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El Homsi M, Zadeh C, Charbel C, Alsheikh Deeb I, Gharzeddine K, Rebeiz K, Hourani R, Khoury N, Moukaddam H. Neurologic pathologies of the vertebral spine. Skeletal Radiol 2024; 53:419-436. [PMID: 37589755 DOI: 10.1007/s00256-023-04428-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
At some institutions, musculoskeletal and general radiologists rather than neuroradiologists are responsible for reading magnetic resonance imaging (MRI) of the spine. However, neurological findings, especially intrathecal ones, can be challenging. Intrathecal neurological findings in the spine can be classified by location (epidural, intradural extramedullary, and intramedullary) or etiology (tumor, infection, inflammatory, congenital). In this paper, we provide a succinct review of the intrathecal neurological findings that can be seen on MRI of the spine, primarily by location and secondarily by etiology, in order that this may serve as a helpful guide for musculoskeletal and general radiologists when encountering intrathecal neurological pathologies.
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Affiliation(s)
- Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Catherina Zadeh
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa, IA, USA
| | - Charlotte Charbel
- Department of Radiology, Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Ibrahim Alsheikh Deeb
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karem Gharzeddine
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karim Rebeiz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roula Hourani
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nabil Khoury
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa, IA, USA
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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Domingo RA, De Biase G, Navarro R, Santos JLM, Rivas GA, Gupta V, Miller D, Bendok BR, Brinjikji W, Fox WC, Huynh TJ, Tawk RG. Clinical and radiographic characteristics of sacral arteriovenous fistulas: a multicenter experience. J Neurosurg Spine 2021:1-11. [PMID: 34624835 DOI: 10.3171/2021.5.spine21119] [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: 01/24/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Available data on management of sacral arteriovenous fistulas (sAVFs) are limited to individual case reports and small series. Management includes observation, endovascular embolization, or surgical ligation, with no clear guidelines on the optimal treatment modality. The authors' objective was to report their multiinstitutional experience with management of sAVF patients, including clinical and radiographic characteristics and postprocedural outcomes. METHODS The electronic medical records of patients with a diagnosis of spinal arteriovenous fistula treated from January 2004 to December 2019 at the authors' institutions were reviewed, and data were summarized using descriptive statistics, including percentage and count for categorical data, median as a measure of central tendency for continuous variables, and interquartile range (IQR) as a measure of dispersion. RESULTS A total of 26 patients with sAVFs were included. The median (IQR) age was 65 (57-73) years, and 73% (n = 19) of patients were male. Lower-extremity weakness was the most common presenting symptom (n = 24 [92%]), and half the patients (n = 13 [50%]) reported bowel and bladder sphincter dysfunction. The median (IQR) time from symptom onset to treatment was 12 (5.25-26.25) months. Radiographically, all patients had T2 hyperintensity at the level of the conus medullaris (CM) (n = 26 [100%]). Intradural flow voids were identified in 85% (n = 22) of patients. The majority of the lesions had a single identifiable arterial feeder (n = 19 [73%]). The fistula was located most commonly at the S1 level (n = 13 [50%]). The site where the draining vein connects to the pial venous plexus was seen predominantly at the lumbar level (n = 16 [62%]). In total, 29 procedures were performed: 10 open surgeries and 19 endovascular embolization procedures. Complete occlusion was achieved in 90% (n = 9) of patients after open surgery and 79% (n = 15) after endovascular embolization. Motor improvement was seen in 68% of patients (n = 15), and bladder and bowel function improved in 9 patients (41%). At last follow-up, 73% (n = 16) of patients had either resolution or improvement of the pretreatment intramedullary T2 signal hyperintensity. CONCLUSIONS T2 hyperintensity of the CM and a dilated filum terminale vein are consistent radiographic signs of sAVF, and delayed presentation is common. Complete occlusion was achieved in almost all patients after surgery, and endovascular embolization was effective in 70% of the patients. Further studies are needed to determine the best treatment modality based on case-specific characteristics.
