Three-dimensional angioarchitecture of spinal dural arteriovenous fistulas, with special reference to the intradural retrograde venous drainage system

Clinical article

Keisuke Takai M.D., Ph.D.1, Taichi Kin M.D., Ph.D.1, Hiroshi Oyama M.D., Ph.D.2, Masaaki Shojima M.D., Ph.D.1, and Nobuhito Saito M.D., Ph.D.1
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  • 1 Department of Neurosurgery, The University of Tokyo Hospital; and
  • | 2 Department of Clinical Information Engineering, Health Science Services, School of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
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Object

There have been significant advances in understanding the angioarchitecture of spinal dural arteriovenous fistulas (AVFs). However, the major intradural retrograde venous drainage system has not been investigated in detail, including the most proximal sites of intradural radiculomedullary veins as they connect to the dura mater, which are the final targets of interruption in both microsurgical and endovascular treatments.

Methods

Between April 1984 and March 2011, 27 patients with 28 AVFs were treated for spinal dural AVFs at the authors' university hospital. The authors assessed vertebral levels of feeding arteries and dural AVFs by using conventional digital subtraction angiography. They also assessed 3D locations of the most proximal sites of intradural radiculomedullary veins and the 3D positional relationship between the major intradural retrograde venous drainage system and intradural neural structures, including the spinal cord, spinal nerves, and the artery of Adamkiewicz, by using operative video recordings plus 3D rotational angiography and/or 3D computer graphics. In addition, they statistically assessed the clinical results of 27 cases. Of these lesions, 23 were treated with open microsurgery and the rest were treated with endovascular methods.

Results

Feeding arteries consisted of T2–10 intercostal arteries with 19 lesions, T-12 subcostal arteries with 3 lesions, and L1–3 lumbar arteries with 6 lesions. The 3D locations of the targets of interruption (the most proximal sites of intradural radiculomedullary veins as they connect to the dura mater) were identified at the dorsolateral portion of the dura mater adjacent to dorsal roots in all 19 thoracic lesions, whereas they were identified at the ventrolateral portion of the dura mater adjacent to ventral roots in 7 (78%) of 9 cases of conus medullaris/lumbar lesions (p < 0.001). The major intradural retrograde venous drainage system was located dorsal to the spinal cord in all 19 thoracic lesions, whereas it was located ventral to the spinal cord in 4 (44%) of 9 cases of conus/lumbar lesions (p = 0.006). In 3 (11%) of 27 cases, AVFs had a common origin of the artery of Adamkiewicz. In 2 lumbar lesions, the artery of Adamkiewicz ascended very close to the vein because of its ventral location. Although all lesions were successfully obliterated without major complications and both gait and micturition status significantly improved (p = 0.005 and p = 0.015, respectively), conus/lumbar lesions needed careful differential diagnosis from ventral intradural perimedullary AVFs, because the ventral location of these lesions contradicted the Spetzler classification system.

Conclusions

The angioarchitecture of spinal dural AVFs in the thoracic region is strikingly different from that in conus/lumbar regions with regard to the intradural retrograde venous drainage system. One should keep in mind that spinal dural AVFs are not always dorsal types, especially in conus/lumbar regions.

Abbreviations used in this paper:

AVF = arteriovenous fistula; CG = computer graphics; DSA = digital subtraction angiography; RA = rotational angiography.

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Contributor Notes

Address correspondence to: Keisuke Takai, M.D., Ph.D., Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. email: takai-nsu@umin.ac.jp.

Please include this information when citing this paper: published online February 22, 2013; DOI: 10.3171/2013.1.SPINE12305.

