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Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
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Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
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Beaman C, Molaie A, Ghochani Y, Fukuda K, Peterson C, Kaneko N, Nour M, Szeder V, Colby GP, Tateshima S, Jahan R, Duckwiler G. Clinical presentation and treatment of 26 spinal epidural arteriovenous fistulas: a single-center experience. J Neurointerv Surg 2024:jnis-2024-021471. [PMID: 38569885 DOI: 10.1136/jnis-2024-021471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Spinal epidural arteriovenous fistulas (SEDAVFs) are rarely diagnosed vascular malformations that can cause spinal cord compression and congestive myelopathy. METHODS This is a single-center, retrospective case series of patients with SEDAVFs who underwent observation or treatment at UCLA medical center between 1993 and 2023. RESULTS Between 1993 and 2023 a total of 26 patients at UCLA were found to have a SEDAVF. The median age at treatment was 59 years (range 4 months to 91 years). Compared with sacral, lumbar, and thoracic SEDAVFs, patients with cervical SEDAVF were younger (41 years vs 63 years, P=0.016) and more likely to be female (66.7% vs 14.3%, P=0.006). Possible triggers for development of SEDAVFs may be prior spinal surgery or trauma (n=4), turning the neck (n=1), lifting a heavy box (n=1), a prolonged period of bending over (n=1), and neurofibromatosis type 1 (n=1). Of the 22 patients treated endovascularly, 18 (82%) were angiographically cured on the first attempt without complications. One patient underwent surgical treatment alone and had a failed surgery on the first attempt, and developed a surgical site infection after the second successful attempt at treatment. Of the 16 patients with adequate clinical follow-up, 11 (69%) demonstrated early improved clinical outcome (eg, improved strength on examination, absent bruit). CONCLUSIONS SEDAVFs are a rarely diagnosed disease that can be treated effectively and safely with endovascular embolization in most cases. Patients with sacral, lumbar, and thoracic SEDAVFs were older and more often male compared to patients with cervical SEDAVFs.
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Affiliation(s)
- Charles Beaman
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Amir Molaie
- Department of Neurology, UCLA Medical Center, Los Angeles, California, USA
| | - Yasmin Ghochani
- Department of Neurology, UCLA Medical Center, Los Angeles, California, USA
| | - Keiko Fukuda
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Catherine Peterson
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Naoki Kaneko
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - May Nour
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Viktor Szeder
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Geoffrey P Colby
- Departments of Neurosurgery and Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Satoshi Tateshima
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Reza Jahan
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Gary Duckwiler
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
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Alwahdy AS. Endovascular treatment of epidural arteriovenous fistula associated with sacral arteriovenous malformation: case report. Front Neurol 2024; 15:1326182. [PMID: 38410195 PMCID: PMC10895013 DOI: 10.3389/fneur.2024.1326182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
Spinal epidural arteriovenous fistulas with sacral arteriovenous malformation (AVM) are a rare type of spinal arteriovenous fistulas. There are two varieties of spinal epidural arteriovenous fistulas (SEDAVFs), with type 1 involving intradural venous drainage and type 2 not involving intradural venous drainage. We present a case of transarterial embolization for type 1 SEDAVFs with sacral AVM. Within 8 months, a 14-year-old boy presented with progressively weaker lower extremities and bladder-bowel dysfunction. Magnetic resonance imaging (MRI) of the whole spine revealed thoracic spinal cord congestion, a single dilated flow void running from the lumbosacral area to the conus medullaris, and continuing cranial draining up to the C5 level via the perimedullary vein. Filling of the venous sac through a preferential feeder after embolizing the AVM nidus was performed. After 3 months, the clinical follow-up showed improvement of motoric function, although mild. Endovascular treatment for SEDAVF type 1 might have achieved total obliteration without any procedural complications. Nevertheless, it can be very challenging due to multiple feeders and the presence of an AVM nidus like in this case. However, the most difficult thing in fistula cases is establishing the diagnosis and finding the fistula point. Early treatment is required, due to the fact that longstanding lesions could cause irreversible damage.
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Affiliation(s)
- Ahmad Sulaiman Alwahdy
- Department of Neurology, Interventional Neurology Subdivision, Fatmawati General Central Hospital, Jakarta, Indonesia
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4
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Alkhaibary A, Alharbi A, Alnefaie N, Alammar H, Arishy AM, Alghanim N, Aldhfyan YM, Albaiahy A, Khormi YH, Alshaya W, AlQahatani S, Aloraidi A, Alkhani A, Khairy S. Spinal dural arteriovenous fistula: a comprehensive review of the history, classification systems, management, and prognosis. Chin Neurosurg J 2024; 10:2. [PMID: 38191586 PMCID: PMC10775532 DOI: 10.1186/s41016-023-00355-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024] Open
Abstract
Spinal dural arteriovenous fistulas account for the majority of spinal vascular malformations. They are typically located in the thoracolumbar region and are diagnosed in the middle-aged and elderly populations. Although spinal dural arteriovenous fistulas have been postulated to be acquired, their exact development remains uncertain. Typically, the arteriovenous shunt is situated close to the spinal nerve root, inside the dura mater, where the blood from the radiculomeningeal artery and radicular vein intermix. Throughout history, there have been multiple classification systems of spinal arteriovenous shunts since 1967. Those were mainly based on the evolution of diagnostic studies as well as the treatment of these lesions. Such classification systems have undergone significant changes over the years. Unlike intracranial dural arteriovenous fistula, spinal dural arteriovenous fistula is progressive in nature. The neurological manifestations, due to venous congestion, tend to be insidious as well as non-specific. These include sensory deficits, such as paresthesia, bilateral and/or unilateral radicular pain affecting the lower limbs, and gait disturbances. Spinal dural arteriovenous fistulas can be suspected on magnetic resonance imaging/magnetic resonance angiography and confirmed by digital subtraction angiography (DSA). The management includes surgery, endovascular therapy, and in selected cases, radiotherapy. The treatment goal of spinal dural arteriovenous fistula is to halt the progression of the disease. The prognosis depends on both the duration of symptoms as well as the clinical condition prior to therapy. The present article comprehensively reviews the pathophysiology, changes in classification systems, natural history, clinical manifestations, radiological features, management, and prognosis.
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Affiliation(s)
- Ali Alkhaibary
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
| | - Ahoud Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Nada Alnefaie
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hajar Alammar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Noor Alghanim
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yazeed M Aldhfyan
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Arwa Albaiahy
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Yahya H Khormi
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Wael Alshaya
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Saad AlQahatani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Aloraidi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alkhani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Sami Khairy
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Ito K, Ryu B, Shima S, Mochizuki T, Sato S, Inoue T, Niimi Y. Pure spinal intraosseous arteriovenous fistula: A case report. Neuroradiol J 2023; 36:755-759. [PMID: 36896863 PMCID: PMC10649538 DOI: 10.1177/19714009231163554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Spinal osseous arteriovenous fistula (AVF) is a rare disease with a characteristic angioarchitecture involving an intraosseous venous pouch (VP) of the vertebral body where the feeders are converging. Using spinal angiography alone, it is difficult to distinguish spinal osseous AVF from classical spinal epidural AVF (EDAVF) with fistulas in the epidural VP and bone erosion because both subtypes have an angiographically similar dilated VP appearance. Thus, spinal osseous AVF may be often misdiagnosed as spinal EDAVF. With advancing imaging techniques, it would be possible to determine the exact location of the fistula. Here, we present the case of a 37-year-old woman with a pure spinal thoracic osseous AVF and radiculopathy. She was diagnosed with spinal intraosseous AVF using high-resolution three-dimensional rotational angiography (3D-RA). The fistula was located in the Th1 lateral mass with a VP where multiple osseous feeders were converging. There was paravertebral venous drainage without intradural venous drainage. Transvenous embolization with Onyx and coils was performed through the azygos vein to the lateral epidural venous plexus, resulting in complete obliteration. This case suggests that 3D-RA reconstructed images are essential for accurate diagnosis and successful treatment of this condition. It is important to occlude only intraosseous VPs by accurate subtype diagnosis. Transvenous embolization is a treatment option for spinal intraosseous AVF with paravertebral epidural venous drainage.