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Affiliation(s)
- Ricardo A Domingo
- 1Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Gaetano De Biase
- 1Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ramon Navarro
- 2Department of Neurologic Surgery, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Jaime L Martinez Santos
- 1Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida.,3Department of Neurologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Gabriella A Rivas
- 4School of Medicine, Saint George's University, Great River, New York
| | - Vivek Gupta
- 5Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - David Miller
- 5Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Bernard R Bendok
- 6Department of Neurologic Surgery, Mayo Clinic, Phoenix, Arizona; and
| | | | - W Christopher Fox
- 1Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Thien J Huynh
- 5Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Rabih G Tawk
- 1Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
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Rahme RJ, Abi-Aad KR, Almekkawi AK, Patra DP, Bendok BR. Endovascular Embolization of a Lateral Sacral Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E313. [PMID: 32171002 DOI: 10.1093/ons/opaa020] [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: 10/15/2019] [Accepted: 12/15/2019] [Indexed: 11/13/2022] Open
Abstract
Spinal dural arteriovenous fistulas are the most common vascular malformations of the spine. They are localized in the sacral spine in 5% to 14% of the cases. They can be fed by the median or the lateral sacral arteries. These lesions present with nonspecific symptoms such as radiculopathy and/or myelopathy, which often leads to a delay in diagnosis. In this video, we present the case of a 65-yr-old gentleman with a lateral sacral dural arteriovenous fistula. The patient was referred to our institution after the outside facility workup was nondiagnostic. He presented with spastic paraparesis and bilateral radiculopathy. After patient informed consent was obtained, we performed a spinal diagnostic angiogram with catheterization and angiography of the internal iliac artery, which revealed the fistula. Onyx (Medtronic, Dublin, Ireland) embolization was performed, which led to a complete occlusion of the fistula. The patient had complete neurological recovery, and at 2-yr follow-up, imaging remained negative for a fistula. In this video, we discuss the nuances and key points related to the epidemiology, diagnosis, and treatment of lateral sacral fistulas.1-3.
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Affiliation(s)
- Rudy J Rahme
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Karl R Abi-Aad
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Ahmad Kareem Almekkawi
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona.,Department of Radiology, Mayo Clinic, Phoenix, Arizona
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Takahashi K, Matsumoto Y, Nagata Y, Hashikawa T, Sakai H, Furuta K, Yoshitake H, Nakagawa S, Fukushima Y. The Shunt Point of the Sacral Dural Arteriovenous Fistula: A Case Report and Literature Review. World Neurosurg 2020; 143:518-526. [PMID: 32068174 DOI: 10.1016/j.wneu.2020.02.037] [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: 11/24/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The occurrence of sacral dural arteriovenous fistula (dAVF) is rare. The detailed vascular architecture of sacral dAVF, including 3-dimensional (3D) angiographic images with operative findings, has not been evaluated compared with that of the thoracic and lumbar levels. We report a case of sacral dAVF with 3D angiographic examination and operative findings, with a literature review. CASE DESCRIPTION A 60-year-old man presented with progressive urinary incontinence and gait disturbance. A sacral dAVF was detected at the S1-2 level. The shunt point was at the medial side of the line between the intermediate sacral crest and the most medial point of the L5 pedicle circle at the anterior posterior view of the angiography; we defined this type as the medial type. After embolization, latent inflow arteries were visualized ipsilaterally and contralaterally. During surgery, because of dAVF recurrence, a vascular tangle was found on the dura. The surgical interruption of the draining vein improved the patient's symptoms. From the literature review, 92% of cases had medial-type shunt point. It is possible for sacral dAVF to have multiple inflow arteries originating ipsilaterally or bilaterally, and a venous pouch. CONCLUSIONS The shunt point of sacral dAVF tended to be located medially, not in the sacral foramen. Sacral dAVF has unique angioarchitecture. The differentiation of dAVF from epidural arteriovenous fistula may not be easy in some cases of sacral lesions. Therefore, further studies with a larger number of patients focused on the detailed vascular architecture are needed.
