scholarly journals Balloon-assisted transarterial embolization of type 1 spinal dural arteriovenous fistula

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1
Author(s):  
Brian Lee ◽  
Vivek A. Mehta ◽  
William J. Mack ◽  
Matthew S. Tenser ◽  
Arun P. Amar
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Mri Imaging ◽  
Spinal Dural Arteriovenous Fistula ◽  
Lower Extremity Weakness ◽  
Segmental Artery ◽  
Spinal Vascular Malformations

Type 1 spinal dural arteriovenous fistula (dAVF) constitute the vast majority of all spinal vascular malformations. Here we present the case of a 71-year-old male with progressive myelopathy, lower-extremity weakness and numbness, and urinary incontinence. MRI imaging of the thoracic spine demonstrated cord edema, and catheter spinal angiography confirmed a type 1 spinal dAVF. The fistula was supplied by small dural branches of the left L-2 segmental artery. Angiographic cure was achieved with a one-stage procedure in which coils were used to occlude the distal segmental vessels, followed by balloon-assisted embolization with Onyx.The video can be found here: http://youtu.be/8aehJbueH0U.

Intraoperative Spinal Angiography during Microsurgical Occlusion of Spinal Dural Arteriovenous Fistula within the Hybrid Operation Room

2021 ◽  
Author(s):  
Jenny Christine Kienzler ◽  
Salome Schoepf ◽  
Serge Marbacher ◽  
Michael Diepers ◽  
Luca Remonda ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Prone Position ◽  
Popliteal Artery ◽  
Dural Arteriovenous Fistula ◽  
Endovascular Embolization ◽  
Treatment Modalities ◽  
Safe Procedure ◽  
Spinal Dural Arteriovenous Fistula ◽  
Segmental Artery ◽  
Small Branch

Abstract Background Spinal dural arteriovenous fistula (SDAVF) is a rare cause of progressive myelopathy in predominantly middle-aged men. Treatment modalities include surgical obliteration and endovascular embolization. In surgically treated cases, failure of obliteration is reported in up to 5%. The aim of this technical note is to present a safe procedure with complete SDAVF occlusion, verified by intraoperative digital subtraction angiography (DSA). Methods We describe four patients with progressive leg weakness who underwent surgical obliteration of SDAVF with spinal intraoperative DSA in the prone position after cannulation of the popliteal artery. All surgeries took place in our hybrid operating room (OR) and were accompanied by electrophysiologic monitoring. Surgeries and cannulation of the popliteal artery were performed in the prone position. Ultrasound was used to guide the popliteal artery puncture. A 5-Fr sheath was inserted and the fistula was displayed using a 5-Fr spinal catheter. Spinal intraoperative DSA was performed prior to and after temporary clipping of the fistula point as well after the final SDAVF occlusion. Results The main feeder of the SDAVF fistula in the first patient arose from the right T11 segmental artery, which also supplied the artery of Adamkiewicz. The second patient initially underwent endovascular treatment and deteriorated 5 months later due to recanalization of the SDAVF via a small branch of the T12 segmental artery. The third and fourth cases were primarily scheduled for surgical occlusion. Access through the popliteal artery for spinal intraoperative DSA proved to be beneficial and safe in the hybrid OR setting, allowing the sheath to be left in place during the procedure. During exposure and after temporary and permanent occlusion of the fistulous point, intraoperative indocyanine green (ICG) video angiography was also performed. In one case, the addition of intraoperative DSA showed failure of fistula occlusion, which was not visible with ICG angiography, leading to repositioning of the clip. Complete fistula occlusion was documented in all cases. Conclusion Spinal intraoperative DSA in the prone position is a feasible and safe intervention for rapid localization and confirmation of surgical SDAVF occlusion.

Spinal dural arteriovenous fistula associated with a spinal perimedullary fistula

2006 ◽  
Vol 4 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Timo Krings ◽  
Volker A. Coenen ◽  
Martin Weinzierl ◽  
Marcus H. T. Reinges ◽  
Michael Mull ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Venous Drainage ◽  
Elevated Pressure ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Dural Arteriovenous Fistulas