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Affiliation(s)
- Koki Ito
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Bikei Ryu
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Shogo Shima
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Tatsuki Mochizuki
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Shinsuke Sato
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
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Lee KJX, Tan TJ, Tan EJ, Yan YY. Magnetic resonance imaging of spinal epidural lesions. Singapore Med J 2023; 64:572-579. [PMID: 37815073 PMCID: PMC10564098 DOI: 10.4103/singaporemedj.smj-2021-215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 01/06/2022] [Indexed: 10/11/2023]
Affiliation(s)
| | - Tien Jin Tan
- Department of Radiology, Changi General Hospital, Singapore
- Radiological Sciences ACP, Duke-NUS Medical School, Singapore
| | - Eu Jin Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Yet Yen Yan
- Department of Radiology, Changi General Hospital, Singapore
- Radiological Sciences ACP, Duke-NUS Medical School, Singapore
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Santangelo G, Singh A, Rahmani R, Kessler A, Bender M. Cervical extradural arteriovenous fistula with radiculopathy managed endovascularly. Surg Neurol Int 2023; 14:265. [PMID: 37560569 PMCID: PMC10408600 DOI: 10.25259/sni_306_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Extradural arteriovenous fistulas (AVFs) of the cervical spine are extremely rare, and typically manifest as slowly progressive myelopathy caused by mass effect. This is a unique case of extradural AVF of the cervical spine manifesting with purely radicular symptoms and treated endovascularly with coil and liquid embolization. CASE DESCRIPTION A 55-year-old woman presented with neck pain and right upper extremity radiculopathy persisting for 9 months. Imaging studies demonstrated an AVF spanning from C4-C6 with extension into the C5-C6 foramen supplied primarily from the deep cervical branch of the costocervical trunk. The patient underwent successful coil and liquid (Onyx) embolization. Six-week postoperatively, the patient's symptoms completely resolved and magnetic resonance imaging and angiographic imaging confirmed complete obliteration of the fistula. CONCLUSION While extradural AVFs typically present with myelopathic symptoms, they may present with solely radicular symptoms and can be successfully treated endovascularly.
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Affiliation(s)
- Gabrielle Santangelo
- Department of Neurosurgery,University of Rochester, Strong Memorial Hospital, Rochester, New York, United States
| | - Aman Singh
- Department of Neurosurgery,University of Rochester, Strong Memorial Hospital, Rochester, New York, United States
| | - Redi Rahmani
- Department of Neurosurgery,University of Rochester, Strong Memorial Hospital, Rochester, New York, United States
| | - Alexander Kessler
- Department of Radiology, University of Rochester, Strong Memorial Hospital, Rochester, New York, United States
| | - Matthew Bender
- Department of Neurosurgery,University of Rochester, Strong Memorial Hospital, Rochester, New York, United States
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Choi JH, Park JC, Ahn JS, Park W. Treatment of Dural Arteriovenous Fistula with Intradural Draining Vein at the Craniocervical Junction: Case Series with Special Reference to the Anatomical Considerations. World Neurosurg 2023; 175:e1226-e1236. [PMID: 37427702 DOI: 10.1016/j.wneu.2023.04.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Dural arteriovenous fistulas at the craniocervical junction (CCJ DAVFs) are a rare vascular disease. Endovascular treatment (EVT) and microsurgery are the primary treatment modalities for CCJ DAVFs. However, incomplete treatment or complications may occur after treatment because of the anatomical complexity. OBJECTIVE We analyzed the neurosurgical treatment experiences of CCJ DAVFs to recommend suitable classification and treatment options. METHODS CCJ DAVFs were anatomically classified into three types according to the feeding arteries and their relationships with the anterior spinal (ASAs) and lateral spinal arteries (LSAs). Type 1 was fed by the radiculomeningeal artery from the vertebral artery and was not associated with the ASA or LSA. Type 2 was fed by the radiculomeningeal artery, and the radicular artery supplied the LSA near the fistula point. Type 3 had the characteristics of type 1 or type 2 CCJ DAVFs, except the ASA also contributed to the fistula. RESULTS There were 5, 7, and 4 cases of type 1, type 2, and type 3 CCJ DAVFs, respectively. EVT was attempted in 12 patients, of whom only 1 (type 1) was completely cured without complications. Nine cases had residual lesions after EVT, and two had spinal cord infarction due to occlusion of the LSA. Fourteen patients underwent microsurgical treatment. In all 14 cases, CCJ DAVFs were completely obliterated after microsurgery. CONCLUSION In cases of type 1 CCJ DAVF, both microsurgical treatment and EVT may be considered. However, for type 2 and 3 CCJ DAVFs, microsurgery may be a superior treatment modality.
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Affiliation(s)
- June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Su H, Yu J. Treatment of high cervical arteriovenous fistulas in the craniocervical junction region. Front Neurol 2023; 14:1164548. [PMID: 37441609 PMCID: PMC10335834 DOI: 10.3389/fneur.2023.1164548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
The craniocervical junction (CCJ) is a complex region. Rarely, arteriovenous fistulas (AVFs) can occur in the CCJ region. Currently, it is accepted that CCJ AVFs should only refer to AVFs at the C1-C2 levels. It is reasonable to assume that high cervical CCJ AVFs are being referred to when discussing CCJ AVFs. High cervical CCJ AVFs can be divided into the following four types: dural AVF, radicular AVF, epidural AVF and perimedullary AVF. Until now, it was difficult to understand high cervical CCJ AVFs and provide a proper treatment for them. Therefore, an updated review of high cervical CCJ AVFs is necessary. In this review, the following issues are discussed: the definition of high cervical CCJ AVFs, vessel anatomy of the CCJ region, angioarchitecture of high cervical CCJ AVFs, treatment options, prognoses and complications. Based on the review and our experience, we found that the four types of high cervical CCJ AVFs share similar clinical and imaging characteristics. Patients may present with intracranial hemorrhage or congestive myelopathy. Treatment, including open surgery and endovascular treatment (EVT), can be used for symptomatic AVFs. Most high cervical CCJ AVFs can be effectively treated with open surgery. EVT remains challenging due to a high rate of incomplete obliteration and complications, and it can only be performed in superselective AVFs with simple angioarchitecture. Appropriate treatment can lead to a good prognosis.
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Yuan H, Pi Y, Zhou H, Wang C, Liu W, Niu Y, Lan Y, Chen D, Liu S, Xiao S. Thoracic epidural arteriovenous malformation causing rapidly progressive myelopathy and mimicking an acute transverse myelitis: A case report. Ibrain 2022; 8:492-499. [PMID: 37786589 PMCID: PMC10528776 DOI: 10.1002/ibra.12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 10/04/2023]
Abstract
Clinical symptoms of spinal arteriovenous malformations (AVMs) combined with acute spontaneous hemorrhage lack specificity, which leads to misdiagnosis and delays treatment. The current study aimed to analyze the causes of misdiagnosis and review the key points of diagnosis and treatment. We presented an extremely rare case of a 25-year-old man whose clinical characteristics mimicked acute transverse myelitis, suffering from rapidly and repeatedly progressive myelopathy with a mass. The pathological diagnosis of the mass was AVM; symptom-based surgical treatment with posterior decompression and the removal of epidural AVMs during the postoperative 12-month follow-up period were performed. The manual muscle testing grade score of the proximal and distal muscles in both lower limbs improved from 1 to 5, and the American Spinal Injury Association motor and sensation grade score improved from B to E. In the case of sudden or progressive spinal cord injury of unknown cause and acute spinal cord dysfunction, there might be a misdiagnosis. The key to a differential diagnosis is to take into account AVMs, and spontaneous hemorrhages and hematomas should also be suspected. Angiography and magnetic resonance imaging are very important for the diagnosis of AVM, and we hope to enhance clinicians' understanding of and vigilance for such diseases.
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Affiliation(s)
- Hao Yuan
- Department of OrthopedicsAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
- Institute of NeuroscienceKunming Medical UniversityKunmingYunnanChina
| | - Yu Pi
- Department of AnesthesiologySouth West Medical UniversityLuzhouChina
| | - Hong‐Su Zhou
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Chong Wang
- Department of OrthopedicsAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Wei Liu
- English Department of College of foreign languagesGuizhou UniversityGuizhouGuiyangChina
| | - Yong‐Min Niu
- Institute of NeuroscienceKunming Medical UniversityKunmingYunnanChina
| | - Yang Lan
- Department of Sports RehabilitationKunming Medical UniversityYunnanKunmingChina
| | - Dong Chen
- Department of Sports RehabilitationKunming Medical UniversityYunnanKunmingChina
| | - Shi‐Ran Liu
- Department of Informatics, Faculty of Business, Economics and InformaticsUniversity of ZurichZurichSwitzerland
| | - Shun‐Wu Xiao
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiChina
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Baba H, Kiyosue H, Ide S, Onishi K, Kubo T, Tokuyama K. Spinal intraosseous arteriovenous fistulas with perimedullary drainage associated with vertebral compression fracture: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 4:CASE22184. [PMID: 36046270 PMCID: PMC9329864 DOI: 10.3171/case22184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Although osseous involvement is occasionally observed in spinal epidural arteriovenous fistulas (AVFs) or seen as a part of diseases of spinal arteriovenous metameric syndrome, purely intraosseous spinal AVFs are extremely rare. Their clinical and imaging characteristic features are not well known. The authors present a case of purely intraosseous AVFs associated with compression fracture.
OBSERVATIONS
A 76-year-old man presented with back pain and progressive myelopathy. Computed tomography showed compression fracture of the T12 vertebral body and dilatation of perimedullary veins. Spinal angiography revealed an intraosseous AVF at the T12 spine level, which was fed by multiple feeders of ventral somatic branches and drained into the paravertebral and perimedullary veins. The intraosseous AVF was completely occluded by the combined techniques of transarterial and transvenous embolization with glue and a coil. The symptoms disappeared within 1 month after embolization.
LESSONS
Although extremely rare, spinal intraosseous AVFs can develop after compression fracture and cause congestive myelopathy. Combined transarterial and transvenous embolization is useful for the specific case of spinal intraosseous AVFs with both paravertebral and perimedullary drainage.