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Affiliation(s)
- Kenji Takahashi
- Department of Neurosurgery, St. Mary's Hospital, Fukuoka, Japan
| | | | - Yui Nagata
- Department of Neurosurgery, St. Mary's Hospital, Fukuoka, Japan
| | | | - Hideki Sakai
- Department of Neurosurgery, St. Mary's Hospital, Fukuoka, Japan
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5
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Ren Y, Liu H, Chen TY, You C, Li J. Successful Management of Sacral Dural Arteriovenous Fistulas: A Case Series and Literature Review. World Neurosurg 2019; 126:164-170. [DOI: 10.1016/j.wneu.2019.02.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
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6
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Wang XC, Du YY, Tan Y, Qin JB, Wang L, Wu XF, Liang X, Zhang L, Li LN, Zhou X, Feng DP, Ma GL, Zhang H. Brainstem Congestion Due to Dural Arteriovenous Fistula at the Craniocervical Junction: Case Report and Review of the Literature. World Neurosurg 2018; 118:181-187. [PMID: 30010077 DOI: 10.1016/j.wneu.2018.06.243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/08/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVFs) at the craniocervical junction are rare. Clinical manifestations range from acute or chronic myelopathy to subarachnoid hemorrhage to brainstem dysfunction. We encountered 4 cases of DAVFs at the craniocervical junction with progressive brainstem dysfunction and investigated the typical magnetic resonance imaging (MRI) features using T2-weighting imaging, susceptibility-weighted imaging, diffusion-weighted imaging, and contrast-enhanced imaging. Literature review revealed 10 case reports of DAVFs at the craniocervical junction manifesting with brainstem dysfunction. CASE DESCRIPTION Four patients presented with DAVFs at the craniocervical junction with progressive brainstem dysfunction. Two patients underwent midline suboccipital craniotomy and C1 laminectomy, and 1 patient underwent transarterial endovascular embolization with Onyx 18 under general anesthesia. All neurologic deficits gradually improved after the operation. In the fourth case, the patient received conservative treatment and did not undergo any surgical procedure. MRI showed high signal intensity on T2-weighted imaging, magnetic resonance angiography, and magnetic resonance venography. Abnormal dilated vessels and flow-void signs around the lesions were detected on susceptibility-weighted imaging and contrast-enhanced images. Two cases revealed no abnormalities and had improved neurological deficits than those showed on diffusion-weighted imaging. CONCLUSIONS Susceptibility-weighted imaging, diffusion-weighted imaging, or contrast-enhanced scanning should be used during MRI examination of patients with progressive brainstem dysfunction to differentiate DAVFs at the craniocervical junction from other diseases, such as glioma or infection. Prompt diagnosis using MRI is of great significance in producing good functional outcomes of the patients.
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Affiliation(s)
- Xiao-Chun Wang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yan-Yao Du
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yan Tan
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Jiang-Bo Qin
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Le Wang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xiao-Feng Wu
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xin Liang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Lei Zhang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Li-Na Li
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xin Zhou
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Dui-Ping Feng
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Guo-Lin Ma
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China.
| | - Hui Zhang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China.
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7
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Gioppo A, Faragò G, Giannitto C, Caputi L, Saladino A, Acerbi F, Ciceri E. Sacral dural arteriovenous fistulas: a diagnostic and therapeutic challenge – single-centre experience of 13 cases and review of the literature. J Neurointerv Surg 2017; 10:415-421. [DOI: 10.1136/neurintsurg-2017-013307] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 11/03/2022]
Abstract
BackgroundSacral dural arteriovenous fistulas (DAVFs) are rare vascular abnormalities of the spine characterised by slowly progressive symptoms that can mimic different myelopathy disorders.ObjectTo report our single Institution experience with sacral DAVFs.MethodsWe retrospectively reviewed the clinical records of patients admitted from 1 January 2006 to 31 December 2016 with a diagnosis of sacral DAVFs, treated by endovascular embolisation or surgical clipping. Clinical presentation, imaging characteristics, treatment results and follow-up were analysed.ResultsWe identify 13 patients with sacral DAVFs supplied by lateral sacral arteries. Clinical presentation was characterised by different degrees of motor weakness and sphincter disturbances. In all patients, spinal MRI showed spinal cord hyperintensities with enhancement and prominent perimedullary vessels. Selective internal iliac angiography was mandatory to identify the exact location of the fistula. A complete embolisation was achieved in eight patients performing a single endovascular embolisation and in three patients performing a single surgical disconnection: two patients required combined procedures. Follow-up imaging showed a complete resolution of the spinal cord hyperintensities in 81% of patients and a reduction of the intramedullary enhancement in 91%. Gait improvement was observed in 73% of patients, while remaining stable in 27%. Sphincter disturbances improved in 36% of patients and remained stable in 64%.ConclusionAwareness of sacral location of DAVFs is critical because standard spinal angiography will not identify sacral supplies, unless internal iliac arteries are properly examined. In our experience, the endovascular treatment show results comparable to surgery when the fistula point is correctly disconnected.
