Article

Endovascular treatment of spinal arteriovenous lesions: beyond the dural fistula.

Division of Interventional Neuroradiology, Departments of Radiology and Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical College, NY 10065, USA.
American Journal of Neuroradiology (Impact Factor: 3.17). 05/2011; 32(5):798-808. DOI: 10.3174/ajnr.A2190
Source: PubMed

ABSTRACT During the past few decades, there have been significant advances in the understanding of spinal vascular lesions, mainly because of the evolution of imaging technology and selective spinal angiography techniques. In this article, we discuss the classification, pathophysiology, and clinical manifestations of spinal vascular lesions other than DAVFs and provide a review of the endovascular approach to treat these lesions.

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    ABSTRACT: Object The authors previously reported a case of complex arteriovenous fistula (AVF) at C-1 with multiple dural and spinal feeders that were linked with a common medullary venous channel. The purpose of the present study was to collect similar cases and analyze their angioarchitecture to gain a better understanding of this malformation. Methods Three such cases, affecting 2 males and 1 female in their 60s who had presented with hematomyelia (2) or progressive myelopathy (1), were treated surgically, and the operative findings from all 3 cases were compared using digital subtraction angiography (DSA) to determine the angioarchitecture. Results The C-1 and C-2 radicular arteries and anterior and posterior spinal arteries supplied feeders to a single medullary draining vein in various combinations and via various routes. The drainage veins ran along the affected ventral nerve roots and lay ventral to the spinal cord. The sites of shunting to the vein were multiple: dural, along the ventral nerve root in the subarachnoid space, and on the spinal cord, showing a vascular structure typical of dural AVF, that is, a direct arteriovenous shunt near the spinal root sleeve fed by one or more dural arteries and ending in a single draining vein, except for intradural shunts fed by feeders from the spinal arteries. In 2 cases with hemorrhagic onset the drainer flowed rostrally, and in 1 case associated with congestive myelopathy the drainer flowed both rostrally and caudally. Preoperative determination of the shunt sites and feeding arteries was difficult because of complex recruitment of the feeders and multiple shunt sites. The angioarchitecture in these cases was clarified postoperatively by meticulous comparison of the DSA images and operative video. Direct surgical intervention led to a favorable outcome in all 3 cases. Conclusions A high cervical complex AVF has unique angioarchitectural characteristics different from those seen in the other spinal regions.
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    ABSTRACT: Explanation Please review proofs carefully for typographical and factual errors only; mark corrections in the file using the editing tools in Adobe Acrobat. Answer (directly on the proofs) all editor's queries. Check references for accuracy. Avoid elective changes, as these are costly and time consuming and will be made at the publisher's discretion. Please read your chapter carefully to confirm that no errors have crept in. Please pay particular attention that figures and their legends and in-text callouts match appropriately.
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    ABSTRACT: Spinal arteriovenous lesions (SAVLs) are rare disorders, the diagnosis of which can be established using various imaging modalities. To discern the various types of SAVL, spinal angiography of the entire neural axis is required. Surgery is the standard treatment of choice; however, ever advancing endovascular technology can provide a viable alternative. This article discusses the normal anatomy, arterial supply, and venous drainage of the spinal cord. The classification, pathophysiology, epidemiology, clinical presentation, natural history, and pathophysiology of SAVLs in adults are reviewed. Finally, endovascular treatment of these lesions is discussed.
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