  • 1

    Afshar JK, , Doppman JL, & Oldfield EH: Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas. J Neurosurg 82:196200, 1995

    • Search Google Scholar
    • Export Citation
  • 2

    Aggarwal S, , Willinsky R, , Montanera W, , Terbrugge K, & Wallace MC: Super-selective angiography of a spinal dural arteriovenous fistula having a common segmental origin with the artery of Adamkiewicz. Neuroradiology 34:352354, 1992

    • Search Google Scholar
    • Export Citation
  • 3

    Aminoff MJ, & Logue V: The prognosis of patients with spinal vascular malformations. Brain 97:211218, 1974

  • 4

    Atkinson JL, , Miller GM, , Krauss WE, , Marsh WR, , Piepgras DG, & Atkinson PP, et al. : Clinical and radiographic features of dural arteriovenous fistula, a treatable cause of myelopathy. Mayo Clin Proc 76:11201130, 2001

    • Search Google Scholar
    • Export Citation
  • 5

    Barrow DL, , Colohan AR, & Dawson R: Intradural perimedullary arteriovenous fistulas (type IV spinal cord arteriovenous malformations). J Neurosurg 81:221229, 1994

    • Search Google Scholar
    • Export Citation
  • 6

    Benhaiem N, , Poirier J, & Hurth M: Arteriovenous fistulae of the meninges draining into the spinal veins. A histological study of 28 cases. Acta Neuropathol 62:103111, 1983

    • Search Google Scholar
    • Export Citation
  • 7

    Britz GW, , Lazar D, , Eskridge J, & Winn HR: Accurate intraoperative localization of spinal dural arteriovenous fistulae with embolization coil: technical note. Neurosurgery 55:252255, 2004

    • Search Google Scholar
    • Export Citation
  • 8

    Dehdashti AR, , Da Costa LB, , terBrugge KG, , Willinsky RA, , Tymianski M, & Wallace MC: Overview of the current role of endovascular and surgical treatment in spinal dural arteriovenous fistulas. Neurosurg Focus 26:1 E8, 2009

    • Search Google Scholar
    • Export Citation
  • 9

    Eddleman CS, , Jeong H, , Cashen TA, , Walker M, , Bendok BR, & Batjer HH, et al. : Advanced noninvasive imaging of spinal vascular malformations. Neurosurg Focus 26:1 E9, 2009

    • Search Google Scholar
    • Export Citation
  • 10

    Gilbertson JR, , Miller GM, , Goldman MS, & Marsh WR: Spinal dural arteriovenous fistulas: MR and myelographic findings. AJNR Am J Neuroradiol 16:20492057, 1995

    • Search Google Scholar
    • Export Citation
  • 11

    Gillilan LA: Veins of the spinal cord. Anatomic details; suggested clinical applications. Neurology 20:860868, 1970

  • 12

    Hanakita S, , Takai K, , Kin T, , Shojima M, & Saito N: Double independent spinal dural arteriovenous fistulas at the thoracic spine. Acta Neurochir (Wien) 154:11571158, 2012

    • Search Google Scholar
    • Export Citation
  • 13

    Hanel RA, , Nakaji P, & Spetzler RF: Use of microscope-integrated near-infrared indocyanine green videoangiography in the surgical treatment of spinal dural arteriovenous fistulae. Neurosurgery 66:978985, 2010

    • Search Google Scholar
    • Export Citation
  • 14

    Jellema K, , Sluzewski M, , van Rooij WJ, , Tijssen CC, & Beute GN: Embolization of spinal dural arteriovenous fistulas: importance of occlusion of the draining vein. J Neurosurg Spine 2:580583, 2005

    • Search Google Scholar
    • Export Citation
  • 15

    Jellema K, , Tijssen CC, & van Gijn J: Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder. Brain 129:31503164, 2006

    • Search Google Scholar
    • Export Citation
  • 16

    Kim LJ, & Spetzler RF: Classification and surgical management of spinal arteriovenous lesions: arteriovenous fistulae and arteriovenous malformations. Neurosurgery 59:5 Suppl 3 S195S201, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Koenig E, , Thron A, , Schrader V, & Dichgans J: Spinal arteriovenous malformations and fistulae: clinical, neuroradiological and neurophysiological findings. J Neurol 236:260266, 1989

    • Search Google Scholar
    • Export Citation
  • 18

    Lai PH, , Weng MJ, , Lee KW, & Pan HB: Multidetector CT angiography in diagnosing type I and type IVA spinal vascular malformations. AJNR Am J Neuroradiol 27:813817, 2006