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8
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Soni V, Vaidya PC, Sahu JK, Yadav M, Singhi P. Spinal Dural Arteriovenous Fistula and Cecal Arteriovenous Malformation in a Boy. APSP J Case Rep 2017; 8:3. [PMID: 28164000 PMCID: PMC5253611 DOI: 10.21699/ajcr.v8i1.510] [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: 09/26/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022] Open
Abstract
Concurrent spinal dural arteriovenous fistula (AVF) and cecal arteriovenous malformation (AVM) are very rare. A 6-year old boy presented with lower limb paresis after trauma. On imaging work-up spinal dural AVF was found. It was managed with endovascular glue embolization. After two years, the boy presented with severe anemia and occult gastrointestinal tract (GIT) bleed. Cecal AVM was diagnosed and managed with embolization.
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Affiliation(s)
- Vimlesh Soni
- Department of Paediatrics, Advanced Paediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj C Vaidya
- Department of Paediatrics, Advanced Paediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kumar Sahu
- Department of Paediatrics, Advanced Paediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mukesh Yadav
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Delhi
| | - Pratibha Singhi
- Department of Paediatrics, Advanced Paediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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9
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Alvarado AM, Haussen DC, Ebersole K, Nogueira RG, Abraham MG. Embolization of Sacral Dural Arteriovenous Fistulas: A Case Series and Literature Review. Interv Neurol 2017; 6:73-81. [PMID: 28611837 DOI: 10.1159/000454929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors report 2 cases of sacral dural arteriovenous fistula (AVF) presenting with gradual neurologic decline characterized by progressive lower extremity weakness and bowel and bladder incontinence. Spinal angiography demonstrated a sacral dural AVF with perimedullary vein engorgement and drainage extending to the level of the cervical spine in both cases. The fistulas were completely obliterated with n-BCA (n-butyl cyanoacrylate) embolic agent in one case, and with ethylene vinyl alcohol (Onyx) in the second, resulting in improvement of the symptoms in both patients. The unique features of this case report include the rare location of the fistula's origin, the necessity for complete spinal angiography, and the use of intraoperative monitoring in one case to guide embolization treatment.
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Affiliation(s)
| | - Diogo C Haussen
- Department of Department of Neurology, Emory University/ Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA, USA
| | - Koji Ebersole
- Department of Neurological Surgery, Kansas City, KS, GA, USA
| | - Raul G Nogueira
- Department of Department of Neurology, Emory University/ Grady Memorial Hospital - Marcus Stroke and Neuroscience Center, Atlanta, GA, USA
| | - Michael G Abraham
- Department of Neurology, Kansas City, KS, GA, USA.,Department of Radiology, Kansas University Medical Center, Kansas City, KS, GA, USA
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10
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Sung KS, Song YJ, Kim KU. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula. J Korean Neurosurg Soc 2016; 59:420-4. [PMID: 27446527 PMCID: PMC4954894 DOI: 10.3340/jkns.2016.59.4.420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/03/2014] [Revised: 05/15/2015] [Accepted: 05/30/2015] [Indexed: 11/27/2022] Open
Abstract
The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system.