✓ Among spinal cord vascular malformations, dural arteriovenous fistulas (DAVFs) must be distinguished from intradural malformations. The concurrence of both is extremely rare. The authors report the case of a 35-year-old man who suffered from progressive myelopathy and who harbored both a DAVF and an intradural perimedullary fistula. During surgery, both fistulas were identified, confirmed, and subsequently obliterated. The fistulas were located at two levels directly adjacent to each other. Although the incidence of concurrent spinal DAVFs is presumed to be approximately 2%, the combination of a dural and an intradural fistula is exceedingly rare; only two other cases have been reported in the literature. One can speculate whether the alteration in venous drainage caused by the (presumably congenital) perimedullary fistula could possibly promote the production of a second dural fistula due to elevated pressure with concomitant venous stagnation and subsequent thrombosis. The authors conclude that despite the rarity of dual pathological entities, the clinician should be aware of the possibility of the concurrence of more than one spinal fistula in the same patient.

scholarly journals A rare case of spinal dural arteriovenous fistula

2012 ◽  
Vol 4 (3) ◽  
pp. 19 ◽  
Author(s):  
Mariya Apostolova ◽  
Samer Nasser ◽  
Samir Kodsi
Keyword(s):  
Lumbar Spine ◽  
Lower Extremity ◽  
Arteriovenous Fistula ◽  
Vascular Malformation ◽  
Rare Case ◽  
Dural Arteriovenous Fistula ◽  
Bladder Dysfunction ◽  
Spinal Dural Arteriovenous Fistula ◽  
Lower Extremity Weakness ◽  
Thoracic And Lumbar Spine

Spinal dural arteriovenous fistula (SDAVF) is a rare vascular malformation of the spine. Only a limited number of cases of SDAVF have been reported in the current literature. We describe the case of a 74 year old male who presented with gradually progressive bilateral lower extremity weakness and bladder dysfunction and was subsequently diagnosed with SDAVF affecting both the thoracic and lumbar spine. The patient later underwent embolization with some improvement in his neurologic symptoms.

scholarly journals Concomitant spinal dural arteriovenous fistula and nodular fasciitis in an adolescent: case report

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Chan-Lin Chu ◽  
Yu-Jen Lu ◽  
Tsong-Hai Lee ◽  
Shih-Ming Jung ◽  
Yu-Cheng Chu ◽  
...  
Keyword(s):  
Case Report ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Subcutaneous Tissue ◽  
Lower Limbs ◽  
Nodular Fasciitis ◽  
Spinal Dural Arteriovenous Fistula ◽  
Case Presentation ◽  
Segmental Artery ◽  
Progressive Weakness

Abstract Background Spinal dural arteriovenous fistula (SDAVF) usually occurs during the 4th to 6th decades of life, and adolescent SDAVF is rarely reported. SDAVF arising around a tumor is also rare, and reported tumors are mostly schwannoma and lipoma. Case presentation We reported a 16-year-old male presented with progressive weakness and numbness of lower limbs for 3 months. A SDAVF was found, which was fed by right radicular arteries from segmental artery at L2 level and drained retrogradely into perimedullary veins. A concomitant spinal extradural nodular fasciitis at right L1/L2 intervertebral foramen was also noted. The SDAVF was completely obliterated by endovascular treatment and the tumor was debulked. The patient recovered well after the procedures. Conclusions Our case report suggests SDAVF can occur in adolescent. The concomitant presence with a nodular fasciitis indicates that although it usually arises in subcutaneous tissue but can rarely form on the dura of spine.

P111 Successful treatment of type 1 spinal dural arteriovenous fistula results in reduction of spinal cord volume

2019 ◽  
Vol 90 (3) ◽  
pp. e51.2-e51
Author(s):  
R Visagan ◽  
I Norman ◽  
A Elhag ◽  
J Correia ◽  
D Walsh
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Surrogate Marker ◽  
Wilcoxon Test ◽  
Rank Test ◽  
Spinal Dural Arteriovenous Fistula ◽  
Small Series ◽  
Spinal Cord Volume

