Tags

Type your tag names separated by a space and hit enter

Three-dimensional angioarchitecture of spinal dural arteriovenous fistulas, with special reference to the intradural retrograde venous drainage system.
J Neurosurg Spine. 2013 Apr; 18(4):398-408.JN

Abstract

OBJECT

There have been significant advances in understanding the angioarchitecture of spinal dural arteriovenous fistulas (AVFs). However, the major intradural retrograde venous drainage system has not been investigated in detail, including the most proximal sites of intradural radiculomedullary veins as they connect to the dura mater, which are the final targets of interruption in both microsurgical and endovascular treatments.

METHODS

Between April 1984 and March 2011, 27 patients with 28 AVFs were treated for spinal dural AVFs at the authors' university hospital. The authors assessed vertebral levels of feeding arteries and dural AVFs by using conventional digital subtraction angiography. They also assessed 3D locations of the most proximal sites of intradural radiculomedullary veins and the 3D positional relationship between the major intradural retrograde venous drainage system and intradural neural structures, including the spinal cord, spinal nerves, and the artery of Adamkiewicz, by using operative video recordings plus 3D rotational angiography and/or 3D computer graphics. In addition, they statistically assessed the clinical results of 27 cases. Of these lesions, 23 were treated with open microsurgery and the rest were treated with endovascular methods.

RESULTS

Feeding arteries consisted of T2-10 intercostal arteries with 19 lesions, T-12 subcostal arteries with 3 lesions, and L1-3 lumbar arteries with 6 lesions. The 3D locations of the targets of interruption (the most proximal sites of intradural radiculomedullary veins as they connect to the dura mater) were identified at the dorsolateral portion of the dura mater adjacent to dorsal roots in all 19 thoracic lesions, whereas they were identified at the ventrolateral portion of the dura mater adjacent to ventral roots in 7 (78%) of 9 cases of conus medullaris/lumbar lesions (p < 0.001). The major intradural retrograde venous drainage system was located dorsal to the spinal cord in all 19 thoracic lesions, whereas it was located ventral to the spinal cord in 4 (44%) of 9 cases of conus/lumbar lesions (p = 0.006). In 3 (11%) of 27 cases, AVFs had a common origin of the artery of Adamkiewicz. In 2 lumbar lesions, the artery of Adamkiewicz ascended very close to the vein because of its ventral location. Although all lesions were successfully obliterated without major complications and both gait and micturition status significantly improved (p = 0.005 and p = 0.015, respectively), conus/lumbar lesions needed careful differential diagnosis from ventral intradural perimedullary AVFs, because the ventral location of these lesions contradicted the Spetzler classification system.

CONCLUSIONS

The angioarchitecture of spinal dural AVFs in the thoracic region is strikingly different from that in conus/lumbar regions with regard to the intradural retrograde venous drainage system. One should keep in mind that spinal dural AVFs are not always dorsal types, especially in conus/lumbar regions.

Authors+Show Affiliations

Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. takai-nsu@umin.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

23432326

Citation

Takai, Keisuke, et al. "Three-dimensional Angioarchitecture of Spinal Dural Arteriovenous Fistulas, With Special Reference to the Intradural Retrograde Venous Drainage System." Journal of Neurosurgery. Spine, vol. 18, no. 4, 2013, pp. 398-408.
Takai K, Kin T, Oyama H, et al. Three-dimensional angioarchitecture of spinal dural arteriovenous fistulas, with special reference to the intradural retrograde venous drainage system. J Neurosurg Spine. 2013;18(4):398-408.
Takai, K., Kin, T., Oyama, H., Shojima, M., & Saito, N. (2013). Three-dimensional angioarchitecture of spinal dural arteriovenous fistulas, with special reference to the intradural retrograde venous drainage system. Journal of Neurosurgery. Spine, 18(4), 398-408. https://doi.org/10.3171/2013.1.SPINE12305
Takai K, et al. Three-dimensional Angioarchitecture of Spinal Dural Arteriovenous Fistulas, With Special Reference to the Intradural Retrograde Venous Drainage System. J Neurosurg Spine. 2013;18(4):398-408. PubMed PMID: 23432326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Three-dimensional angioarchitecture of spinal dural arteriovenous fistulas, with special reference to the intradural retrograde venous drainage system. AU - Takai,Keisuke, AU - Kin,Taichi, AU - Oyama,Hiroshi, AU - Shojima,Masaaki, AU - Saito,Nobuhito, Y1 - 2013/02/22/ PY - 2013/2/26/entrez PY - 2013/2/26/pubmed PY - 2013/6/5/medline SP - 398 EP - 408 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 18 IS - 4 N2 - OBJECT: There have been significant advances in understanding the angioarchitecture of spinal dural arteriovenous fistulas (AVFs). However, the major intradural retrograde venous drainage system has not been investigated in detail, including the most proximal sites of intradural radiculomedullary veins as they connect to the dura mater, which are the final targets of interruption in both microsurgical and endovascular treatments. METHODS: Between April 1984 and March 2011, 27 patients with 28 AVFs were treated for spinal dural AVFs at the authors' university hospital. The authors assessed vertebral levels of feeding arteries and dural AVFs by using conventional digital subtraction angiography. They also assessed 3D locations of the most proximal sites of intradural radiculomedullary veins and the 3D positional relationship between the major intradural retrograde venous drainage system and intradural neural structures, including the spinal cord, spinal nerves, and the artery of Adamkiewicz, by using operative video recordings plus 3D rotational angiography and/or 3D computer graphics. In addition, they statistically assessed the clinical results of 27 cases. Of these lesions, 23 were treated with open microsurgery and the rest were treated with endovascular methods. RESULTS: Feeding arteries consisted of T2-10 intercostal arteries with 19 lesions, T-12 subcostal arteries with 3 lesions, and L1-3 lumbar arteries with 6 lesions. The 3D locations of the targets of interruption (the most proximal sites of intradural radiculomedullary veins as they connect to the dura mater) were identified at the dorsolateral portion of the dura mater adjacent to dorsal roots in all 19 thoracic lesions, whereas they were identified at the ventrolateral portion of the dura mater adjacent to ventral roots in 7 (78%) of 9 cases of conus medullaris/lumbar lesions (p < 0.001). The major intradural retrograde venous drainage system was located dorsal to the spinal cord in all 19 thoracic lesions, whereas it was located ventral to the spinal cord in 4 (44%) of 9 cases of conus/lumbar lesions (p = 0.006). In 3 (11%) of 27 cases, AVFs had a common origin of the artery of Adamkiewicz. In 2 lumbar lesions, the artery of Adamkiewicz ascended very close to the vein because of its ventral location. Although all lesions were successfully obliterated without major complications and both gait and micturition status significantly improved (p = 0.005 and p = 0.015, respectively), conus/lumbar lesions needed careful differential diagnosis from ventral intradural perimedullary AVFs, because the ventral location of these lesions contradicted the Spetzler classification system. CONCLUSIONS: The angioarchitecture of spinal dural AVFs in the thoracic region is strikingly different from that in conus/lumbar regions with regard to the intradural retrograde venous drainage system. One should keep in mind that spinal dural AVFs are not always dorsal types, especially in conus/lumbar regions. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/23432326/Three_dimensional_angioarchitecture_of_spinal_dural_arteriovenous_fistulas_with_special_reference_to_the_intradural_retrograde_venous_drainage_system_ L2 - https://thejns.org/doi/10.3171/2013.1.SPINE12305 DB - PRIME DP - Unbound Medicine ER -