scholarly journals Surgical correction of a spinal arteriovenous fistula with an unusual presentation

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1
Author(s):  
Aaron Cohen-Gadol
Keyword(s):  
Arteriovenous Fistula ◽  
Nerve Root ◽  
Cervical Spinal Cord ◽  
Cervical Lesions ◽  
Spinal Dural Arteriovenous Fistula ◽  
Spinal Arteriovenous Fistula ◽  
Clinical Presentations ◽  
Wide Range ◽  
Brainstem Dysfunction ◽  
Microsurgical Techniques

Spinal dural arteriovenous fistula (dAVF) is an acquired abnormal arterial-to-venous connection within the spinal dura with a wide range of clinical presentations and natural history. Spinal dAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dura of the nerve root sleeve. Cervical dAVF is a rare entity as the majority of spinal dAVFs present within the thoracolumbar segment with myelopathy. Only a small number of cervical lesions have been described, and only one presented with brainstem dysfunction. Herein we present one patient with brainstem dysfunction secondary to a spinal dAVF. The fistula was located within the C-3 nerve root sleeve. The details of microsurgical techniques to disconnect the fistula will be discussed. Although the option of endovascular disconnection of the fistula is reasonable, the author elected to proceed with microsurgical disconnection after discussion regarding the risks of such an endovascular route for the cervical spinal cord. The video can be found here: http://youtu.be/t8rUnZ8qVfY.

Microsurgical ligation of spinal arteriovenous fistulae: techniques

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video11
Author(s):  
Chad A. Tuchek ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Natural History ◽  
Lower Extremity ◽  
Vascular Malformation ◽  
Dural Arteriovenous Fistula ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulae ◽  
Lower Extremity Weakness ◽  
Clinical Presentations ◽  
Wide Range ◽  
Microsurgical Techniques

Spinal dural arteriovenous fistula (dAVF) is an acquired abnormal arterial-to-venous connection within the spinal dura with a wide range of clinical presentations and natural history. Spinal dAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dura of the nerve root sleeve. Spinal dAVFs are the most common vascular malformation of the spine.The authors present a patient who presented with sudden temporary lower extremity weakness secondary to an L-1 spinal dAVF. The details of microsurgical techniques to disconnect the fistula are discussed in this video.The video can be found here: http://youtu.be/F9Kiffs3s6A.

Dural arteriovenous fistulas presenting with brainstem dysfunction: diagnosis and surgical treatment

2012 ◽  
Vol 32 (5) ◽  
pp. E10 ◽  
Author(s):  
Charles Kulwin ◽  
Bradley N. Bohnstedt ◽  
John A. Scott ◽  
Aaron Cohen-Gadol
Keyword(s):  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Craniocervical Junction ◽  
Rare Entity ◽  
Arteriovenous Fistulas ◽  
Drainage Patterns ◽  
Clinical Presentations ◽  
Wide Range ◽  
Brainstem Dysfunction ◽  
Dural Arteriovenous Fistulas

A cerebral dural arteriovenous fistula (DAVF) is an acquired abnormal arterial-to-venous connection within the leaves of the intracranial dura with a wide range of clinical presentations and natural history. The Cognard classification correlates venous drainage patterns with neurological course, identifying 5 DAVF types with increasing rates of symptomatic presentation. A spinal DAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dural leaflets of the nerve root sleeve. A cervical DAVF is a rare entity, as most spinal DAVFs present as thoracolumbar lesions with myelopathy. In this paper the authors present 2 patients presenting initially with brainstem dysfunction rather than myelopathy secondary to craniocervical DAVF. The literature is then reviewed for similar rare aggressive DAVFs at the craniocervical junction presenting with brainstem symptomatology.

