Article
Spinal epidural arteriovenous fistula with perimedullary venous drainage: Clinical and neuroradiological features
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Authors
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Fidaa Jablawi
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland; RWTH Aachen, Klinik für Diagnostische und Interventionelle Neuroradiologie, Aachen, Deutschland
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Michael Mull
- RWTH Aachen, Klinik für Diagnostische und Interventionelle Neuroradiologie, Aachen, Deutschland
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Gerrit Alexander Schubert
- RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Franz-Josef Hans
- Paracelsus-Klinik Osnabrück, Klinik für Neurochirurgie, Osnabrück, Deutschland
| Published: | June 18, 2018 |
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Outline
Text
Objective: Spinal epidural arteriovenous fistula (SEAVF) is a rare entity among all other spinal vascular malformations and has been rarely reported in the literature. Clinical and neuroradiological characteristics of this rare disease are the subject of our recent study.
Methods: Eleven consecutive patients were diagnosed with SEAVF and treated in our center between 2000 and 2017 and were included in this analysis. Spinal MRI and DSA were performed in all patients. In addition, 8 of these 11 patients received spinal contrast enhanced MRA (CE-MRA). Dyna-CT was performed in 4 of these 11 patients. Clinical and neuroradiological data of all 11 patients were evaluated for this study.
Results: Mean patient's age was 73±7 years (median, 77; range, 70-83 years). At the time of admission in our center, parparesis was present in ten (91%) patients. The remaining one patient (9%) suffered a neurogenic claudication without manifest motor deficits. Seven (63.6%) patients presented with a sphincter dysfunction, as well as sensory symptoms of different degrees were documented in other five (50%) patients. The mean duration of symptoms was 7.5±9 months.
Congestive myelopathy on MR/CE-MRA imaging was present in all patients, as were dilated perimedullary vessels of variable extent. In 6 of 8 patients with CE-MRA, the shunt zone was located ventrolaterally in the spinal epidural space. Moreover, DSA images featured a multisegmental extension of the epidural fistula zone in 6 (55%) of 11 cases. In 4 of these 6 cases, the intradural venous drainage was localized at a significant distance from the fistula feeding artery. In addition Dyna-CT provided a precise visualization of the shunt zone and the adjacent osseous structures in the respective field of view in 4 patients. A bilateral arterial supply was found in 3 (27%) cases.
Conclusion: SEAVF with perimedullary venous drainage can induce a congestive myelopathy resulting in relatively subacute parapresis compared to classical SDAVF. The fistula zone frequently extended over several segments in the ventrolateral epidural space, presenting with a complex angiomorphology. To optimize the diagnosis, spinal CE-MRA, DSA are obligatory. In addition, Dyna-CT may provide excellent opacification of the shunt zone.