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Affiliation(s)
| | - Hiro Kiyosue
- Department of Diagnostic Radiology, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | | | - Kouhei Onishi
- Neurosurgery, Oita University Faculty of Medicine, Yufu, Oita, Japan; and
| | - Takeshi Kubo
- Neurosurgery, Oita University Faculty of Medicine, Yufu, Oita, Japan; and
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Lizana J, Aliaga N, Marani W, Escribano A, Montemurro N. Spinal Vascular Shunts: Single-Center Series and Review of the Literature of Their Classification. Neurol Int 2022; 14:581-99. [PMID: 35893282 DOI: 10.3390/neurolint14030047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
Spinal arteriovenous shunts (sAVSs) are an uncommon disease, constituting 3 to 4% of intradural lesions; 70% of these lesions are spinal arteriovenous fistulas (sAVFs), whereas spinal arteriovenous malformations (sAVMs) are rarer. Both share the problem of their classification due to the heterogeneity of their angioarchitecture. The aim of this study is to report a series of sAVSs treated in the neurosurgery department of the Hospital Nacional Guillermo Almenara during the 2018–2020 period and to present an overview of the current literature on sAVS classification. We reviewed all medical records of patients diagnosed with sAVFs and sAVMs during the 2018–2020 period, and then we analyzed images with Horos v4.0.0, illustrated some cases with Clip Studio Paint v1.10.5, and performed a descriptive statistical analysis with SPSS v25. Twelve patients were included in this study, eight of which were women (67%) and four of which were men (33%); the age range was from 3 to 74 years. Eight sAVSs were sAVFs, whereas four were sAVMs. The most frequent clinical manifestation was chronic myelopathy in seven patients (58%). Of those treated only by embolization, seven (70%) resulted in complete occlusion (five sAVFs and two sAVMs), while three (30%) remained with a residual lesion. At last follow-up, five patients (42%) improved clinically, and the seven remaining (58%) maintained the same neurological state. sAVSs require a detailed study of their angioarchitecture for proper management. The endovascular treatment is safe with acceptable cure rates. The surgical option should not be set aside.
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13
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Chen X, Ge L, Wan H, Huang L, Jiang Y, Lu G, Zhang X. Onyx embolization of a spinal epidural hemorrhage caused by thoracic spinal epidural arteriovenous fistula: A case report and literature review. J Interv Med 2022; 5:111-115. [PMID: 35936657 PMCID: PMC9349020 DOI: 10.1016/j.jimed.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022] Open
Abstract
Spinal epidural hemorrhages (SEDH) caused by spinal epidural arteriovenous fistulas (SEAVFs) are rare; thus, their specific pathogenesis has not been explained. Furthermore, the standard treatment for SEAVFs has not yet been defined. Here we report the case of a 36-year-old Chinese man who experienced acute onset chest pain and tightness. His symptoms rapidly aggravated until the lower limbs were unable to support him. Spinal magnetic resonance angiography (MRA) revealed a localized SEAVF and a secondary spinal cord lesion at the T4 level. Digital subtraction angiography (DSA) confirmed the presence of the SEDH/SEAVF at the T3-4 level with the left radicular artery feeding the fistula. Based on DSA and MRA findings, SEDH, local spinal cord infarction, and spinal venous reflux disorder were conditionally diagnosed. Using the arterial route, Onyx-34 was injected into the fistula to embolize the feeding arteries and the venous system. Angiography was performed after the microcatheter was withdrawn, and no residual fistula or anterior spinal artery was observed. The six-week follow-up MRI showed acceptable healing of the SEAVF, and the patient improved neurologically. This case suggests that endovascular treatment with Onyx-34 embolization should be considered a promising treatment strategy for this type of complicated SEAVF.
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Affiliation(s)
| | | | - Hailin Wan
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Lei Huang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yeqing Jiang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Gang Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiaolong Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
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14
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Sim SY. Pathophysiology and classification of intracranial and spinal dural AVF. J Cerebrovasc Endovasc Neurosurg 2022; 24:203-209. [PMID: 35443276 PMCID: PMC9537653 DOI: 10.7461/jcen.2022.e2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/13/2021] [Indexed: 11/23/2022] Open
Abstract
Dural arteriovenous fistulas (DAVFs) are pathologic shunts between pachymeningeal arteries and dural venous channel. DAVFs are relatively rare, however, DAVFs can lead to significant morbidity and mortality due to intracranial hemorrhage and non-hemorrhagic neurologic deterioration related to leptomeningeal venous drainage. The etiology and pathophysiology of DAVFs is not fully understood. Several hypotheses for development of DAVF and classifications for predicting risk of hemorrhage and neurological deficit have been proposed to help clinical decision making according to its natural history. Herein, incidence, etiology, pathophysiology of development of intracranial and spinal DAVF including their classifications are briefly described with short historical review.
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Affiliation(s)
- Sook Young Sim
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Goyang, Korea
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15
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Ehresman J, Catapano JS, Baranoski JF, Jadhav AP, Ducruet AF, Albuquerque FC. Treatment of Spinal Arteriovenous Malformation and Fistula. Neurosurg Clin N Am 2022; 33:193-206. [PMID: 35346451 DOI: 10.1016/j.nec.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
With the rapid advancements in endovascular therapy over previous decades, the treatment of spinal arteriovenous malformations (AVMs) continues to evolve. The decision to use endovascular versus surgical therapy largely depends on the type of lesion and its anatomic location. Recent studies demonstrate that endovascular treatment is effective for extradural arteriovenous fistulas (AVFs), intradural ventral (perimedullary) AVMs, and intramedullary spinal AVMs. Treatment of intradural dorsal (dural) AVFs remains largely surgical because of lower recurrence rates, although recent studies demonstrate equivocal outcomes. Extradural-intradural (juvenile) AVMs and conus AVMs remain difficult-to-treat lesions.
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Affiliation(s)
- Jeff Ehresman
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Ashutosh P Jadhav
- Department of Interventional Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
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16
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Nistor Cseppento CD, Iovanovici DC, Andronie – Cioara FL, Tarce AG, Bochiș CF, Bochiș SA, Dogaru BG. The recovery management of patients with operated extrame-dullary spinal arteriovenous fistula, evolution and socio-professional reintegration: case report and review of the litera-ture. Balneo and PRM Research Journal 2022. [DOI: 10.12680/balneo.2022.490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adequate therapeutic intervention performed in the case of extradural spinal AVM and an inten-sive recovery program allow the amelioration of neurological manifestations in a very high percentage. With the ultimate goal of practicing a trade, a good biological recovery is needed for social recovery. The effectiveness of strategies for professional integration and reintegration de-pends largely on the patient’s experiences before the onset of the disease. The paper aims to re-view the treatment, the evolution of patients with extradural spinal AV and the possibilities of socio-professional reintegration. Methods and analysis. A case presentation of a patient diag-nosed with extradural spinal AV fistula is proposed, along with a review of the current literature on the treatment of this pathology, the evolution and the possibilities of vocational recovery. The studies will be analysed and selected in two stages, in the first stage the titles and abstracts, in the second stage, the articles with full text will be analysed, selected and a narrative synthesis of the included studies will be made. Summary case. The 51-year-old urban patient, a profes-sional driving instructor who underwent endovascular and surgical treatment for extradural spinal AV fistula, is hospitalized for a moderate motor deficit, such as paraparesis, back pain, mechanical pain in the knees and gait disorders. The objectives of recovery are represented by neuromotor recovery and socio-professional reintegration. Conclusions. Spinal EAVFs are rare lesions with a low risk of bleeding; the clinical manifestations are determined by the compres-sion of the bone marrow; these being significantly improved after the endovascular and surgical treatment. Studies show a good long-term prognosis, which is determined by the absence of re-currences. An essential role in the integration of patients with disabilities in the socio-professional life is the identification of their deficiencies and their reorientation according to the outstanding abilities, the stimulation of the preserved skills.
Keywords: rehabilitation, disc hernia, low back pain, paraplegia
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Affiliation(s)
- Carmen Delia Nistor Cseppento
- Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Diana Carina Iovanovici
- Institute of Cardiovascular and Heart Diseases of Timișoara, 300310 Timișoara, Romania 3 Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Felicia Liana Andronie – Cioara
- Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | | | - Călin Florin Bochiș
- Clinical Emergency Municipal Hospital Timisoara, Oro-maxillo-facial Surgery Clinical, 300062 Timișoara, Romania
| | - Sergiu Alin Bochiș
- Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Bombonica Gabriela Dogaru
- Department of Medical Rehabilitation, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
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17
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Okazaki T, Ohara Y, Matsuoka H, Shimoji K, Kogure K, Kikuchi N, Kimura T, Nakajima S, Tani S, Mizuno J, Arai H, Oishi H. Cervical Extradural Arteriovenous Fistula without Intradural Drainage Successfully Treated with Endovascular Treatment Using Both Transvenous and Transarterial Approach: Case Report and Review of Literatures. NMC Case Rep J 2022; 8:335-342. [PMID: 35079485 PMCID: PMC8769398 DOI: 10.2176/nmccrj.cr.2020-0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/21/2020] [Indexed: 11/20/2022] Open
Abstract
The classification of spinal extradural arteriovenous fistulas (AVFs) was reported based on a case series treated by microsurgery in 2009 and endovascular interventions in 2011. The present report describes a patient with extradural AVFs at the cervical spine manifesting gradual progressive radiculomyelopathy of bilateral upper extremities. Magnetic resonance imaging (MRI) revealed a mass sign from C1 to C4 at the right ventral side and the spinal cord was deviated to the left and indicated as a flow void sign. Diagnostic angiography revealed an extradural AVFs located at the C1-C4 level that was supplied by bilateral radicular artery from the vertebral artery (VA) and right ascending cervical artery (ACA). The shunting points were recognized multiply at C2/3 and C3/4 levels on the right. The transvenous embolization to the enlarged extradural venous plexus around the shunting points via right hypoglossal canal and the transarterial embolization against multi-feeders of the branch of left radicular artery, right ACA achieved complete occlusion of the lesions. His symptom was gradually recovered, and angiography performed 2 weeks after embolization showed no recurrence. When the arteriovenous shunts in the upper cervical spine were high flow shunts, transvenous approach via the hypoglossal canal might be one option for the treatment of spinal extradural AVFs.
