Endovascular treatment of intracranial dural arteriovenous fistulas with spinal perimedullary venous drainage

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  • 1 Service de Neuroradiologie, Hôpital Lariboisière, Paris, Service de Radiologie, Hôpital Pasteur, Nice, and Service de Neuroradiologie, Hôpital Pitie-Salpetrière, Paris, France
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✓ Intracranial dural arteriovenous (AV) fistulas with spinal perimedullary venous drainage are rare lesions that have distinctive clinical, radiological, and therapeutic aspects. Five patients presented with an ascending myelopathy, which extended to involve the brain stem in three cases. Myelography and magnetic resonance imaging showed slightly dilated spinal perimedullary vessels. Spinal angiograms were normal in the arterial phase. Diagnosis was only possible after cerebral angiography, which demonstrated posterior fossa AV fistulas fed by meningeal arteries and draining into spinal perimedullary veins. Endovascular treatment alone resulted in angiographic obliteration of the lesion in three patients. Two patients required surgery in addition to endovascular therapy. One patient died postoperatively, and in one a transient complication of embolization was observed. Improvement after treatment was good in two cases and fair in two. Transverse sinus thrombosis was observed in three cases and was probably the cause of the aberrant venous drainage of the fistula into the spinal perimedullary veins. The pathophysiology is related to spinal cord venous hypertension. These lesions were classified as Type 5 in the Djindjian and Merland classification of dural intracranial AV fistulas. Endovascular therapy is a safe effective method in the treatment of these fistulas and should be tried first.

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  • 1.

    Awad IA, , Little JR, & Akrawi WP, et al: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72:839850, 1990 Awad IA, Little JR, Akrawi WP, et al: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72:839–850, 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Barnwell SL, , Halbach VV, & Dowd CF, et al: Multiple dural arteriovenous fistulas of the cranium and spine. AJNR 12:441445, 1991 Barnwell SL, Halbach VV, Dowd CF, et al: Multiple dural arteriovenous fistulas of the cranium and spine. AJNR 12:441–445, 1991

    • Search Google Scholar
    • Export Citation
  • 3.

    Castaigne P, , Bories J, & Brunet P, et al: Les fistules artério-veineuses méningées pures à drainage veineux cortical. Rev Neurol 132:169182, 1976 Castaigne P, Bories J, Brunet P, et al: Les fistules artério-veineuses méningées pures à drainage veineux cortical. Rev Neurol 132:169–182, 1976

    • Search Google Scholar
    • Export Citation
  • 4.

    Djindjian R, & Merland JJ: Superselective Arteriography of the External Carotid Artery. Berlin: Springer-Verlag, 1978, pp 606628 Djindjian R, Merland JJ: Superselective Arteriography of the External Carotid Artery. Berlin: Springer-Verlag, 1978, pp 606–628

    • Search Google Scholar
    • Export Citation
  • 5.

    Fermand M, , Reizine D, & Melki JP, et al: Long term follow-up of 43 pure dural arteriovenous fistulae (AVF) of the lateral sinus. Neuroradiology 29:348353, 1987 Fermand M, Reizine D, Melki JP, et al: Long term follow-up of 43 pure dural arteriovenous fistulae (AVF) of the lateral sinus. Neuroradiology 29:348–353, 1987

    • Search Google Scholar
    • Export Citation
  • 6.

    Gaensler EH, , Jackson DE, & Halbach VV: Arteriovenous fistulas of the cervicomedullary junction as a cause of myelopathy: radiographic findings in two cases. AJNR 11:518521, 1990 Gaensler EH, Jackson DE, Halbach VV: Arteriovenous fistulas of the cervicomedullary junction as a cause of myelopathy: radiographic findings in two cases. AJNR 11:518–521, 1990

    • Search Google Scholar
    • Export Citation
  • 7.

    Gaston A, , Chiras J, & Bourbotte G, et al: Meningeal arteriovenous fistulae draining into cortical veins. 31 cases. J Neuroradiol 11:161177, 1984 Gaston A, Chiras J, Bourbotte G, et al: Meningeal arteriovenous fistulae draining into cortical veins. 31 cases. J Neuroradiol 11:161–177, 1984

    • Search Google Scholar
    • Export Citation
  • 8.

    Houser OW, , Baker HL Jr, & Rhoton AL Jr, et al: Intracranial dural arteriovenous malformations. Radiology 105:5564, 1972 Houser OW, Baker HL Jr, Rhoton AL Jr, et al: Intracranial dural arteriovenous malformations. Radiology 105:55–64, 1972

    • Search Google Scholar
    • Export Citation
  • 9.

