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Microsurgical and Endovascular Treatments of Spinal Extradural Arteriovenous Fistulas with or without Intradural Venous Drainage.
World Neurosurg. 2018 Mar; 111:e819-e829.WN

Abstract

OBJECTIVE

To present treatment strategies for spinal extradural arteriovenous fistulas (AVFs) in relation to angioarchitecture.

METHODS

A retrospective analysis comprising 14 patients treated at 2 hospitals was performed.

RESULTS

The 14 AVFs included 4 cervical, 1 thoracic, and 9 lumbosacral lesions. Three key angiographic features were observed: the feeding artery, an enlarged extradural venous plexus, and intradural retrograde venous drainage. In 3 patients (3 cervical AVFs) with compressive myelopathy owing to an enlarged venous plexus, the treatment goal was mass reduction of the venous plexus. Combined endovascular and microsurgical treatments may be curative for a large venous lake with multiple feeders. No intradural procedure was required because of the absence of intradural venous drainage. In contrast, in the other 11 patients (1 cervical, 1 thoracic, and 9 lumbosacral AVFs) with congestive myelopathy owing to intradural retrograde venous drainage, the goal of treatment was occlusion of the intradural proximal vein. Microsurgery or endovascular treatment may be curative by itself for a small venous pouch with a single intradural draining vein. Extradural procedures were not required in most patients treated by microsurgery because the extradural venous plexus was small. In all 14 patients, neurologic deficits improved or stabilized, and no recurrence was noted in the follow-up period (29 months).

CONCLUSIONS

Spinal extradural AVFs consist of 2 subtypes-type A with intradural drainage and type B without intradural drainage-characterized by regional differences at each spinal level in angioarchitecture, causes of myelopathy, and treatment goals.

Authors+Show Affiliations

Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan. Electronic address: takai-nsu@umin.ac.jp.Department of Neurosurgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.Department of Neurosurgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.Department of Neurosurgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29309979

Citation

Takai, Keisuke, et al. "Microsurgical and Endovascular Treatments of Spinal Extradural Arteriovenous Fistulas With or Without Intradural Venous Drainage." World Neurosurgery, vol. 111, 2018, pp. e819-e829.
Takai K, Shojima M, Imai H, et al. Microsurgical and Endovascular Treatments of Spinal Extradural Arteriovenous Fistulas with or without Intradural Venous Drainage. World Neurosurg. 2018;111:e819-e829.
Takai, K., Shojima, M., Imai, H., Saito, N., & Taniguchi, M. (2018). Microsurgical and Endovascular Treatments of Spinal Extradural Arteriovenous Fistulas with or without Intradural Venous Drainage. World Neurosurgery, 111, e819-e829. https://doi.org/10.1016/j.wneu.2017.12.162
Takai K, et al. Microsurgical and Endovascular Treatments of Spinal Extradural Arteriovenous Fistulas With or Without Intradural Venous Drainage. World Neurosurg. 2018;111:e819-e829. PubMed PMID: 29309979.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microsurgical and Endovascular Treatments of Spinal Extradural Arteriovenous Fistulas with or without Intradural Venous Drainage. AU - Takai,Keisuke, AU - Shojima,Masaaki, AU - Imai,Hideaki, AU - Saito,Nobuhito, AU - Taniguchi,Makoto, Y1 - 2018/01/05/ PY - 2017/07/27/received PY - 2017/12/25/revised PY - 2017/12/27/accepted PY - 2018/1/9/pubmed PY - 2018/5/16/medline PY - 2018/1/9/entrez KW - Angioarchitecture KW - Arteriovenous malformation KW - Arteriovenous shunt KW - Endovascular treatment KW - Epidural arteriovenous fistula KW - Pathology KW - Surgical treatment SP - e819 EP - e829 JF - World neurosurgery JO - World Neurosurg VL - 111 N2 - OBJECTIVE: To present treatment strategies for spinal extradural arteriovenous fistulas (AVFs) in relation to angioarchitecture. METHODS: A retrospective analysis comprising 14 patients treated at 2 hospitals was performed. RESULTS: The 14 AVFs included 4 cervical, 1 thoracic, and 9 lumbosacral lesions. Three key angiographic features were observed: the feeding artery, an enlarged extradural venous plexus, and intradural retrograde venous drainage. In 3 patients (3 cervical AVFs) with compressive myelopathy owing to an enlarged venous plexus, the treatment goal was mass reduction of the venous plexus. Combined endovascular and microsurgical treatments may be curative for a large venous lake with multiple feeders. No intradural procedure was required because of the absence of intradural venous drainage. In contrast, in the other 11 patients (1 cervical, 1 thoracic, and 9 lumbosacral AVFs) with congestive myelopathy owing to intradural retrograde venous drainage, the goal of treatment was occlusion of the intradural proximal vein. Microsurgery or endovascular treatment may be curative by itself for a small venous pouch with a single intradural draining vein. Extradural procedures were not required in most patients treated by microsurgery because the extradural venous plexus was small. In all 14 patients, neurologic deficits improved or stabilized, and no recurrence was noted in the follow-up period (29 months). CONCLUSIONS: Spinal extradural AVFs consist of 2 subtypes-type A with intradural drainage and type B without intradural drainage-characterized by regional differences at each spinal level in angioarchitecture, causes of myelopathy, and treatment goals. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29309979/Microsurgical_and_Endovascular_Treatments_of_Spinal_Extradural_Arteriovenous_Fistulas_with_or_without_Intradural_Venous_Drainage_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)30017-2 DB - PRIME DP - Unbound Medicine ER -