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Affiliation(s)
- Kyoung-Su Sung
- Brain Tumor Institute, Novalis Stereotactic Radiosurgery Center, Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
| | - Young-Jin Song
- Brain Tumor Institute, Novalis Stereotactic Radiosurgery Center, Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
| | - Ki-Uk Kim
- Brain Tumor Institute, Novalis Stereotactic Radiosurgery Center, Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
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11
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Wang JY, Molenda J, Bydon A, Colby GP, Coon AL, Tamargo RJ, Huang J. Natural history and treatment of craniocervical junction dural arteriovenous fistulas. J Clin Neurosci 2015. [PMID: 26195333 DOI: 10.1016/j.jocn.2015.05.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [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: 11/29/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) located at the craniocervical junction are rare vascular malformations with distinctive features, and their natural history and the optimal treatment strategy remains unclear. We retrospectively reviewed eight patients with craniocervical junction DAVF who were evaluated at our institution between 2009 and 2012. We also conducted a MEDLINE search for all reports of craniocervical junction DAVF between 1970 and 2013, and reviewed 119 patients from 56 studies. From a total of 127 patients, 46 (37.1%) presented with myelopathy, 53 (43.1%) with subarachnoid hemorrhage (SAH), and four (3.3%) with brainstem dysfunction. SAH was typically mild, most often Hunt and Hess Grade I or II (83.3%), and associated with ascending venous drainage via the intracranial veins (p<0.001). Higher rates of obliteration were observed after microsurgery compared to embolization. Overall, younger age (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01-1.12; p=0.011), hemorrhagic presentation (OR 0.17; 95% CI 0.06-0.50; p=0.001), and microsurgery (OR 0.23; 95% CI 0.08-0.6; p=0.004) were independently predictive of good outcome at the last follow-up. Microsurgery was the only independent predictor of overall improvement at the last follow-up (OR 4.35; 95% CI 1.44-13.2; p=0.009). Prompt diagnosis and microsurgical management, offering a greater chance of immediate obliteration, may optimize the outcomes for patients with craniocervical junction DAVF. Endovascular treatment is often not feasible due to lesion angioarchitecture, and is associated with a higher risk of lesion recanalization or recurrence. However, long term studies with newer embolic agents such as Onyx (ev3 Endovascular, Plymouth, MN, USA) are yet to be performed.
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Affiliation(s)
- Joanna Y Wang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Joseph Molenda
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Alexander L Coon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Zayed Tower, 6115F, 1800 Orleans Street, Baltimore, MD 21287, USA.
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12
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Wu Q, Wang HD, Shin YS, Zhang X. Brainstem Congestion due to Dural Ateriovenous Fistula at the Craniocervical Junction. J Korean Neurosurg Soc 2014; 55:152-5. [PMID: 24851151 PMCID: PMC4024815 DOI: 10.3340/jkns.2014.55.3.152] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 10/05/2012] [Revised: 06/17/2013] [Accepted: 02/28/2014] [Indexed: 11/27/2022] Open
Abstract
Dural ateriovenous fistula (DAVF) at the craniocervical junction is rare. We report a patient presenting with brainstem dysfunction as an uncommon onset. Brainstem lesion was suggested by magnetic resonance image study. Angiogram revealed a DAVF at a high cervical segment supplied by the meningeal branch of the right vertebral artery, with ascending and descending venous drainage. Complete obliteration of the fistula was achieved via transarterial Onyx embolization. Clinical cure was achieved in the follow-up period; meanwhile, imaging abnormalities of this case disappeared. Accordingly, we hypothesize that a brainstem lesion of this case was caused by craniocervical DAVF, which induced venous hypertension. Thus, venous drainage patterns should be paid attention to because they are important for diagnosis and theraputic strategy.
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Affiliation(s)
- Qi Wu
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Han-Dong Wang
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Xin Zhang
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
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Owen NC, Smith LT, Massey L, Durnford AJ, Hillier CEM. Decompensation of undiagnosed spinal dural arteriovenous fistulae after lumbar epidural injection and spinal anaesthesia. Br J Anaesth 2011; 107:109-11. [PMID: 21685124 DOI: 10.1093/bja/aer179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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