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Minimally invasive approach for the treatment of lumbar epidural arteriovenous fistulas with intradural venous reflux.
Neurochirurgie. 2016 Oct; 62(5):258-262.N

Abstract

BACKGROUND

Vascular lesions of the spinal cord are increasingly recognized. The most common types of these lesions are dural arteriovenous fistulas (AVFs) whereas, extradural AVFs are a very rare type of spinal AVF and can be associated with either extradural or intradural venous reflux. This results in neurological deficits through congestive or compressive myeloradiculopathy. These lesions must be treated to allow stabilization or improvement of neurologic status, either by endovascular therapy or microsurgical interruption. However, because some patients are not amenable to endovascular treatment, surgery is often warranted, which usually involves hemi- or bilateral laminectomy following a midline approach with bilateral muscle stripping. The main drawback of this procedure is directly related to the morbidity of the approach. Although, minimally invasive approaches are likely to overcome this drawback, there is a lack of reported experience supporting their use for treating spinal dural AVFs.

CASE PRESENTATION

Two patients, aged 62 and 79 years old, presented with rapidly progressive myelopathy characterized by paraparesis and sphincter disturbance. Spinal magnetic resonance imaging showed spinal cord oedema with perimedullary flow voids in both cases. Digital subtraction angiography revealed extradural AVFs associated with perimedullary venous reflux. Endovascular therapy was not feasible. Both patients were treated with microsurgical interruption of the intradural vein through a non-expendable retractor. Complete exclusion was confirmed on postoperative angiography, resulting in resolution of spinal cord edema and improved neurological functional status at 2-year follow-up.

CONCLUSION

The minimally invasive surgical treatment of spinal AVFs with epidural venous reflux is safe and effective. This approach is a valuable alternative to endovascular therapy and the standard open microsurgical approach.

Authors+Show Affiliations

Division of neurosurgery, department of surgery, Notre Dame hospital, university of Montreal, Montreal, Quebec, Canada.Division of neurosurgery, department of surgery, Notre Dame hospital, university of Montreal, Montreal, Quebec, Canada; Department of neurosurgery, Lille university hospital, 59000 Lille, France. Electronic address: Fahed.zairi@gmail.com.Division of neurosurgery, department of surgery, Notre Dame hospital, university of Montreal, Montreal, Quebec, Canada.Division of neurosurgery, department of surgery, Notre Dame hospital, university of Montreal, Montreal, Quebec, Canada.Division of neuroradiology, department of radiology, Notre Dame hospital, Montreal, Quebec, Canada.Division of neuroradiology, department of radiology, Notre Dame hospital, Montreal, Quebec, Canada.Division of neurosurgery, department of surgery, Notre Dame hospital, university of Montreal, Montreal, Quebec, Canada.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27615153

Citation

Najjar, A, et al. "Minimally Invasive Approach for the Treatment of Lumbar Epidural Arteriovenous Fistulas With Intradural Venous Reflux." Neuro-Chirurgie, vol. 62, no. 5, 2016, pp. 258-262.
Najjar A, Zairi F, Sunna T, et al. Minimally invasive approach for the treatment of lumbar epidural arteriovenous fistulas with intradural venous reflux. Neurochirurgie. 2016;62(5):258-262.
Najjar, A., Zairi, F., Sunna, T., Weil, A., Estrade, L., Weill, A., & Shedid, D. (2016). Minimally invasive approach for the treatment of lumbar epidural arteriovenous fistulas with intradural venous reflux. Neuro-Chirurgie, 62(5), 258-262. https://doi.org/10.1016/j.neuchi.2016.06.001
Najjar A, et al. Minimally Invasive Approach for the Treatment of Lumbar Epidural Arteriovenous Fistulas With Intradural Venous Reflux. Neurochirurgie. 2016;62(5):258-262. PubMed PMID: 27615153.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minimally invasive approach for the treatment of lumbar epidural arteriovenous fistulas with intradural venous reflux. AU - Najjar,A, AU - Zairi,F, AU - Sunna,T, AU - Weil,A, AU - Estrade,L, AU - Weill,A, AU - Shedid,D, Y1 - 2016/09/08/ PY - 2015/10/01/received PY - 2016/02/27/revised PY - 2016/06/12/accepted PY - 2016/9/13/pubmed PY - 2017/3/31/medline PY - 2016/9/13/entrez KW - Arteriovenous fistula KW - Draining vein KW - Microsurgery KW - Minimally invasive KW - Myelopathy SP - 258 EP - 262 JF - Neuro-Chirurgie JO - Neurochirurgie VL - 62 IS - 5 N2 - BACKGROUND: Vascular lesions of the spinal cord are increasingly recognized. The most common types of these lesions are dural arteriovenous fistulas (AVFs) whereas, extradural AVFs are a very rare type of spinal AVF and can be associated with either extradural or intradural venous reflux. This results in neurological deficits through congestive or compressive myeloradiculopathy. These lesions must be treated to allow stabilization or improvement of neurologic status, either by endovascular therapy or microsurgical interruption. However, because some patients are not amenable to endovascular treatment, surgery is often warranted, which usually involves hemi- or bilateral laminectomy following a midline approach with bilateral muscle stripping. The main drawback of this procedure is directly related to the morbidity of the approach. Although, minimally invasive approaches are likely to overcome this drawback, there is a lack of reported experience supporting their use for treating spinal dural AVFs. CASE PRESENTATION: Two patients, aged 62 and 79 years old, presented with rapidly progressive myelopathy characterized by paraparesis and sphincter disturbance. Spinal magnetic resonance imaging showed spinal cord oedema with perimedullary flow voids in both cases. Digital subtraction angiography revealed extradural AVFs associated with perimedullary venous reflux. Endovascular therapy was not feasible. Both patients were treated with microsurgical interruption of the intradural vein through a non-expendable retractor. Complete exclusion was confirmed on postoperative angiography, resulting in resolution of spinal cord edema and improved neurological functional status at 2-year follow-up. CONCLUSION: The minimally invasive surgical treatment of spinal AVFs with epidural venous reflux is safe and effective. This approach is a valuable alternative to endovascular therapy and the standard open microsurgical approach. SN - 1773-0619 UR - https://www.unboundmedicine.com/medline/citation/27615153/Minimally_invasive_approach_for_the_treatment_of_lumbar_epidural_arteriovenous_fistulas_with_intradural_venous_reflux_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0028-3770(16)30088-1 DB - PRIME DP - Unbound Medicine ER -