ObjectivesTo examine the utility of standardised volumetric spinal cord measurement as an indicator of successful disconnection of a Type 1 spinal dural arteriovenous fistula.DesignRetrospective analysis at a tertiary neuroscience centre.SubjectsPatients with symptomatic Type 1 spinal dAVFs presenting to the senior author and neurovascular MDT (June 2009 – December 2017). Inclusion based on availability of appropriate cross-sectional imaging. DAVFs arising below T12 excluded: 18 patients with a total 19 dAVFs identified.MethodsType 1 fistulation demonstrated on TRICKS MR angiography and spinal catheter angiography. Sagittal volumes evaluated using Horos (Purview, Annapolis, USA) and wireframe models created. Measurement arbitrarily standardised at ±2 levels from the origin of the fistulous draining vein. Pre- and post-operative clinical outcomes assessed using the Aminoff-Logue Scale. Wilcoxon test employed for between-group comparisons and Spearman’s rank test for clinico-radiological correlation (Prism 7, GraphPad Software, Inc. California).ResultsCord volumes reduced by a mean of 0.854 cm3 (p=0.0181; 95% CI=−1.55,–0.16; SD=1.44). Volume change was not related to gait (r=0.037, p=0.8812, 95% CI=−0.44, 0.49) or micturition scores (r=−0.24, p=0.3165, 95% CI=−0.64, 0.25).ConclusionsSurgical disconnection of type 1 dAVF resulted in a reduction in spinal cord volume. This was not predictive of change in clinical indices in this small series but perhaps merits investigation of this as a surrogate marker in a larger series.

Selective transvenous liquid embolization of a Type 1 dural arteriovenous fistula at the junction of the transverse and sigmoid sinuses

2000 ◽  
Vol 92 (6) ◽  
pp. 1045-1049 ◽  
Author(s):  
Kazuhiro Ohtakara ◽  
Kenichi Murao ◽  
Kenji Kawaguchi ◽  
Yoshihiro Kuga ◽  
Tadashi Kojima ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Skull Fracture ◽  
Venous Access ◽  
Extradural Hematoma ◽  
Content Type ◽  
Transvenous Approach ◽  
Fine Print

✓ The authors describe the case of a 51-year-old man with a Type 1 dural arteriovenous fistula (AVF) located at the junction of the transverse and sigmoid sinuses. The dural AVF developed after the patient underwent a craniotomy for an acute extradural hematoma. The patient suffered pulsatile tinnitus 3 months after surgery. After several attempts at transarterial embolization (TAE), the venous channel located close to the skull fracture was accessed via a transfemoral—transvenous approach and was embolized by administering a liquid nonadhesive agent. Successful embolization of the dural AVF was achieved both clinically and radiologically without causing considerable hemodynamic alterations. This procedure, either alone or combined with TAE, would seem to be an alternative treatment for dural AVFs in this location, without causing compromise of flow within the affected sinuses, when selective venous access is available.

Angio-RM post-trattamento delle malformazioni vascolari spinali

1997 ◽  
Vol 10 (2_suppl) ◽  
pp. 174-176
Author(s):  
G. Ferrito ◽  
M. Mascalchi ◽  
F. Scazzeri ◽  
D. Prosetti ◽  
P. Petruzzi ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arteriovenous Fistula ◽  
Phase Contrast ◽  
Mr Angiography ◽  
Dural Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Post Treatment ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Dural Arteriovenous Fistulas

Twenty-five patients with spinal vascular malformations demonstrated by spinal arteriography (21 dural arteriovenous fistulas, 2 perimedullary arteriovenous fistulas and 2 intramedullary arteriovenous malformations) underwent MR imaging and contrast enhanced phase-contrast MR angiography before and after endovascular (n?18) or surgical (n=7) treatment. In 3 patients with dural arteriovenous fistula treated with glue embolization, early post-treatment MR angiography showed persistence of flow in the perimedullary vessels. The patency of the fistula was confirmed by spinal arteriography or surgery in all three patients. In two other patients with dural arteriovenous fistulas treated with glue injection, delayed MR angiography showed flow in perimedullary vessels which was not observable in early post-treatment MR angiography controls. Reopening (“recurrence”) of the fistula was confirmed by arteriography in one patient. In the remaining 16 patients with dural arteriovenous fistula, post-treatment MR angiography showed disappearance of flow in the perimedullary vessels consistent with obliteration of the fistula. This finding was associated with persistent intramedullary signal changes and contrast enhancement in 13 patients and perimedullary contrast enhancing vessels in 6 patients. Arteriography in one of the latter patients showed exclusion of the fistula confirming the result of the posttreatment MR angiography study. In the 4 patients with high flow spinal vascular malformations, all treated with endovascular approach, early post-treatment MR angiography showed reduction or disappearance of flow in the abnormal vessels. This remained unchanged in two patients, where as increased flow in the same vessels was demonstrated by further follow-up MR angiography studies in two patients. Phase contrast MR angiography is a useful complement to MR imaging in the post-treatment evaluation of spinal vascular malformations. An early post-treatment MR-angiography control is recommended as it enables prompt identification of treatment failures and may constitute a reference term for lesion monitoring over time.

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