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Affiliation(s)
- Toshiyuki Okazaki
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Yukoh Ohara
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan.,Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hidenori Matsuoka
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazunari Kogure
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Nahoko Kikuchi
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Takaoki Kimura
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Shintaro Nakajima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Tani
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Junichi Mizuno
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hidenori Oishi
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
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18
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Shimizu K, Mitsuhara T, Takeda M, Kurisu K, Yamaguchi S. Spinal Osseous Epidural Arteriovenous Fistula with Intradural Reflux: A Case Report. NMC Case Rep J 2022; 8:229-233. [PMID: 35079468 PMCID: PMC8769409 DOI: 10.2176/nmccrj.cr.2020-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 09/17/2020] [Indexed: 11/20/2022] Open
Abstract
The authors report a rare case of spinal osseous epidural arteriovenous fistula (AVF) with intradural reflux. A 71-year-old lady with a past history of a T12 compression fracture and neurofibromatosis type 1 presented with progressive paraparesis. Magnetic resonance (MR) images of the thoracolumbar spine showed edema of the spinal cord and flow voids. Catheter angiography revealed segmental arteries from T11 to L1 feeding an AVF in the epidural space. The AVF drained not only into the epidural venous plexus but also into the perimedullary veins. Of note, there was an intraosseous drainage route that involved the basivertebral vein of T12. Under the diagnosis of spinal osseous epidural AVF with intradural reflux, surgical interruption of the intradural arterialized draining vein was performed. Spinal osseous epidural AVF with intradural reflux is rare with only four cases reported in the past. We believe that spinal osseous epidural AVF should be recognized as a variant of spinal epidural AVF.
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Affiliation(s)
- Kiyoharu Shimizu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Takafumi Mitsuhara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Masaaki Takeda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital, Hiroshima, Hiroshima, Japan
| | - Satoshi Yamaguchi
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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19
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Park D, Kim D, Kang DH, Lee S, Cho DC. Cervical Radiculopathy Caused by Spinal Epidural Arteriovenous Fistula (SEDAVF) Without Intradural Drainage: A Case Report and Literature Review. Korean J Neurotrauma 2022; 18:145-149. [PMID: 35557638 PMCID: PMC9064750 DOI: 10.13004/kjnt.2022.18.e11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/10/2022] [Accepted: 01/22/2022] [Indexed: 11/29/2022] Open
Abstract
Spinal epidural arteriovenous fistula (SEDAVF) is a rare vascular malformation. Due to the mass effect of enlarged epidural veins and venous hypertension, progressive radiculopathy and myelopathy are likely to occur. A 33-year-old female presented with right upper extremity weakness for a month. The cause of this symptom was a SEDAVF, which was located near the C5-6-7 foramens and compressed the nerve roots. In the absence of intradural venous drainage, endovascular treatment is often difficult because of the large venous pouch. We performed endovascular trapping of the vertebral artery (VA) and loose packing of the coil material on the AVF to minimize mass effects. Immediately after embolization, the fistula was occluded, but a small new feeder vessel developed a day later. An n-butyl cyanoacrylate embolization was performed, and the fistula was successfully occluded.
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Affiliation(s)
- Daewon Park
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Donghan Kim
- Department of Neurosurgery, ParkWeonWook Hospital, Busan, Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Subum Lee
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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20
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Zhang K, Li C, Hou K, Yu J. Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend? Front Neurol 2021; 12:761006. [PMID: 34764934 PMCID: PMC8576071 DOI: 10.3389/fneur.2021.761006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
The cervical anterior spinal artery (ASA) is a very important artery arising from the intracranial vertebral artery (VA). It can play different roles in endovascular treatment (EVT) of spinal vascular diseases. The current understanding of these roles is incomplete; therefore, we performed this review. We found that cervical ASA can be involved in many spinal vascular diseases, such as arteriovenous fistula (AVF), arteriovenous malformation (AVM), and aneurysm, and can serve as a collateral channel in proximal VA occlusion. In AVF and AVM, when the cervical ASA is involved, it often plays the role of an accomplice or victim because it acts as the feeder or as a bystander that does not provide blood flow to the AVF and AVM. In cervical ASA aneurysm, the ASA is a victim. During EVT of VA aneurysms or stenoses, the cervical ASA ostia can be covered or occluded, resulting in ASA ischemia. In this situation, the ASA is a victim. In VA occlusion or the subclavian steal phenomenon, the cervical ASA can serve as a collateral channel to provide blood flow to the posterior circulation. In this case, the ASA plays the role of a friend. According to the role of the cervical ASA in spinal vascular diseases, EVT should be determined “case by case.” Most importantly, when EVT is performed to treat these diseases, the cervical ASA axis must be preserved. Therefore, understanding the role of the cervical ASA in spinal vascular diseases is crucial.
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Affiliation(s)
- Kun Zhang
- Department of Cerebrovascular Disease, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Chao Li
- Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Kun Hou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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21
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Hwang H, Shin JH, Hong JT, Ihn YK. Endovascular Treatment of a Lumbar Spinal Epidural Arteriovenous Fistula with Radiculopathy: A Case Report. Taehan Yongsang Uihakhoe Chi 2021; 82:1628-1633. [PMID: 36238887 PMCID: PMC9431973 DOI: 10.3348/jksr.2020.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/02/2021] [Accepted: 03/11/2021] [Indexed: 11/15/2022]
Abstract
Spinal epidural arteriovenous fistulas (SEDAVFs) are rare spinal vascular malformations that are difficult to diagnose and treat. SEDAVFs can be asymptomatic; however, symptoms can arise from the compression of adjacent nerve roots by dilated vein and perimedullary venous reflux, caused by shunting into the epidural venous plexus. A 31-year-old male presented to our institution with a 2-year history of progressively worsening low-back pain, radiating thigh pain, and sensory changes in his lower extremities. MRI and CT angiography demonstrated dilated epidural vascular lesion compressing the nerve root. The SEDAVF was embolized with multiple coils, which alleviated the nerve root compression from the engorged venous varix and improved the patient's radiculopathy. Our experience from this case shows that endovascular coil embolization using the transarterial approach can be an effective treatment for SEDAVF and an alternative to surgical ligations.
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22
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Wang T, Richard SA, He J, Zhang C, Wang C, You C, Xie X. Spinal intraosseous epidural arteriovenous fistula; a late complication of vertebral compression fracture: Two case reports. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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23
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Al-Abdulwahhab AH, Song Y, Kwon B, Suh DC. Embolization Tactics of Spinal Epidural Arteriovenous Fistulas. Neurointervention 2021; 16:252-259. [PMID: 34425638 PMCID: PMC8561027 DOI: 10.5469/neuroint.2021.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Spinal epidural arteriovenous fistulas (SEDAVFs) show an epidural venous sac often with venous congestive myelopathy (VCM) due to intradural reflux at a remote level to which a transarterial approach would be difficult. We present 12 cases of SEDAVF with VCM and describe 3 main tactics for effective transarterial embolization. Materials and Methods Among 152 patients with spinal vascular malformations diagnosed in our tertiary hospital between 1993 and 2019, 12 SEDAVF patients with VCM were included. Three different transarterial embolization tactics were applied according to the vascular configuration and microcatheter accessibility. We evaluated treatment results and clinical outcomes before and after treatment. Results Transarterial embolization with glue (20–30%) was performed in all patients. The embolization tactics applied in 12 patients were preferential flow (n=2), plug-and-push (n=6), and filling of the venous sac (n=4). Total occlusion of the SEDAVF, including intradural reflux, was achieved in 11 (91.7%) of 12 patients, and partial occlusion was achieved in 1 patient. No periprocedural complications were reported. Spinal cord edema was improved in all patients for an average of 18 months after treatment. Clinical functional outcome in terms of the pain, sensory, motor, and sphincter scale and modified Rankin scores improved during a mean 25-month follow-up (6.3 vs. 3.3, P=0.002; 3.6 vs. 2.3, P=0.002, respectively). Conclusion Endovascular treatment for 12 SEDAVF patients with VCM achieved a total occlusion rate of 91.7% without any periprocedural complication. The combined embolization tactics can block intradural reflux causing VCM, resulting in overall good clinical outcomes.