Spinal dural arteriovenous fistula associated with L-4 isthmic spondylolisthesis

2014 ◽  
Vol 20 (6) ◽  
pp. 670-674 ◽  
Author(s):  
Yusuke Nishimura ◽  
Atsushi Natsume ◽  
Howard J. Ginsberg
Keyword(s):  
Arteriovenous Fistula ◽  
Nerve Root ◽  
Dural Arteriovenous Fistula ◽  
Pedicle Screws ◽  
Concomitant Treatment ◽  
Isthmic Spondylolisthesis ◽  
Spinal Dural Arteriovenous Fistula ◽  
Posterior Instrumented Fusion ◽  
Mri Study ◽  
Spine Mri

The authors describe a case of a 79-year-old man with a lumbar spinal dural arteriovenous fistula (DAVF) and isthmic spondylolisthesis at the same level. The patient's thoracic spine MRI study demonstrated swelling and increased T2 signal in the spinal cord and regional dilated perimedullary vessels. Lumbar spine MRI showed L-4 isthmic spondylolisthesis with severe bilateral L4–5 foraminal stenoses. Spinal angiography revealed a fistulous connection at the left L-4 nerve root sleeve between perimedullary veins and a dural branch of the L-4 radicular artery. Based on previous reports about secondary spinal DAVFs, the abnormal vascular communication likely developed secondary to the microtrauma and inflammation on the left L-4 nerve root sleeve, which was attributable to the isthmic spondylolisthesis. The authors performed disconnection of the arteriovenous shunt as well as an L4–5 decompression and posterior instrumented fusion with pedicle screws. The patient's postoperative course was uneventful, and he improved neurologically. It is important to bear in mind that a spinal DAVF may develop as a consequence of any sort of trauma or inflammation involving nerve roots. One should consider the concomitant treatment of both the spinal DAVF and the underlying pathology that may have given rise to the spinal DAVF.

scholarly journals Intraoperative microvascular Doppler monitoring of blood flow within a spinal dural arteriovenous fistula: a precious surgical tool

2001 ◽  
Vol 10 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Domenico Gerardo Iacopino ◽  
Maria Giusa ◽  
Alfredo Conti ◽  
Salvatore Cardali ◽  
Francesco Tomasello
Keyword(s):  
Flow Velocity ◽  
Arteriovenous Fistula ◽  
Clinical Results ◽  
Spinal Dural Arteriovenous Fistula ◽  
Surgical Closure ◽  
Spinal Arteriovenous Fistula ◽  
Surgical Tool ◽  
Reliable Monitoring ◽  
Velocity Changes ◽  
Monitoring Modality

The authors describe a case of spinal arteriovenous fistula (AVF) treated by a microvauscular Doppler–assisted surgical interruption of the arterialized vein. Microvascular Doppler monitoring represents a valid, widely available, non-invasive tool that enables identification, through flow spectrum analysis, of components of this type of vascular malformation. In this case because the location of the fistula was identified prior to opening the dura only minimally invasive surgery was required. Direct recordings of the arterialized draining vein and the nidus of the fistula demonstrated a pathological spectrum caused by the arterial supply and the disturbed venous outflow in which a high-resistance flow pattern and low diastolic flow resembling an arterial-like flow velocity were observed. The fistula was obliterated by interruption of the draining vein, and Doppler measurements provided information on flow velocity changes in the medullary veins from an arterial to a venous pattern. The absence of any residual flow in the AVF confirmed successful hemodynamic treatment. Intraoperative microvascular Doppler recording during surgical closure of spinal AVF is a widely available and reliable monitoring modality that helps to produce excellent clinical results.

scholarly journals СLINICAL ASPECTS, DIAGNOSTICS AND MICROSURGICAL TREATMENT OF SPINAL DURAL ARTERIOVENOUS FISTULAS (LECTURE)

2019 ◽  
Vol 21 (2) ◽  
pp. 53-65
Author(s):  
G. Yu. Evzikov ◽  
V. А. Parfenov ◽  
А. V. Farafontov ◽  
P. V. Kuchuk ◽  
S. А. Kondrashin ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Spinal Dural Arteriovenous Fistula ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Wide Range ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

The lecture is dedicated to spinal dural arteriovenous fistula – infrequent disorder which not well known among wide range of neurosurgeons. The findings on etiology, clinic and treatment are presented.