    Lasjaunias P, , Chiu M, & TerBrugge K, et al: Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 64:724730, 1986 Lasjaunias P, Chiu M, TerBrugge K, et al: Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 64:724–730, 1986

    • Search Google Scholar
    • Export Citation
  • 10.

    Launay M, , Chiras J, & Bories J: Angiography of the spinal cord: venous phase. Normal features. Pathological application. J Neuroradiol 6:287315, 1979 Launay M, Chiras J, Bories J: Angiography of the spinal cord: venous phase. Normal features. Pathological application. J Neuroradiol 6:287–315, 1979

    • Search Google Scholar
    • Export Citation
  • 11.

    Merland JJ, , Riché MC, & Chiras J: Intraspinal extramedullary arteriovenous fistulae draining into the medullary veins. J Neuroradiol 7:271320, 1980 Merland JJ, Riché MC, Chiras J: Intraspinal extramedullary arteriovenous fistulae draining into the medullary veins. J Neuroradiol 7:271–320, 1980

    • Search Google Scholar
    • Export Citation
  • 12.

    Newton TH, & Cronqvist S: Involvement of the dural arteries in intracranial arteriovenous malformations. Radiology 93:10711078, 1969 Newton TH, Cronqvist S: Involvement of the dural arteries in intracranial arteriovenous malformations. Radiology 93:1071–1078, 1969

    • Search Google Scholar
    • Export Citation
  • 13.

    Picard L, , Bracard S, & Moret J, et al: Spontaneous dural arteriovenous fistulas. Semin Intervent Radiol 4:219241, 1987 Picard L, Bracard S, Moret J, et al: Spontaneous dural arteriovenous fistulas. Semin Intervent Radiol 4:219–241, 1987

    • Search Google Scholar
    • Export Citation
  • 14.

    Piton J, , Guilleux MH, & Guibert-Tranier F, et al: Fistulae of the lateral sinus. J Neuroradiol 11:143159, 1984 Piton J, Guilleux MH, Guibert-Tranier F, et al: Fistulae of the lateral sinus. J Neuroradiol 11:143–159, 1984

    • Search Google Scholar
    • Export Citation
  • 15.

    Rivierez M, , Gazengel J, & Chiras J, et al: Les fistules artério-veineuses vertébro-durales du trou occipital à drainage médullaire. Deux observations. Neurochirurgie 37:179184, 1991 Rivierez M, Gazengel J, Chiras J, et al: Les fistules artério-veineuses vertébro-durales du trou occipital à drainage médullaire. Deux observations. Neurochirurgie 37:179–184, 1991

    • Search Google Scholar
    • Export Citation
  • 16.

    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 Symon L, Kuyama H, Kendall B: Dural arteriovenous malformations of the spine. Clinical features and surgical results in 55 cases. J Neurosurg 60:238–247, 1984

    • Search Google Scholar
    • Export Citation
  • 17.

    Viñuela F, , Fox AJ, & Pelz DM, et al: Unusual clinical manifestations of dural arteriovenous malformations. J Neurosurg 64:554558, 1986 Viñuela F, Fox AJ, Pelz DM, et al: Unusual clinical manifestations of dural arteriovenous malformations. J Neurosurg 64:554–558, 1986

    • Search Google Scholar
    • Export Citation
  • 18.

    Willinsky R, , Lasjaunias P, & Terbrugge K, et al: Angiography in the investigation of spinal dural arteriovenous fistula. A protocol with application of the venous phase. Neuroradiology 32:114116, 1990 Willinsky R, Lasjaunias P, Terbrugge K, et al: Angiography in the investigation of spinal dural arteriovenous fistula. A protocol with application of the venous phase. Neuroradiology 32:114–116, 1990

    • Search Google Scholar
    • Export Citation
  • 19.

    Woimant F, , Merland JJ, & Riché MC, et al: Syndrome bulbo-médullaire en rapport avec une fistule artério-veineuse méningée du sinus latéral à drainage veineux médullaire. Rev Neurol 138:559566, 1982 Woimant F, Merland JJ, Riché MC, et al: Syndrome bulbo-médullaire en rapport avec une fistule artério-veineuse méningée du sinus latéral à drainage veineux médullaire. Rev Neurol 138:559–566, 1982

    • Search Google Scholar
    • Export Citation
  • 20.

    Wrobel CJ, , Oldfield EH, & Di Chiro G, et al: Myelopathy due to intracranial dural arteriovenous fistulas draining intrathecally into spinal medullary veins. Report of three cases. J Neurosurg 69:934939, 1988 Wrobel CJ, Oldfield EH, Di Chiro G, et al: Myelopathy due to intracranial dural arteriovenous fistulas draining intrathecally into spinal medullary veins. Report of three cases. J Neurosurg 69:934–939, 1988

    • Search Google Scholar
    • Export Citation

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