P , Brugieres P , Poirier J : Sacral lipoma of the filum terminale with dural arteriovenous fistula. Case report . J Neurosurg 71 : 768 – 771 , 1989 6 Djindjian M , Djindjian R , Rey A , Hurth M , Houdart R : Intradural extramedullary spinal arteriovenous malformations fed by the anterior spinal artery . Surg Neurol 8 : 85 – 93 , 1977 7 Gueguen B , Merland JJ , Riche MC , Rey A : Vascular malformations of the

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S. V. Ramana Reddy, William E. Karnes, Franklin Earnest IV, and Thoralf M. Sundt Jr.

segment of the left internal carotid artery. Fig. 1. Sequential angiograms, lateral view, of the right carotid and the vertebral arteries demonstrating extensive fibromuscular dysplasia of the vertebral artery. A large vertebral arteriovenous fistula located at the C-2 vertebral level, and rapid opacification of the cervical venous plexus, can be seen. The right carotid artery shows no evidence of fibromuscular dysplasia. Fig. 3. Angiography, anteroposterior and lateral views, of the left vertebral artery showing typical changes of fibromuscular

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G. Rees Cosgrove and Jacques Théron

fistula and good filling of the distal vertebral artery ( Fig. 2 right ). The bruit has not recurred during 2 years of follow-up monitoring. Fig. 2. Case 2. Left: Right vertebral angiogram, anteroposterior projection, showing the arteriovenous fistula (arrow) at the C5-6 level between the vertebral artery and vertebral plexus. Right: Right subclavian angiogram performed after detachment of a balloon (arrow) into the fistula. The veins of the vertebral plexus are no longer opacified and the distal vertebral artery fills normally. Discussion

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Roberto C. Heros, Gerard M. Debrun, Robert G. Ojemann, Pierre L. Lasjaunias, and Pierre J. Naessens

S pinal cord arteriovenous malformations (AVM's) can be classified into one of three categories: Type I, the dorsal extramedullary AVM; Type II, the compact, usually intramedullary AVM with multiple feeders; and Type III, the extensive juvenile malformation. 8, 17, 26, 30 This report describes a patient with a direct arteriovenous fistula involving the anterior spinal artery, which cannot be classified under any of these categories. The literature is reviewed and it is proposed that a new category — Type IV, a direct arteriovenous fistula involving the normal

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Intracranial pial arteriovenous fistulas with single-vein drainage

Report of three cases and review of the literature

Yi-Chou Wang, Ho-Fai Wong, and Yi-Shian Yeh

malformations as related to haemorrhagic risks and size of the lesion. Acta Neurochir 103 : 30 – 34 , 1990 Albert P, Salgado H, Polaina M, et al: A study on the venous drainage of 150 cerebral arteriovenous malformations as related to haemorrhagic risks and size of the lesion. Acta Neurochir 103: 30–34, 1990 2. Antunes JL , DiGiacinto GV , Michelsen WJ : Giant hemispheric arteriovenous fistula in an infant. Surg Neurol 7 : 45 – 48 , 1977 Antunes JL, DiGiacinto GV, Michelsen WJ: Giant hemispheric arteriovenous

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Young H. Kim, Philip L. Gildenberg, and Paul M. Duchesneau

R eports of arteriovenous fistulas involving the vertebral arteries are rare, and most are thought to be traumatic. 1, 4, 5, 9 13, 27, 28 Increasing numbers of congenital (spontaneous) fistulas have been reported. 5, 7, 8, 12, 14, 16, 19, 22, 25, 26, 28, 29 Early surgical intervention has usually been recommended whether the lesion was congenital or traumatic. Although there are a few reports of angiographically confirmed spontaneous closure of traumatic arteriovenous fistulas of the vertebral artery, 2, 21 the rare reports of spontaneous closure have not