Paraplegia after Tethered Cord Surgery: An Uncommon Combined Anomaly of Spinal Arteriovenous Fistula and Sacral Lipoma— Case Report

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. E598-E598 ◽  
Author(s):  
Arnold C. Cheung ◽  
Steven N. Kalkanis ◽  
Christopher S. Ogilvy
Keyword(s):  
Arteriovenous Fistula ◽  
Bladder Dysfunction ◽  
Tethered Cord ◽  
Transverse Sinus ◽  
Spinal Dural Arteriovenous Fistula ◽  
Spinal Arteriovenous Malformation ◽  
Spinal Arteriovenous Fistula ◽  
Progressive Paraparesis ◽  
Dural Avm

ABSTRACT OBJECTIVE AND IMPORTANCE: The coexistence of spinal arteriovenous malformation (AVM) with congenital abnormalities is relatively common. However, the association of a spinal AVM and lipoma is rare. We present an adult patient with this combined anomaly and discuss the clinical relevance of this case. CLINICAL PRESENTATION: A 42-year-old Caucasian man with progressive paraparesis initially underwent surgery for a tethered spinal cord. Postoperatively, he became paraplegic. He improved gradually over an interval of 8 months and, at that point, worsened again. Subsequent angiographic study revealed a spinal dural arteriovenous fistula located at S1–S2. Additionally, an occipital dural AVM was discovered near the transverse sinus. INTERVENTION: The spinal arteriovenous fistula was excised along with the sacral lipoma. The occipital arteriovenous fistula was embolized successfully at a later time. CONCLUSION: The patient had immediate improvement in sensory symptoms after surgery. At a 9 month follow-up examination, he had regained the ability to walk with crutches, but his bladder dysfunction persisted. Recognition of co-existing vascular anomalies, such as spinal AVMs, is important in patients with tethered cords. The mechanisms involved in this patient's worsening neurological condition after release of the tethered cord are discussed.

scholarly journals Arteriovenous Fistula in a Nerve Root of the Cauda Equina Fed by a Proximal Radiculo-Medullary Artery

2011 ◽  
Vol 17 (2) ◽  
pp. 217-223 ◽  
Author(s):  
T. Ohtonari ◽  
S. Ota ◽  
N. Nishihara ◽  
K. Suwa ◽  
T. Ota ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Nerve Root ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Magnetic Resonance Images ◽  
Digital Subtraction ◽  
Feeding Artery ◽  
Spinal Arteriovenous Fistula ◽  
First Case ◽  
Flow Void

While there have been a few reports on cases of intradural spinal arteriovenous fistula located on the filum terminale, no cases of its location in a nerve root of the cauda equina have been reported to date. We describe two such cases and describe the intraoperative findings. A 40-year-old man presented weakness of his left leg. Another 62-year-old man presented paraparesis dominantly in his left leg with urinary hesitation. In both cases, spinal T2-weighted magnetic resonance images showed edema of the spinal cord, indicating a flow void around it. Digital subtraction angiography disclosed an anterior radicular artery branching from the anterior spinal artery on the surface of the conus medullaris and a turnaround vein running in the opposite direction within the cauda equina. In the first patient, while the feeding artery running along a nerve root was detected, the draining vein and the fistula were not identified at first sight. An incision into the respective nerve root exposed their location within it. In the second patient, unlike the first case, the feeding artery and the fistula were buried in a nerve root, while the draining vein was running along the nerve's surface. In both cases, permanent clips were applied to the draining vein closest to the fistula. The recognition of a hidden fistulous point in a nerve root of the cauda equina is essential for successful obliteration of the fistula.

Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Nur Setiawan Suroto
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Vascular Malformation ◽  
Dural Arteriovenous Fistula ◽  
Motor Symptoms ◽  
Elderly Men ◽  
Spinal Dural Arteriovenous Fistula ◽  
Sensory Disturbances ◽  
Av Fistulas ◽  
Low Rate

Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region.Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances.

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