    • Search Google Scholar
    • Export Citation
  • 19

    Lasjaunias P, , Berenstein A, & Raybaud C: Surgical Neuroangiography Volume 3 Functional Vascular Anatomy of Brain, Spinal Cord and Spine Berlin Heidelberg, Springer-Verlag, 1990. 6879

    • Search Google Scholar
    • Export Citation
  • 20

    McCutcheon IE, , Doppman JL, & Oldfield EH: Microvascular anatomy of dural arteriovenous abnormalities of the spine: a microangiographic study. J Neurosurg 84:215220, 1996

    • Search Google Scholar
    • Export Citation
  • 21

    Oldfield EH, , Di Chiro G, , Quindlen EA, , Rieth KG, & Doppman JL: Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula. J Neurosurg 59:10191030, 1983

    • Search Google Scholar
    • Export Citation
  • 22

    Prestigiacomo CJ, , Niimi Y, , Setton A, & Berenstein A: Three-dimensional rotational spinal angiography in the evaluation and treatment of vascular malformations. AJNR Am J Neuroradiol 24:14291435, 2003

    • Search Google Scholar
    • Export Citation
  • 23

    Rosenblum B, , Oldfield EH, , Doppman JL, & Di Chiro G: Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM's in 81 patients. J Neurosurg 67:795802, 1987

    • Search Google Scholar
    • Export Citation
  • 24

    Saraf-Lavi E, , Bowen BC, , Quencer RM, , Sklar EM, , Holz A, & Falcone S, et al. : Detection of spinal dural arteriovenous fistulae with MR imaging and contrast-enhanced MR angiography: sensitivity, specificity, and prediction of vertebral level. AJNR Am J Neuroradiol 23:858867, 2002

    • Search Google Scholar
    • Export Citation
  • 25

    Spetzler RF, , Detwiler PW, , Riina HA, & Porter RW: Modified classification of spinal cord vascular lesions. J Neurosurg 96:2 Suppl 145156, 2002

    • Search Google Scholar
    • Export Citation
  • 26

    Steinmetz MP, , Chow MM, , Krishnaney AA, , Andrews-Hinders D, , Benzel EC, & Masaryk TJ, et al. : Outcome after the treatment of spinal dural arteriovenous fistulae: a contemporary single-institution series and meta-analysis. Neurosurgery 55:7788, 2004

    • Search Google Scholar
    • Export Citation
  • 27

    Symon L, , Kuyama H, & Kendall B: Dural arteriovenous malformations of the spine. Clinical features and surgical results in 55 cases. J Neurosurg 60:238247, 1984

    • Search Google Scholar
    • Export Citation
  • 28

    Tadié M, , Hemet J, , Freger P, , Clavier E, & Creissard P: Morphological and functional anatomy of spinal cord veins. J Neuroradiol 12:320, 1985

    • Search Google Scholar
    • Export Citation
  • 29

    Takai K, , Kin T, , Oyama H, , Iijima A, , Shojima M, & Nishido H, et al. : The use of 3D computer graphics in the diagnosis and treatment of spinal vascular malformations. Clinical article. J Neurosurg Spine 15:654659, 2011

    • Search Google Scholar
    • Export Citation
  • 30

    Takai K, & Taniguchi M: Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: a systematic literature review. Neurosurg Focus 32:5 E8, 2012

    • Search Google Scholar
    • Export Citation
  • 31

    Takai K, & Usui M: Spontaneous thrombosis of a spinal conus perimedullary arteriovenous fistula. Case report Neurol Med Chir (Tokyo) 52:103106, 2012

    • Search Google Scholar
    • Export Citation
  • 32

    Van Dijk JM, , TerBrugge KG, , Willinsky RA, , Farb RI, & Wallace MC: Multidisciplinary management of spinal dural arteriovenous fistulas: clinical presentation and long-term follow-up in 49 patients. Stroke 33:15781583, 2002

    • Search Google Scholar
    • Export Citation

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