Clinical features and treatment outcomes of the spinal arteriovenous fistulas and malformations

Clinical article

Restricted access

Object

Spinal vascular diseases, such as spinal dural arteriovenous fistulas (DAVFs), perimedullary arteriovenous fistulas (AVFs), and spinal arteriovenous malformations (AVMs), are very rare. The authors analyzed the features and treatment outcomes of these conditions.

Methods

Data from 64 patients were retrospectively reviewed. There were 33 spinal DAVFs (1 patient had 2 lesions), 20 perimedullary AVFs, and 12 spinal AVMs. Clinical features, radiological findings, treatment results, and clinical outcomes were evaluated according to the diseases, subtypes, and treatment modalities. The median duration of follow-up was 20, 42, and 56 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively.

Results

Spinal DAVFs showed faster progression of symptoms (median 5, 12, and 36 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively) and worse neurological status at diagnosis (poor neurological status in 56%, 65%, and 33%, respectively). On MRI, signal voids were demonstrated in all except 1 spinal DAVF. At the last follow-up, 94% of spinal DAVFs, 68% of perimedullary AVFs, and 50% of spinal AVMs were completely obliterated. Favorable clinical outcomes were achieved in 91%, 95%, and 58%, respectively. In detail, the majority (78%) of spinal DAVFs were embolized, resulting in complete obliteration in 92% and favorable clinical outcomes in 92%. Most Type IVa and IVb perimedullary AVFs were surgically treated (71% and 88%), with complete obliterations of 86% and 71%, and favorable clinical outcomes in 100% and 86%, respectively. All Type IVc lesions were embolized with a low cure rate of 40%; however, clinical outcomes were satisfactory. Spinal AVMs were generally embolized (67%), and only glomus-type lesions attained a satisfactory cure rate (80%) and clinical outcome (100%).

Conclusions

Embolization produced satisfactory outcomes in spinal DAVFs and glomus-type spinal AVMs. Surgery is advantageous in Type IVa and IVb perimedullary AVFs. Palliative embolization can be effective in Type IVc perimedullary AVFs and juvenile spinal AVMs.

Abbreviations used in this paper:ASA = anterior spinal artery; AVF = arteriovenous fistula; AVM = arteriovenous malformation; DAVF = dural AVF; PSA = posterior spinal artery.

Article Information

Address correspondence to: Chun Kee Chung, M.D., Ph.D., Department of Neurosurgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea. email: chungc@snu.ac.kr.

Please include this information when citing this paper: published online May 24, 2013; DOI: 10.3171/2013.4.SPINE12732.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Distributions of the spinal DAVFs (A), perimedullary AVFs (B), and AVMs (C). FM = foramen magnum.

  • View in gallery

    Treatment results of the spinal vascular diseases immediately after treatment (left) and at the last follow-up period (right). One patient with a spinal DAVF (SDAVF) refused to undergo imaging during follow-up. One patient with perimedullary AVF (PMAVF) was lost to follow-up. Dark bars indicate complete obliteration, and light bars indicate incomplete or partial obliteration. Numbers indicate the number of cases. SAVM = spinal AVM.

  • View in gallery

    Clinical outcomes of the spinal vascular diseases immediately after treatment (left) and at the last follow-up period (right). One patient with perimedullary AVF was lost to follow-up. Dark bars indicate favorable outcome, and light bars indicate unfavorable outcome.

  • View in gallery

    Clinical outcomes according to the subtypes of spinal vascular diseases at the last follow-up period. Dark bars indicate favorable outcome, and light bars indicate unfavorable outcome.

  • View in gallery

    Clinical outcomes of the spinal vascular diseases at the last follow-up period according to treatment modality. Dark bars indicate favorable outcome, and light bars indicate unfavorable outcome. E = embolization; S = surgery.

References

1

Afshar JKDoppman JLOldfield EH: Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas. J Neurosurg 82:1962001995

2

Aminoff MJLogue V: Clinical features of spinal vascular malformations. Brain 97:1972101974

3

Aminoff MJLogue V: The prognosis of patients with spinal vascular malformations. Brain 97:2112181974

4

Antonietti LSheth SAHalbach VVHigashida RTDowd CFLawton MT: Long-term outcome in the repair of spinal cord perimedullary arteriovenous fistulas. AJNR Am J Neuroradiol 31:182418302010

5

Baker HL JrLove JGLayton DD Jr: Angiographic and surgical aspects of spinal cord vascular anomalies. Radiology 88:107810851967

6

Barrow DLColohan ARDawson R: Intradural perimedullary arteriovenous fistulas (type IV spinal cord arteriovenous malformations). J Neurosurg 81:2212291994

7

Biondi AMerland JJReizine DAymard AHodes JELecoz P: Embolization with particles in thoracic intramedullary arteriovenous malformations: long-term angiographic and clinical results. Radiology 177:6516581990

8

Cho KTLee DYChung CKHan MHKim HJ: Treatment of spinal cord perimedullary arteriovenous fistula: embolization versus surgery. Neurosurgery 56:2322412005

