Recognition of the variant type of spinal dural arteriovenous fistula: a rare but important consideration

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  • 1 Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada;
  • | 2 Department of Neuroradiology, Royal Victoria Hospital, Belfast, County Antrim, United Kingdom; and
  • | 3 Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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OBJECTIVE

Spinal dural arteriovenous fistulas (SDAVFs) typically represent abnormal shunts between a radiculomeningeal artery and radicular vein, with the point of fistulization classically directly underneath the pedicle of the vertebral body, at the dural sleeve of the nerve root. However, SDAVFs can also develop in atypical locations or have more than one arterial feeder, which is a variant of SDAVF. The aim of this study was to describe the incidence and multidisciplinary treatment of variant SDAVFs in a single-center case series.

METHODS

Following institutional review board approval, the authors retrospectively analyzed their prospectively maintained database of patients with SDAVFs who presented between 2008 and 2020. For all patients, spinal digital subtraction angiograms were reviewed and variant SDAVFs were identified. Variant types of SDAVFs were defined as cases in which the fistulous point was not located underneath the pedicle. Patient demographics, angiographic features, clinical outcomes, and treatment modalities were assessed.

RESULTS

Of 59 patients with SDAVFs treated at the authors’ institution, 4 patients (6.8%) were identified as having a variant location of the shunt zone, pinpointed on the dura mater at the intervertebral level, further posteriorly within the spinal canal. In 3 cases (75%), a so-called bimetameric arterial supply was demonstrated.

CONCLUSIONS

Recognition of the variant type of SDAVF is crucial for management, as correct localization of the fistulous point and bimetameric supply are critical for successful surgical disconnection, preventing delay in achieving definitive treatment.

ABBREVIATIONS

DSA = digital subtraction angiography; SDAVF = spinal dural arteriovenous fistula.

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  • 1

    Kendall BE, Logue V. Spinal epidural angiomatous malformations draining into intrathecal veins. Neuroradiology. 1977;13(4):181189.

  • 2

    Merland JJ, Riche MC, Chiras J. Intraspinal extramedullary arteriovenous fistulae draining into the medullary veins. J Neuroradiol. 1980;7(4):271320.

  • 3

    Behrens S, Thron A. Long-term follow-up and outcome in patients treated for spinal dural arteriovenous fistula. J Neurol. 1999;246(3):181185.

  • 4

    Krings T, Geibprasert S. Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2009;30(4):639648.

  • 5

    Jellema K, Tijssen CC, van Gijn J. Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder. Brain. 2006;129(Pt 12):31503164.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Kataoka H, Miyamoto S, Nagata I, Ueba T, Hashimoto N. Venous congestion is a major cause of neurological deterioration in spinal arteriovenous malformations. Neurosurgery. 2001;48(6):12241230.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Hurst RW, Kenyon LC, Lavi E, Raps EC, Marcotte P. Spinal dural arteriovenous fistula: the pathology of venous hypertensive myelopathy. Neurology. 1995;45(7):13091313.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Krings T, Lasjaunias PL, Hans FJ, et al. Imaging in spinal vascular disease. Neuroimaging Clin N Am. 2007;17(1):5772.

  • 9

    Krings T, Lasjaunias PL, Geibprasert S, et al. Classification of spinal vascular malformations. Neuroradiol J. 2009;22(1 suppl):97106.

  • 10

    Kiyosue H, Matsumaru Y, Niimi Y, et al. Angiographic and clinical characteristics of thoracolumbar spinal epidural and dural arteriovenous fistulas. Stroke. 2017;48(12):32153222.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Nasr DM, Brinjikji W, Clarke MJ, Lanzino G. Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas. J Neurosurg Spine. 2017;26(5):613620.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Geibprasert S, Pereira V, Krings T, et al. Dural arteriovenous shunts: a new classification of craniospinal epidural venous anatomical bases and clinical correlations. Stroke. 2008;39(10):27832794.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Lasjaunias P, Berenstein A, ter Brugge KG. Spinal and spinal cord arteries and veins. In: Lasjaunias P, Berenstein A, ter Brugge KG. Clinical Vascular Anatomy and Variations. Springer-Verlag Berlin Heidelberg; 2001:154158.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Berenstein A, Lasjaunias P, ter Brugge KG. Spinal dural arteriovenous fistulae. In: Berenstein A, Lasjaunias P, ter Brugge KG. Surgical Neuroangiography. Vol 2: Clinical and Endovascular Treatment Aspects in Adults. Springer-Verlag Berlin Heidelberg; 2004:851-852.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Gemmete JJ, Chaudhary N, Elias AE, et al. Spinal dural arteriovenous fistulas: clinical experience with endovascular treatment as a primary therapy at 2 academic referral centers. AJNR Am J Neuroradiol. 2013;34(10):19741979.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Aminoff MJ, Logue V. The prognosis of patients with spinal vascular malformations. Brain. 1974;97(1):211218.

  • 17

    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. 2009;26(1):E8.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Song JK, Viñuela F, Gobin YP, et al. Surgical and endovascular treatment of spinal dural arteriovenous fistulas: long-term disability assessment and prognostic factors. J Neurosurg. 2001;94(2 Suppl):199204.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Safaee MM, Clark AJ, Burkhardt JK, Winkler EA, Lawton MT. Timing, severity of deficits, and clinical improvement after surgery for spinal dural arteriovenous fistulas. J Neurosurg Spine. 2018;29(1):8591.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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