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Osseous versus Nonosseous Spinal Epidural Arteriovenous Fistulas: Experiences of 13 Patients
- Source :
- American Journal of Neuroradiology. 40:129-134
- Publication Year :
- 2018
- Publisher :
- American Society of Neuroradiology (ASNR), 2018.
-
Abstract
- BACKGROUND AND PURPOSE: Spinal epidural arteriovenous fistulas are rare vascular malformations. We present 13 patients with spinal epidural arteriovenous fistulas, noting the various presenting symptom patterns, imaging findings related to bone involvement, and outcomes. MATERIALS AND METHODS: Among 111 patients with spinal vascular malformations in the institutional data base from 1993 to 2017, thirteen patients (11.7%) had spinal epidural arteriovenous fistulas. We evaluated presenting symptoms and imaging findings, including bone involvement and mode of treatment. To assess the treatment outcome, we compared initial and follow-up clinical status using the modified Aminoff and Logue Scale of Disability and the modified Rankin Scale. RESULTS: The presenting symptoms were lower back pain (n = 2), radiculopathy (n = 5), and myelopathy (n = 7). There is overlap of symptoms in 1 patient (No. 11). Distribution of spinal epidural arteriovenous fistulas was cervical (n = 3), thoracic (n = 2), lumbar (n = 6), and sacral (n = 2). Intradural venous reflux was identified in 7 patients with congestive venous myelopathy. The fistulas were successfully treated in all patients who underwent treatment (endovascular embolization, n = 10; operation, n = 1) except 2 patients who refused treatment due to tolerable symptoms. Transarterial glue (n = 7) was used in nonosseous types; and transvenous coils (n = 3), in osseous type. After 19 months of median follow-up, the patients showed symptom improvement after treatment. CONCLUSIONS: Although presenting symptoms were diverse, myelopathy caused by intradural venous reflux was the main target of treatment. Endovascular treatment was considered via an arterial approach in nonosseous types and via a venous approach in osseous types.
- Subjects :
- Epidural Space
Male
medicine.medical_specialty
medicine.medical_treatment
Treatment outcome
030218 nuclear medicine & medical imaging
03 medical and health sciences
Myelopathy
0302 clinical medicine
Lumbar
Modified Rankin Scale
Back pain
medicine
Humans
Radiology, Nuclear Medicine and imaging
Embolization
Aged
Interventional
business.industry
Middle Aged
medicine.disease
Embolization, Therapeutic
Surgery
Treatment Outcome
Spinal epidural
Spinal Cord
Arteriovenous Fistula
Venous reflux
Female
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 1936959X and 01956108
- Volume :
- 40
- Database :
- OpenAIRE
- Journal :
- American Journal of Neuroradiology
- Accession number :
- edsair.doi.dedup.....5cca55585fefb77d29e311a4f0c82d27