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Affiliation(s)
- Abdulrahman Hamad Al-Abdulwahhab
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Saudi Arabia
| | - Yunsun Song
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boseong Kwon
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Chul Suh
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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24
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Feng Y, Yu J, Xu J, He C, Bian L, Li G, Ye M, Hu P, Sun L, Jiang N, Ling F, Hong T, Zhang H. Natural History and Clinical Outcomes of Paravertebral Arteriovenous Shunts. Stroke 2021; 52:3873-3882. [PMID: 34412511 DOI: 10.1161/strokeaha.120.033963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Paravertebral arteriovenous shunts (PVAVSs) are rare. Whether the intradural venous system is involved in drainage may lead to differences in clinical characteristics through specific pathophysiological mechanisms. This study aims to comprehensively evaluate the natural history and clinical outcomes of PVAVSs with or without intradural drainage. METHODS Sixty-four consecutive patients with PVAVSs from 2 institutes were retrospectively reviewed. Lesions were classified as type A (n=28) if the intradural veins were involved in drainage; otherwise, they were classified as type B (n=36). The clinical course from initial presentation to the last follow-up was analyzed. RESULTS The patients with type A shunts were older at presentation (52.5 versus 35.5 years, P<0.0001) and more likely to have lower spinal segments affected than patients with type B PVAVSs (67.8% versus 13.9%, P=0.00006). After presentation, the deterioration rates related to gait and sphincter dysfunction were significantly higher in patients with type A than type B shunts (gait dysfunction: 71.8%/y versus 17.0%/y, P=0.0006; sphincter dysfunction: 63.7%/y versus 11.3%/y, P=0.0002). According to the angiogram at the end of the latest treatment, 79% of type A and 75% of type B PVAVSs were completely obliterated. If the lesions were partially obliterated, a significantly higher clinical deterioration rate was observed in patients with type A shunts than those with type B shunts (69.9%/y versus 3.2%/y, P=0.0253). CONCLUSIONS Type A PVAVSs feature rapid progressive neurological deficits; therefore, early clinical intervention is necessary. For complex lesions that cannot be completely obliterated, surgical disconnection of all refluxed radicular veins is suggested.
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Affiliation(s)
- Yueshan Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Jiaxing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Jiankun Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Lisong Bian
- Department of Neurosurgery, Beijing Haidian Hospital, China (L.B.)
| | - Guilin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Liyong Sun
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Nan Jiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.).,International Neuroscience Institute, Beijing, China (Y.F., J.Y., J.X., C.H., G.L., M.Y., P.H., L.S., N.J., F.L., T.H., H.Z.)
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Da Ros V, Picchi E, Ferrazzoli V, Schirinzi T, Sabuzi F, Grillo P, Muto M, Garaci F, Muto M, Di Giuliano F. Spinal vascular lesions: anatomy, imaging techniques and treatment. Eur J Radiol Open 2021; 8:100369. [PMID: 34307789 DOI: 10.1016/j.ejro.2021.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 11/23/2022] Open
Abstract
Vascular myelopathies include different aetiology and mechanism of damage. The level of the lesion and the localization within the SC correlates with the clinical symptoms. CT, MRI and angiography are essential for diagnosis and treatment playing a complementary role. MRI is the gold standard for the evaluation of spinal cord lesions. Spinal angiography is the gold standard for evaluation of spinal cord vasculature and vascular malformations.
Background Vascular lesions of the spinal cord are rare but potentially devastating conditions whose accurate recognition critically determines the clinical outcome. Several conditions lead to myelopathy due to either arterial ischemia, venous congestion or bleeding within the cord. The clinical presentation varies, according with the different aetiology and mechanism of damage. Purpose The aim is to provide a comprehensive review on the radiological features of the most common vascular myelopathies, passing through the knowledge of the vascular spinal anatomy and the clinical aspects of the different aetiologies, which is crucial to promptly address the diagnosis and the radiological assessment.
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Furuta T, Nakagawa I, Park H, Nakase K, Yokoyama S, Kotsugoi M, Takeshima Y, Nakase H. Thoracolumbar intraosseous spinal epidural arteriovenous fistulas after vertebral compression fracture: A case report and literature review. Surg Neurol Int 2021; 12:270. [PMID: 34221601 PMCID: PMC8247718 DOI: 10.25259/sni_349_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022] Open
Abstract
Background: The pathophysiology of spinal epidural arteriovenous fistulas (SEAVFs) with perimedullary venous drainage remains to be elucidated. This report describes a case of intraosseous SEAVF in a patient with a history of a thoracolumbar vertebral fracture at the same level 10 years before presenting with progressive myelopathy secondary to retrograde venous reflux into the perimedullary vein. Case Description: A 71-year-old man presenting with progressive paraparesis was diagnosed with a SEAVF involving a previous Th12 and L1 vertebral compression fracture on which feeders from multiple segmental arteries converged. The interesting feature of this case was that the fistula was located in the fractured vertebral body. The fistula was totally obliterated by transarterial embolization of the segmental arteries followed by symptom improvement. Conclusion: We presented a rare case of an intraosseous SEAVF secondary to a thoracolumbar compression fracture with perimedullary venous reflux causing progressive myelopathy. The fistula was located in the fractured vertebral body.
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Affiliation(s)
- Takanori Furuta
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - HunSoo Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kenta Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugoi
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
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Iampreechakul P, Liengudom A, Wangtanaphat K, Tirakotai W, Wattanasen Y, Lertbutsayanukul P, Siriwimonmas S. Spinal epidural arteriovenous fistula with intradural venous reflux: The possibility of acquired origin caused by spinal stenosis and/or disc herniation. Clin Neurol Neurosurg 2021; 207:106794. [PMID: 34245987 DOI: 10.1016/j.clineuro.2021.106794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/30/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinal epidural arteriovenous fistulas (SEAVFs) are relative rare lesions. The pathogenesis of these fistulas remains unclear. Our aim is to review cases of SEAVFs at our institution. METHODS We reviewed a consecutive series of spinal vascular disease at our institution and collected all patients harboring SEAVFs. Medical charts were retrospectively reviewed regarding patient demographic data (i.e., gender and age), presenting symptoms and signs, previous history of spinal surgery or trauma, treatment methods, and neurological outcome after treatment. All image studies, including plain radiography, spinal MRI, MRA, and angiography were analyzed. RESULTS We identified 9 cases of lumbosacral SEAVFs with intradural venous reflux treated at our institution from June 2010 to August 2020. Their median age was 67 years, range 52-83 years. Only one patient had a history of trauma. Interestingly, our observations found that all fistulas are associated with spinal stenosis and/or disc herniation. An additional literature search about SEAVFs coexisting with spinal stenosis and/or disc herniation was performed and found another 19 cases with median age 69 years, range 39-83 years. Only 2 patients had a history of previous spinal surgery. The level of shunted pouch in all 28 patients was correlated with the level of spinal canal stenosis and/or disc herniation. CONCLUSIONS Our study may provide an additional evidence supporting an acquired etiology of SEAVFs, which mainly manifest in late adulthood. It is possible that spinal stenosis and/or disc herniation may result in thrombosis or impairment of venous drainage, causing increased venous pressure, leading to fistulous formation.
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Affiliation(s)
| | - Anusak Liengudom
- Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand.
| | | | - Wuttipong Tirakotai
- Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand.
| | - Yodkhwan Wattanasen
- Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand.
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Brinjikji W, Colombo E, Cloft HJ, Lanzino G. Clinical and Imaging Characteristics of Spinal Dural Arteriovenous Fistulas and Spinal Epidural Arteriovenous Fistulas. Neurosurgery 2021; 88:666-673. [PMID: 33428765 DOI: 10.1093/neuros/nyaa492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation and are distinct from spinal dural arteriovenous fistulas (SDAVFs). Differentiating between these 2 entities is important as operative strategies often differ based on angioarchitecture. OBJECTIVE To compare demographic, clinical, anatomic, and imaging findings of SDAVFs and SEDAVFs. METHODS Consecutive patients diagnosed and/or treated for SDAVF or SEDAVF at our institution between January 2000 and November 2018 were included. Data were collected on demographics, clinical presentation, and imaging findings. All cross-sectional and angiographic imaging were reviewed. To compare continuous variables, t-test was used Chi-squared was used for categorical variables. RESULTS A total of 169 patients were included. In total 47 patients had SEDAVFs and 122 patients had SDVAFs. Clinical presentation and magnetic resonance imaging (MRI) imaging findings were similar between the 2 groups. SEDAVF patients were significantly more likely to have an epidural venous pouch on gadolinium bolus MR angiography (MRA) (0.0% vs 92.1%, P < .0001). SEDAVFs were more commonly located in the lumbar and sacral spine than SDAVFs (85.1% vs 34.4%, P < .0001). When in the lumbar spine, SEDAVFs unlike SDAVFs were more likely to involve the most caudal segments (L4 and L5, P = .02). CONCLUSION SEDAVF share clinical and radiological findings similar to SDAVFS, including high T2 cord signal, cord enhancement, and perimedullary flow voids on conventional MRI. However, they have a characteristic appearance on spinal MRA and DSA with a pouch of epidural contrast. SEDAVFs are more commonly located in the lumbosacral spine.
