Microvascular anatomy of dural arteriovenous abnormalities of the spine: a microangiographic study

Restricted access

✓ Although most vascular abnormalities of the spinal cord are now ascribed to an abnormal communication between a dural artery and a medullary vein on the dura near a sensory nerve root, these lesions are too small for their anatomy to be demonstrated directly by spinal arteriography. Thus, it is unknown whether the site of dural arteriovenous shunting is an arteriovenous malformation (AVM), implying a congenital origin, or is a direct arteriovenous fistula (AVF), implying an acquired etiology.

The authors treated six patients by en bloc resection of the involved dural root sleeve, proximal nerve root, and adjacent spinal dura. All of the patients presented with myelopathy and their arteriograms were consistent with a spinal dural vascular malformation. The lesions occurred between T-6 and T-12, levels at which clinical deficits from such resection are minimal. The dural artery or medullary vein associated with the vascular malformation was cannulated and a dilute solution of barium sulfate was injected during sequential fine-grain radiography. In all of the lesions the artery split into daughter vessels that coalesced one to three times to form a skein of arterial loops in the dura that invariably emptied into a medullary vein without an intervening capillary plexus. Several medium-to-small collateral vessels arising from adjacent intercostal or lumbar arteries were commonly present in the dura and converged at the site of the AVF to join a single medullary vein.

These results show that spinal dural AVMs are direct AVFs that link the dural branch of the radiculo-medullarydural artery with the intradural medullary vein. They also provide an anatomical explanation for the presence of a multiple segmental arterial supply and a single draining medullary vein of spinal dural AVFs, and the propensity for reestablishment of flow through the arteriovenous shunt after embolic occlusion.

Article Information

Contributor Notes

Current address for Dr. McCutcheon: The University of Texas M.D. Anderson Cancer Center, Houston, Texas.Address reprint requests to: Edward H. Oldfield, M.D., Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, Room 5D37, Bethesda, Maryland 20892.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1.

    Afshar JKBDoppman JLOldfield EH: Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas. J Neurosurg 82:1962001995Afshar JKB Doppman JL Oldfield EH: Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas. J Neurosurg 82:196–200 1995

    • Search Google Scholar
    • Export Citation
  • 2.

    Aminoff MJBarnard ROLogue V: The pathophysiology of spinal vascular malformations. J Neurol Sci 23:2552631974Aminoff MJ Barnard RO Logue V: The pathophysiology of spinal vascular malformations. J Neurol Sci 23:255–263 1974

    • Search Google Scholar
    • Export Citation
  • 3.

    Benhaiem NPoirier JHurth M: Arteriovenous fistulae of the meninges draining into the spinal veins. A histological study of 28 cases. Acta Neuropathol 62:1031111983Benhaiem N Poirier J Hurth M: Arteriovenous fistulae of the meninges draining into the spinal veins. A histological study of 28 cases. Acta Neuropathol 62:103–111 1983

    • Search Google Scholar
    • Export Citation
  • 4.

    Biondi AMerland JJReizine Det al: Embolization with particles in thoracic intramedullary arteriovenous malformations: long-term angiographic and clinical results. Radiology 177:6516581990Biondi A Merland JJ Reizine D et al: Embolization with particles in thoracic intramedullary arteriovenous malformations: long-term angiographic and clinical results. Radiology 177:651–658 1990

    • Search Google Scholar
    • Export Citation
  • 5.

    Cahan LDHigashida RTHalbach VVet al: Variants of radiculomeningeal vascular malformations of the spine. J Neurosurg 66:3333371987Cahan LD Higashida RT Halbach VV et al: Variants of radiculomeningeal vascular malformations of the spine. J Neurosurg 66:333–337 1987

    • Search Google Scholar
    • Export Citation
  • 6.

    Chaudhary MYSachdev VPCho SHet al: Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR 3:13191982Chaudhary MY Sachdev VP Cho SH et al: Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR 3:13–19 1982

    • Search Google Scholar
    • Export Citation
  • 7.

    Criscuolo GROldfield EHDoppman JL: Reversible acute and subacute myelopathy in patients with dural arteriovenous fistulas. Foix-Alajouanine syndrome reconsidered. J Neurosurg 70:3543591989Criscuolo GR Oldfield EH Doppman JL: Reversible acute and subacute myelopathy in patients with dural arteriovenous fistulas. Foix-Alajouanine syndrome reconsidered. J Neurosurg 70:354–359 1989

    • Search Google Scholar
    • Export Citation
  • 8.