9

Connolly ES JrZubay GPMcCormick PCStein BM: The posterior approach to a series of glomus (Type II) intramedullary spinal cord arteriovenous malformations. Neurosurgery 42:7747861998

10

Di Chiro GDoppman JOmmaya AK: Selective arteriography of arteriovenous aneurysms of spinal cord. Radiology 88:106510771967

11

Di Chiro GWener L: Angiography of the spinal cord. A review of contemporary techniques and applications. J Neurosurg 39:1291973

12

Djindjian MDjindjian RRey AHurth MHoudart R: Intradural extramedullary spinal arterio-venous malformations fed by the anterior spinal artery. Surg Neurol 8:85931977

13

Er UYigitkanli KSimsek SAdabag ABavbek M: Spinal intradural extramedullary cavernous angioma: case report and review of the literature. Spinal Cord 45:6326362007

14

Eskandar ENBorges LFBudzik RF JrPutman CMOgilvy CS: Spinal dural arteriovenous fistulas: experience with endovascular and surgical therapy. J Neurosurg 96:2 Suppl1621672002

15

Hall WAOldfield EHDoppman JL: Recanalization of spinal arteriovenous malformations following embolization. J Neurosurg 70:7147201989

16

Hassler WThron AGrote EH: Hemodynamics of spinal dural arteriovenous fistulas. An intraoperative study. J Neurosurg 70:3603701989

17

Heros RCDebrun GMOjemann RGLasjaunias PLNaessens PJ: Direct spinal arteriovenous fistula: a new type of spinal AVM. Case report. J Neurosurg 64:1341391986

18

Hurth MHoudart RDjindjian RRey ADjindjian M: Arteriovenous malformations of the spinal cord: clinical, anatomical and therapeutic consideration—a series of 150 cases. Prog Neurol Surg 9:2382661978

19

Jellema KCanta LRTijssen CCvan Rooij WJKoudstaal PJvan Gijn J: Spinal dural arteriovenous fistulas: clinical features in 80 patients. J Neurol Neurosurg Psychiatry 74:143814402003

20

Kendall BELogue V: Spinal epidural angiomatous malformations draining into intrathecal veins. Neuroradiology 13:1811891977

21

McCormick PCTorres RPost KDStein BM: Intramedullary ependymoma of the spinal cord. J Neurosurg 72:5235321990

22

Merland JJReizine DEmbolization techniques in the spinal cord. Dondelinger RFRossi PKurdziel JC: Interventional Radiology New YorkThieme1990. 433442

23

Mourier KLGobin YPGeorge BLot GMerland JJ: Intradural perimedullary arteriovenous fistulae: results of surgical and endovascular treatment in a series of 35 cases. Neurosurgery 32:8858911993

24

Narvid JHetts SWLarsen DNeuhaus JSingh TPMcSwain H: Spinal dural arteriovenous fistulae: clinical features and long-term results. Neurosurgery 62:1591672008

25

Niimi YBerenstein ASetton ANeophytides A: Embolization of spinal dural arteriovenous fistulae: results and followup. Neurosurgery 40:6756831997

26

Oldfield EHDoppman JL: Spinal arteriovenous malformations. Clin Neurosurg 34:1611831988

27

Ommaya AKDi Chiro GDoppman J: Ligation of arterial supply in the treatment of spinal cord arteriovenous malformations. J Neurosurg 30:6796921969

28

Park SBHan MHJahng TAKwon BJChung CK: Spinal dural arteriovenous fistulas: clinical experience with endovascular treatment as a primary therapeutic modality. J Korean Neurosurg Soc 44:3643692008

29

Rosenblum BOldfield EHDoppman JLDi Chiro G: Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM's in 81 patients. J Neurosurg 67:7958021987

30

Song JKVinuela FGobin YPDuckwiler GRMurayama YKureshi I: Surgical and endovascular treatment of spinal dural arteriovenous fistulas: long-term disability assessment and prognostic factors. J Neurosurg 94:2 Suppl1992042001

31

Spetzler RFDetwiler PWRiina HAPorter RW: Modified classification of spinal cord vascular lesions. J Neurosurg 96:2 Suppl1451562002

32

Steinmetz MPChow MMKrishnaney AAAndrews-Hinders DBenzel ECMasaryk TJ: Outcome after the treatment of spinal dural arteriovenous fistulae: a contemporary single-institution series and meta-analysis. Neurosurgery 55:77882004

33

Symon LKuyama HKendall B: Dural arteriovenous malformations of the spine. Clinical features and surgical results in 55 cases. J Neurosurg 60:2382471984

34

Yaşargil MGSymon LTeddy PJArteriovenous malformations of the spinal cord. Symon L: Advances and Technical Standards in Neurosurgery ViennaSpringer-Verlag1984. 11:61102

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 105 105 15
Full Text Views 105 105 10
PDF Downloads 67 67 9
EPUB Downloads 0 0 0

PubMed

Google Scholar