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Affiliation(s)
- Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Elisa Colombo
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Harry J Cloft
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Condette-Auliac S, Gratieux J, Boulin A, Di Maria F, Consoli A, Coskun O, Smajda S, Rodesch G. Imaging of vascular diseases of the spinal cord. Rev Neurol (Paris) 2021; 177:477-489. [PMID: 33902944 DOI: 10.1016/j.neurol.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Affiliation(s)
- S Condette-Auliac
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France.
| | - J Gratieux
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Boulin
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - F Di Maria
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - O Coskun
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - S Smajda
- Department of interventional Neuroradiology, Fondation Rotschild, Paris, France
| | - G Rodesch
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
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Shetty GS, Singh V, Prasad SN, Phadke RV, Neyaz Z, Udiya A, Behari S. Spinal Epidural Fistulas-A Separate Entity to Dural Fistulas with Different Angioarchitecture and Treatment Approach. World Neurosurg 2021; 149:e600-e611. [PMID: 33548535 DOI: 10.1016/j.wneu.2021.01.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Spinal epidural arteriovenous fistulas (SEAVFs) are the rarest variety of spinal vascular malformation and are often misdiagnosed as type 1 spinal dural fistula. This retrospective study highlights the salient anatomic differentiating points of these entities and also highlights the importance of a planned endovascular treatment approach using different routes of access. Efficacy of the endovascular treatment at 3 months follow-up was also studied. METHODS We retrospectively reviewed 11 treated patients with SEAVF. Existence of epidural arteriovenous fistula in all these patients was confirmed by spinal angiography. The Aminoff-Logue Scale score was assigned both before and after the procedure. The statistical results were expressed as percentages, and the preprocedure scale was compared with the postprocedure scale at 3 months by using a nonparametric Wilcoxon signed-rank test. RESULTS The patients ranged in age from 7 to 53 years, with male predominance. Paraparesis was the commonest symptom, and 1 patient had congestive cardiac failure caused by a large fistula. Location was mostly dorsolumbar with intradural venous reflux into the perimedullary venous system (Castilla type A) noted in 3/11(27%) patients, and the remaining 73% patients had Castilla type B1 with an enlarged epidural venous sac. Therapeutic embolization was performed from arterial, venous, or combined routes. The 3-month postprocedure clinical assessment showed statistically significant (P < 0.004) improvement in the Aminoff-Logue Scale score. CONCLUSIONS The differentiating points between SEAVF compared with type 1 spinal dural fistula are emphasized. The study also highlights the importance of a good angiographic assessment to best access the fistula by arterial, venous, percutaneous, or combined routes. Endovascular treatment resulted in statistically significant clinical improvement at 3 months follow-up.
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Affiliation(s)
| | - Vivek Singh
- Department of Radiodiagnosis (Neuroradiology Section), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | - Surya Nandan Prasad
- Department of Radiodiagnosis (Neuroradiology Section), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rajendra V Phadke
- Department of Radiodiagnosis (Neuroradiology Section), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Zafar Neyaz
- Department of Radiodiagnosis (Neuroradiology Section), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Kim AY, Khil EK, Choi I, Choi JA. Spinal extradural arteriovenous fistula after lumbar epidural injection: CT angiographic diagnosis using 3D-volume rendering. Skeletal Radiol 2020; 49:2073-2079. [PMID: 32533205 DOI: 10.1007/s00256-020-03504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023]
Abstract
Spinal extradural arteriovenous fistulas (SEDAVFs) are a rare form of spinal arteriovenous fistulas, the etiology of which has not been completely elucidated. To our knowledge, this is the first reported case of SEDAVF that may have been caused by a spinal procedure. This report describes a 50-year-old female patient who presented with an SEDAVF at the L3/4 level that developed 3 years after a transforaminal epidural block due to disc extrusion, after which she underwent no other operation or trauma. From routine spine magnetic resonance imaging, disc sequestration was considered more likely than vascular malformation. However, on lumbar CT angiography (CTA) and three-dimensional volume rendering images (3D-VRI), the lesion showed good association with arteries of the aortic branches, allowing us to confirm the exact diagnosis of the lesion as SEDAVF. A limitation of 3D-VRI reconstruction is the difficulty in separate visualization of the vertebral body and blood vessels. On follow-up CTA, 3D dual-energy computed tomography (DECT) depicted smaller vascular structures and showed their anatomical relationships to the bone. While spinal angiography has been traditionally known as the gold standard for SEDAVF diagnosis, CTA with 3D-VRI, especially obtained by DECT, allows clinicians to make an accurate diagnosis and treatment plan that are difficult to judge by routine MRI.
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Affiliation(s)
- A Yeon Kim
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Korea
| | - Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Korea.
| | - Il Choi
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Korea
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Ogura T, Sakamoto M, Yoshioka H, Torihashi K, Kambe A, Kurosaki M. Unusual Manifestation of Spinal Epidural Arteriovenous Fistula as Sudden Paraplegia. World Neurosurg 2020; 144:60-63. [DOI: 10.1016/j.wneu.2020.08.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/25/2022]
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Iampreechakul P, Liengudom A, Wangtanaphat K, Narischat P, Lertbutsayanukul P, Siriwimonmas S. Intramedullary Hemorrhage Caused by Lumbosacral Epidural Arteriovenous Fistula with Dual Retrograde Perimedullary Venous Draining Routes: A Case Report and Review of the Literature. World Neurosurg 2020; 143:295-307. [DOI: 10.1016/j.wneu.2020.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 11/20/2022]
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Watanabe Y, Naito K, Arima H, Kawakami T, Yamagata T, Takami T. Microsurgical or endovascular strategy for complete obliteration of spinal arteriovenous shunts in a single-institute 10-year retrospective study. J Clin Neurosci 2020; 80:195-202. [PMID: 33099345 DOI: 10.1016/j.jocn.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 11/24/2022]
Abstract
The objective of this retrospective study is to more fully understand the optimal strategy to manage spinal arteriovenous (AV) shunts. This study included a cohort of 35 patients with a diagnosis of spinal AV shunts who were treated over the past 10 years at a single institute. Angiographic diagnosis of intramedullary AV malformations (IM-AVM), perimedullary AV fistulas (PM-AVF), dural AV fistulas (D-AVF), or epidural AV fistulas (ED-AVF) was carefully made, and the microsurgical or endovascular strategy for them was determined at the interdisciplinary meeting consisting of neurospinal surgeons and endovascular specialists. Endovascular surgery was first considered whenever safely possible. Microscopic direct surgery using intraoperative image guidance was considered for cases in which endovascular access was challenging or not safely possible. Combined treatment was another option. The clinical condition was assessed using the modified Rankin scale (mRS). Seventeen of 35 cases were treated with microscopic direct surgery, 13 cases with endovascular surgery, and the remaining five cases with the combination. Complete angiographic obliteration was achieved in 30 of 35 cases (85.7%). Although residual AV shunts was recognized in 3 cases of IM-AVM, 1 case of PM-AVF and 1 case of ED-AVF, no angiographic recurrence was present with an average postoperative follow-up period of 44 months. The average mRS before surgery was 2.37 and significantly improved to 1.94 at the most recent follow-up. Interdisciplinary collaboration between neurospinal surgeons and endovascular specialists should be standard to achieve safe and successful outcomes in treating such rare and difficult spinal disorders.
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Ryu B, Sato S, Mochizuki T, Niimi Y. Spinal arteriovenous fistula located in the filum terminale externa: A case report and review of the literature. Interv Neuroradiol 2020; 27:451-455. [PMID: 33092430 DOI: 10.1177/1591019920968363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A filum terminale arteriovenous fistula (FTAVF) is an extremely rare spinal arteriovenous fistula (AVF) and typically presents with myelopathy and conus medullaris syndrome caused by venous congestion in the spinal cord. Most reported FTAVFs are intradural pial AVFs with perimedullary drainage in the filum terminale interna. However, there are no reports of AVFs in the filum terminale externa (FTE). We describe a case involving a 68-year-old man with an AVF in the FTE who presented with progressive myelopathy and underwent successful endovascular treatment. We identified the specific shunt point by fusing postoperative computed tomography and magnetic resonance images. The features of the extradural sac AVF developed in the FTE may mimic those of a dural AVF with dural supply to the FTE covered by the dural component, unlike typical FTAVFs where the shunt develops at the pia mater. This case makes a significant contribution to the field by increasing the understanding of the clinical characteristics of an AVF that develops in the FTE and its angioarchitecture.