    Doppman JLDi Chiro GDwyer AJet al: Magnetic resonance imaging of spinal arteriovenous malformations. J Neurosurg 66:8308341987Doppman JL Di Chiro G Dwyer AJ et al: Magnetic resonance imaging of spinal arteriovenous malformations. J Neurosurg 66:830–834 1987

    • Search Google Scholar
    • Export Citation
  • 9.

    Doppman JLDi Chiro GOldfield EH: Origin of spinal arteriovenous malformation and normal cord vasculature from a common segmental artery: angiographic and therapeutic considerations. Radiology 154:6876891985Doppman JL Di Chiro G Oldfield EH: Origin of spinal arteriovenous malformation and normal cord vasculature from a common segmental artery: angiographic and therapeutic considerations. Radiology 154:687–689 1985

    • Search Google Scholar
    • Export Citation
  • 10.

    Dormont DGelbert FAssouline Eet al: MR imaging of spinal cord arteriovenous malformations at 0.5 T: study of 34 cases. AJNR 9:8338381988Dormont D Gelbert F Assouline E et al: MR imaging of spinal cord arteriovenous malformations at 0.5 T: study of 34 cases. AJNR 9:833–838 1988

    • Search Google Scholar
    • Export Citation
  • 11.

    Giller CAMeyer YJBatjer HH: Hemodynamic assessment of the spinal cord arteriovenous malformation with intraoperative microvascular Doppler ultrasound: case report. Neurosurgery 25:2702751989Giller CA Meyer YJ Batjer HH: Hemodynamic assessment of the spinal cord arteriovenous malformation with intraoperative microvascular Doppler ultrasound: case report. Neurosurgery 25:270–275 1989

    • Search Google Scholar
    • Export Citation
  • 12.

    Gillilan LA: The arterial blood supply to the human spinal cord. J Comp Neurol 110:751031958Gillilan LA: The arterial blood supply to the human spinal cord. J Comp Neurol 110:75–103 1958

    • Search Google Scholar
    • Export Citation
  • 13.

    Gillilan LA: Veins of the spinal cord. Anatomic details; suggested clinical applications. Neurology 20:8608681970Gillilan LA: Veins of the spinal cord. Anatomic details; suggested clinical applications. Neurology 20:860–868 1970

    • Search Google Scholar
    • Export Citation
  • 14.

    Hall WAOldfield EHDoppman JL: Recanalization of spinal arteriovenous malformations following embolization. J Neurosurg 70:7147201989Hall WA Oldfield EH Doppman JL: Recanalization of spinal arteriovenous malformations following embolization. J Neurosurg 70:714–720 1989

    • Search Google Scholar
    • Export Citation
  • 15.

    Hassler WThron AGrote EH: Hemodynamics of spinal dural arteriovenous fistulas. An intraoperative study. J Neurosurg 70:3603701989Hassler W Thron A Grote EH: Hemodynamics of spinal dural arteriovenous fistulas. An intraoperative study. J Neurosurg 70:360–370 1989

    • Search Google Scholar
    • Export Citation
  • 16.

    Heier LALee BCP: A dural spinal arteriovenous malformation with epidural venous drainage: a case report. AJNR 8:5615631987Heier LA Lee BCP: A dural spinal arteriovenous malformation with epidural venous drainage: a case report. AJNR 8:561–563 1987

    • Search Google Scholar
    • Export Citation
  • 17.

    Isu TIwasaki YAkino Met al: Magnetic resonance imaging in cases of spinal dural arteriovenous malformation. Neurosurgery 24:9199231989Isu T Iwasaki Y Akino M et al: Magnetic resonance imaging in cases of spinal dural arteriovenous malformation. Neurosurgery 24:919–923 1989

    • Search Google Scholar
    • Export Citation
  • 18.

    Kendall BELogue V: Spinal epidural angiomatous malformations draining into intrathecal veins. Neuroradiology 13:1811891977Kendall BE Logue V: Spinal epidural angiomatous malformations draining into intrathecal veins. Neuroradiology 13:181–189 1977

    • Search Google Scholar
    • Export Citation
  • 19.