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Affiliation(s)
- Bikei Ryu
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan.,Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan.,Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shinsuke Sato
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan.,Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan.,Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tatsuki Mochizuki
- Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
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Iampreechakul P, Tirakotai W, Lertbutsayanukul P, Thammachantha S, Siriwimonmas S. Spontaneous Spinal Osseous Epidural Arteriovenous Fistula with Long Segments of Prominent Epidural Venous Drainage Causing Severe Compressive Thoracic Myelopathy Successfully Treated with Combined Endovascular and Surgical Treatments: A Case Report and Review of the Literature. Asian J Neurosurg 2020; 15:1041-1049. [PMID: 33708687 PMCID: PMC7869281 DOI: 10.4103/ajns.ajns_353_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
The authors describe an extremely rare case of spinal osseous epidural arteriovenous fistulas (SOEAVFs) with unique characteristic features. A 25-year-old man presented with progressive weakness and paresthesia of the lower extremities for 1 month. Magnetic resonance imaging of the thoracic spine showed an extradural dilated vascular flow void structure extending from T4 to T8 levels with abnormal hyperintense T2 signal from T6 to T8 levels. Magnetic resonance angiography and spinal angiography revealed unique features of SOEAVF supplied by multiple small arterial feeders of intercostal arteries converging into a dilated round venous sac corresponding to a bony defect of T7 lamina and spinous process. The venous drainage directly drained into prominent epidural venous plexus extending from the level of T4 to T8 without intradural venous drainage, causing severe compressive myelopathy. Transarterial embolization was performed using N-butyl cyanoacrylate through the main feeder. Subsequently, he successfully underwent laminectomy and total excision of the fistula and large epidural draining venous plexus. Histopathology confirmed spinal vascular malformations with evidence of previous embolization. He gradually improved until being ability to walk independently 3 months later. Follow-up spinal angiography confirmed complete resection of SOEAVF. The patient has remained clinically asymptomatic 5 years after operation.
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Affiliation(s)
| | - Wuttipong Tirakotai
- Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand
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Park JS, Kwon MY, Lee CY. Cervical spinal extradural arteriovenous fistula successfully treated using transarterial balloon-assisted coil embolization. J Cerebrovasc Endovasc Neurosurg 2020; 22:182-189. [PMID: 32971577 PMCID: PMC7522392 DOI: 10.7461/jcen.2020.22.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
We present the case of a patient who developed compressive radiculopathy that was found to be associated with a spinal extradural arteriovenous fistula. The fistula was successfully obliterated with transarteiral balloon-assisted coiling, after which the patient was symptom-free. Although spinal extradural arteriovenous fistula is rare, this pathology should be considered in the differential diagnosis of spinal radiculopathy or myelopathy. Endovascular treatment appears to have been successful in resolving the symptoms associated with this pathology.
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Affiliation(s)
- Jung-Sik Park
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Min-Yong Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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38
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Kanematsu R, Hanakita J, Takahashi T, Tomita Y, Minami M. An Acquired Cervical Dural Arteriovenous Fistula After Cervical Anterior Fusion: Case Report and Literature Review. World Neurosurg 2019; 128:50-4. [DOI: 10.1016/j.wneu.2019.04.202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/22/2022]
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Lenck S, Nicholson P, Tymianski R, Hilditch C, Nouet A, Patel K, Krings T, Tymianski M, Radovanovic I, Mendes Pereira V. Spinal and Paraspinal Arteriovenous Lesions. Stroke 2019; 50:2259-2269. [DOI: 10.1161/strokeaha.118.012783] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Stéphanie Lenck
- From the Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto (S.L., P.N., C.H., T.K., V.M.P.), University Health Network, ON, Canada
- Division of Neuroradiology (S.L.), Groupe Hospitalier Pitié-Salpêtrière, Paris Sorbonne University, France
| | - Patrick Nicholson
- From the Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto (S.L., P.N., C.H., T.K., V.M.P.), University Health Network, ON, Canada
| | - Rachel Tymianski
- Adelaide Medical School, University of Adelaide, Australia (R.T.)
| | - Christopher Hilditch
- From the Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto (S.L., P.N., C.H., T.K., V.M.P.), University Health Network, ON, Canada
| | - Aurélien Nouet
- Division of Neurosurgery (A.N.), Groupe Hospitalier Pitié-Salpêtrière, Paris Sorbonne University, France
| | - Krunal Patel
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada (K.P., M.T., I.R., V.M.P.)
| | - Timo Krings
- From the Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto (S.L., P.N., C.H., T.K., V.M.P.), University Health Network, ON, Canada
| | - Michael Tymianski
- Krembil Neuroscience Center (M.T., I.R.), University Health Network, ON, Canada
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada (K.P., M.T., I.R., V.M.P.)
| | - Ivan Radovanovic
- Krembil Neuroscience Center (M.T., I.R.), University Health Network, ON, Canada
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada (K.P., M.T., I.R., V.M.P.)
| | - Vitor Mendes Pereira
- From the Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto (S.L., P.N., C.H., T.K., V.M.P.), University Health Network, ON, Canada
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada (K.P., M.T., I.R., V.M.P.)
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Mansour A, Endo T, Inoue T, Sato K, Endo H, Fujimura M, Tominaga T. Clipping of an anterior spinal artery aneurysm using an endoscopic fluorescence imaging system for craniocervical junction epidural arteriovenous fistula: technical note. J Neurosurg Spine 2019; 31:279-284. [PMID: 31026820 DOI: 10.3171/2019.1.spine18983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/29/2019] [Indexed: 01/12/2023]
Abstract
The authors report the case of a 78-year-old man with a craniocervical junction epidural arteriovenous fistula who presented with subarachnoid hemorrhage from a ruptured anterior spinal artery (ASA) aneurysm. Because endovascular embolization was difficult, a posterolateral approach was chosen and a novel endoscopic fluorescence imaging system was utilized to clip the aneurysm. The fluorescence imaging system provided clear and magnified views of the ventral spinal cord simultaneously with the endoscope-integrated indocyanine green videoangiography, which helped safely obliterate the ASA aneurysm. With the aid of this novel imaging system, surgeons can appreciate and manipulate complex vascular pathologies of the ventral spinal cord through a posterolateral approach, even when the lesion is closely related to the ASA.
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Affiliation(s)
- Ahmed Mansour
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine
- 4Department of Neurosurgery, Menoufia University Graduate School of Medicine, Menoufia, Egypt
| | - Toshiki Endo
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine
- 2Department of Neurosurgery, Kohnan Hospital
| | - Tomoo Inoue
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | - Kenichi Sato
- 3Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan; and
| | - Hidenori Endo
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | | | - Teiji Tominaga
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine
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Rinaldo L, Cloft HJ, Lanzino G, Rangel-Castilla L. Embolization of a large lumbar type A epidural arteriovenous fistula. Neurosurg Focus 2019; 46:V6. [DOI: 10.3171/2019.1.focusvid.18435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/07/2018] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Giuseppe Lanzino
- Departments of 1Neurosurgery and
- 2Radiology, Mayo Clinic, Rochester, Minnesota
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42
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Tolias CM, Giamouriadis A, Hogg FRA, Ghimire P. Spinal Dural Arteriovenous Fistula. Neurosurgery 2019. [DOI: 10.1007/978-3-319-98234-2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Kajitani T, Endo T, Inoue T, Sato K, Matsumoto Y, Tominaga T. Lumbar tap–induced subarachnoid hemorrhage in a case of spinal epidural arteriovenous fistula. J Neurosurg Spine 2018; 29:535-540. [DOI: 10.3171/2018.3.spine171343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/29/2018] [Indexed: 11/06/2022]
Abstract
The authors report the case of a 70-year-old woman with lumbar spinal epidural arteriovenous fistula (SEDAVF) who experienced subarachnoid hemorrhage (SAH) after a diagnostic lumbar puncture. According to the literature, perimedullary spinal vein enlargement is a hallmark of spinal vascular diseases; however, there are certain cases in which routine sagittal MRI fails to disclose signal flow voids. In such cases, patients may undergo a lumbar tap to investigate the possible causes of spinal inflammatory or demyelinating disease. Recognizing this phenomenon is essential because lumbar puncture of the epidural venous pouch or an enlarged intradural vein in SEDAVF may induce severe SAH. A high clinical index of suspicion can prevent similar cases in lumbar SEDAVF.
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Affiliation(s)
- Takumi Kajitani
- 1Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi; and
| | - Toshiki Endo
- 1Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi; and
- Departments of 2Neurosurgery and
| | - Tomoo Inoue
- 1Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi; and
| | - Kenichi Sato
- 3Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan
| | | | - Teiji Tominaga
- 1Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi; and
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Mull M, Othman A, Dafotakis M, Hans FJ, Schubert GA, Jablawi F. Spinal Epidural Arteriovenous Fistula with Perimedullary Venous Reflux: Clinical and Neuroradiologic Features of an Underestimated Vascular Disorder. AJNR Am J Neuroradiol 2018; 39:2095-2102. [PMID: 30337434 DOI: 10.3174/ajnr.a5854] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/13/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to discuss the clinical and radiologic characteristics of spinal epidural arteriovenous fistulas (SEAVF) and demonstrate their specific angiomorphology in a single-center series. MATERIALS AND METHODS Thirteen consecutive patients were diagnosed with SEAVF at RWTH Aachen University Hospital between 2006 and 2018 and were included in this study. All patients had MR imaging and DSA before treatment; 10 of these 13 patients received contrast-enhanced MRA (CE-MRA). RESULTS The mean patient age was 72 ± 8 years. Paraparesis was present in 12 (92%) patients. Sphincter dysfunction and sensory symptoms were observed in 7 (54%) and 6 (46%) patients, respectively. The mean duration of symptoms was 6 ± 8 months. Congestive myelopathy on MR imaging was present in all patients. Prominent arterialized perimedullary veins were demonstrated in only 3 cases. CE-MRA revealed arterialized perimedullary veins and an arterialized epidural pouch in 9/10 (90%) patients, mostly located ventrolaterally. DSA demonstrated a multisegmental extension of the arterialized ventrolateral epidural pouch in 6 (46%) cases. An intradural radicular drainage vein was localized distant from the original fistula point in 3 (23%) patients. CONCLUSIONS Congestive myelopathy with an acute/subacute clinical course was the dominant finding in spinal epidural arteriovenous fistulas. CE-MRA is a powerful diagnostic tool for identifying arterialized perimedullary veins as well as an arterialized epidural pouch. While arterialized perimedullary veins frequently present with only mild enlargement and elongation in spinal epidural arteriovenous fistulas, the arterialized epidural pouch is frequently located ventrolaterally and may extend over several vertebral levels. DSA remains the criterion standard to precisely visualize a spinal epidural arteriovenous fistula and its intradural radicular drainage vein, which may be located distant from the fistulous point.
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Affiliation(s)
- M Mull
- From the Departments of Diagnostic and Interventional Neuroradiology (M.M., A.O., F.J.)
| | - A Othman
- From the Departments of Diagnostic and Interventional Neuroradiology (M.M., A.O., F.J.).,Department of Diagnostic and Interventional Radiology (A.O.), University Hospital Tübingen, Tübingen, Germany
| | | | - F-J Hans
- Department of Neurosurgery (F.-J.H.), Paracelsus Kliniken, Osnabrück, Germany
| | - G A Schubert
- Neurosurgery (G.A.S.), University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - F Jablawi
- From the Departments of Diagnostic and Interventional Neuroradiology (M.M., A.O., F.J.).,Department of Neurosurgery (F.J.), Justus-Liebig-University, Giessen, Giessen, Germany
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Caruso C, McDonnell M, Chiappetta G. Development of Postoperative Spinal Arteriovenous Fistula After Lumbar Laminectomy, Decompression, and Posterior Spinal Fusion. J Am Acad Orthop Surg Glob Res Rev 2017; 1:e041. [PMID: 30211360 DOI: 10.5435/JAAOSGlobal-D-17-00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spinal dural arteriovenous fistulas are a rare cause of low back pain, bilateral lower extremity weakness, or pain with sensory changes. They are typically found in males in the fifth and sixth decades of life, associated with a progressive decline in symptoms that make initial diagnosis challenging in some patients. We present a case report and literature review of an 80-year-old woman with a long-standing history of progressively worsening back pain and lower extremity pain that has limited her daily activities. When preoperative MRI of the lumbar spine showed high-grade stenosis and listhesis of L4-L5, the patient was taken to the operating room for an L4-L5 laminectomy, decompression, facetecomy, and instrumented fusion. Her postoperative course did not show improvement of symptoms, which in fact worsened, leading to gait imbalance and instability. Postoperative MRIs of the patient were concerning for a spinal dural arteriovenous fistula, which was confirmed and treated by spinal angiography and embolization.
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Takei J, Tochigi S, Arai M, Tanaka T, Kajiwara I, Hatano K, Ichinose D, Sakamoto H, Hasegawa Y, Ishibashi T, Tani S, Murayama Y. Spinal Extradural Arteriovenous Fistula with Cowden Syndrome: A Case Report and Literature Review Regarding Pathogenesis and Therapeutic Strategy. NMC Case Rep J 2018; 5:83-85. [PMID: 30327747 PMCID: PMC6187262 DOI: 10.2176/nmccrj.cr.2018-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 05/02/2018] [Indexed: 11/22/2022] Open
Abstract
We report the case of a patient with a spinal extradural arteriovenous fistula (AVF) associated with Cowden syndrome (CS) that was successfully treated by endovascular surgery. CS is an autosomal dominant disorder associated with diverse symptoms caused by a deleterious mutation in the phosphatase and tensin homolog (PTEN) gene. A 67-year-old woman was diagnosed with CS based on her medical history of multiple cancers for which she underwent abdominal surgery, macrocephaly, Lhermitte-Duclos disease, and facial papules. Her genetic testing demonstrated a PTEN mutation. She presented with progressive paraparesis and her MRI of the thoracolumbar spine showed the spinal cord edema along with flow voids. A spinal angiogram demonstrated a spinal extradural AVF with the perimedullary drainage. The AVF was successfully treated by endovascular surgery. The PTEN mutation can accelerate angiogenesis; thus, vascular anomalies are one of the diagnostic criteria of CS. However, only two cases of vascular anomalies involving the spinal cord in patients with CS have been reported previously. As the present case, both cases had a history of abdominal or retroperitoneal cancer. The PTEN mutation accompanied with abdominal surgery might have caused this vascular anomaly as the consequences of venous congestion around the thoracolumbar spine. A spinal extradural AVF should be considered in patients with CS who present with myelopathy, especially when the patient has a history of abdominal or retroperitoneal surgery. Regarding the treatment strategy, endovascular surgery should be considered because surgical insult could prompt secondary vascular anomalies resulting from neovascularization due to the PTEN mutation.
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Affiliation(s)
- Jun Takei
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Satoru Tochigi
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Masami Arai
- Department of Clinical Genetic Oncology, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Ikki Kajiwara
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Keisuke Hatano
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Daisuke Ichinose
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Hiroki Sakamoto
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Tani
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
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Byun JS, Tsang ACO, Hilditch CA, Nicholson P, Fang YB, Krings T, Pereira VM, Lanzino G, Brinjikji W. Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas: a systematic review and meta-analysis. J Neurointerv Surg 2018; 11:95-98. [DOI: 10.1136/neurintsurg-2018-014203] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 11/04/2022]
Abstract
Background and purposeThoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study was to perform a systematic review of the demographics, clinical presentation and treatment results of thoracolumbar SEDAVFs.Materials and methodsPubmed, Scopus and Web of Science databases were searched from January 2000 to January 2018 for articles on treatment of SEDAVFs. Pooled data of individual patients were analyzed for demographic and clinical features of SEDAVFs as well as treatment outcomes.ResultsThere were 125 patients from 11 studies included. Mean age was 63.5 years. There was a male sex predilection (69.6%). Sensory symptoms including pain or numbness were the most frequently presenting symptoms. Fistula location was the lumbosacral spine in 79.2% and the thoracic spine in 20.8%. Involvement of intradural venous drainage was more common than extradural venous drainage only (89.6% vs 10.4%). Of the 123 treated patients, endovascular therapy was performed in 67.5% of patients, microsurgery in 23.6%, and combined treatment in 8.9%. The overall complete obliteration rate was 83.5% and did not differ between groups. Clinical symptoms improved in 70.7% of patients, were stable in 25%, and worsened in 1.7% with no difference between treatment modalities.ConclusionsThoracic and lumbosacral SEDAVFs often present with symptoms secondary to congestive myelopathy or compressive symptoms. Both endovascular and microsurgical treatments were associated with high obliteration rates and good clinical outcomes.
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Shaban A, Moritani T, Al Kasab S, Sheharyar A, Limaye KS, Adams HP. Spinal Cord Hemorrhage. J Stroke Cerebrovasc Dis 2018; 27:1435-46. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/31/2018] [Accepted: 02/08/2018] [Indexed: 12/13/2022] Open
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Takai K, Shojima M, Imai H, Saito N, Taniguchi M. Microsurgical and Endovascular Treatments of Spinal Extradural Arteriovenous Fistulas with or without Intradural Venous Drainage. World Neurosurg 2018; 111:e819-29. [DOI: 10.1016/j.wneu.2017.12.162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/25/2017] [Accepted: 12/27/2017] [Indexed: 12/16/2022]
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50
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Wettstein RKRW, van der Kallen BFW, Moojen WA, Tewarie RN. Thoracic epidural haematoma due to a subclavian steal syndrome and secondary formed thoracic collateral circuits, coincidence or consequence: a case report. Acta Neurochir (Wien) 2018; 160:205-208. [PMID: 29167977 DOI: 10.1007/s00701-017-3402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/13/2017] [Indexed: 11/26/2022]
Abstract
Despite profound diagnostics, the aetiology of spinal epidural haematoma (SEH) often remains unknown. In this case, diagnostics revealed an SEH at the fifth and sixth thoracic levels due to a subclavian steal syndrome with a tortuous vascular loop between the sixth thoracic intercostal artery and the costocervical arteries deriving from the left subclavian artery with plump arteries in the epidural space. The patient underwent decompression surgery and a percutaneous transluminal angioplasty. The patient showed good recovery at follow-up. The SEH was a result of secondary formed thoracic collateral circuits with epidural involvement due to a subclavian steal syndrome.
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Affiliation(s)
- Ravian K R W Wettstein
- Department of Neurosurgery, Haaglanden Medical Centre, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
| | | | - Wouter A Moojen
- Department of Neurosurgery, Haaglanden Medical Centre, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rishi Nandoe Tewarie
- Department of Neurosurgery, Haaglanden Medical Centre, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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