    Logue V: Angiomas of the spinal cord: review of the pathogenesis, clinical features, and results of surgery. J Neurol Neurosurg Psychiatry 42:1111979Logue V: Angiomas of the spinal cord: review of the pathogenesis clinical features and results of surgery. J Neurol Neurosurg Psychiatry 42:1–11 1979

    • Search Google Scholar
    • Export Citation
  • 20.

    Manelfe CLazorthes GRoulleau J: Artères de la dure-mère rachidienne chez l'homme. Acta Radiol (Diag) 13:8298411972Manelfe C Lazorthes G Roulleau J: Artères de la dure-mère rachidienne chez l'homme. Acta Radiol (Diag) 13:829–841 1972

    • Search Google Scholar
    • Export Citation
  • 21.

    Merland JJRiche MCChiras J: Intraspinal extramedullary arteriovenous fistulae draining into the medullary veins. AJNR 7:2713201980Merland JJ Riche MC Chiras J: Intraspinal extramedullary arteriovenous fistulae draining into the medullary veins. AJNR 7:271–320 1980

    • Search Google Scholar
    • Export Citation
  • 22.

    Morgan MKMarsh WR: Management of spinal dural arteriovenous malformations. J Neurosurg 70:8328361989Morgan MK Marsh WR: Management of spinal dural arteriovenous malformations. J Neurosurg 70:832–836 1989

    • Search Google Scholar
    • Export Citation
  • 23.

    Mourier KLGelbert FRey Aet al: Spinal dural arteriovenous malformations with perimedullary drainage. Indications and results of surgery in 30 cases. Acta Neurochir 100:1361411989Mourier KL Gelbert F Rey A et al: Spinal dural arteriovenous malformations with perimedullary drainage. Indications and results of surgery in 30 cases. Acta Neurochir 100:136–141 1989

    • Search Google Scholar
    • Export Citation
  • 24.

    N'Diaye MChiras JMeder JFet al: Water-soluble myelography for the study of dural arteriovenous fistulae of the spine draining in the spinal venous system. AJNR 11:3273391984N'Diaye M Chiras J Meder JF et al: Water-soluble myelography for the study of dural arteriovenous fistulae of the spine draining in the spinal venous system. AJNR 11:327–339 1984

    • Search Google Scholar
    • Export Citation
  • 25.

    Oldfield EHDi Chiro GQuindlen EAet al: Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula. J Neurosurg 59:101910301983Oldfield EH Di Chiro G Quindlen EA et al: Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula. J Neurosurg 59:1019–1030 1983

    • Search Google Scholar
    • Export Citation
  • 26.

    Oldfield EHDoppman JL: Spinal arteriovenous malformations. Clin Neurosurg 34:1611831988Oldfield EH Doppman JL: Spinal arteriovenous malformations. Clin Neurosurg 34:161–183 1988

    • Search Google Scholar
    • Export Citation
  • 27.

    Rosenblum BOldfield EHDoppman JLet al: Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM's in 81 patients. J Neurosurg 67:7958021987Rosenblum B Oldfield EH Doppman JL et al: Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM's in 81 patients. J Neurosurg 67:795–802 1987

    • Search Google Scholar
    • Export Citation
  • 28.

    Symon LKuyama HKendall B: Dural arteriovenous malformations of the spine: clinical features and surgical results in 55 cases. J Neurosurg 60:2382471984Symon 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
  • 29.

    Tanaka KWaga SKojima Tet al: Spinal dural arteriovenous malformation: report of an unusual case. Neurosurgery 24:9159181989Tanaka K Waga S Kojima T et al: Spinal dural arteriovenous malformation: report of an unusual case. Neurosurgery 24:915–918 1989

    • Search Google Scholar
    • Export Citation
  • 30.

    Terwey BBecker HThron AKet al: Gadolinium-DTPA enhanced MR imaging of spinal dural arteriovenous fistulas. J Comput Assist Tomogr 13:30371989Terwey B Becker H Thron AK et al: Gadolinium-DTPA enhanced MR imaging of spinal dural arteriovenous fistulas. J Comput Assist Tomogr 13:30–37 1989

    • Search Google Scholar
    • Export Citation
  • 31.

    Wrobel CJOldfield EHDi Chiro Get al: Myelopathy due to intracranial dural arteriovenous fistulas draining intrathecally into spinal medullary veins. Report of three cases. J Neurosurg 69:9349391988Wrobel 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
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 385 382 67
Full Text Views 182 127 1
PDF Downloads 82 42 2
EPUB Downloads 0 0 0
PubMed
Google Scholar