Incidence and clinical characteristics of spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan

OBJECTIVE There have been no accurate surveillance data regarding the incidence rate of spinal arteriovenous shunts (SAVSs). Here, the authors investigate the epidemiology and clinical characteristics of SAVSs. METHODS The authors conducted multicenter hospital-based surveillance as an inventory survey at 8 core hospitals in Okayama Prefecture between April 1, 2009, and March 31, 2019. Consecutive patients who lived in Okayama and were diagnosed with SAVSs on angiographic studies were enrolled. The clinical characteristics and the incidence rates of each form of SAVS and the differences between SAVSs at different spinal levels were analyzed. RESULTS The authors identified a total of 45 patients with SAVSs, including 2 cases of spinal arteriovenous malformation, 5 cases of perimedullary arteriovenous fistula (AVF), 31 cases of spinal dural AVF (SDAVF), and 7 cases of spinal epidural AVF (SEAVF). The crude incidence rate was 0.234 per 100,000 person-years for all SAVSs including those at the craniocervical junction (CCJ) level. The incidence rate of SDAVF and SEAVF combined increased with advancing age in men only. In a comparative analysis between upper and lower spinal SDAVF/SEAVF, hemorrhage occurred in 7/14 cases (50%) at the CCJ/cervical level and in 0/24 cases (0%) at the thoracolumbar level (p = 0.0003). Venous congestion appeared in 1/14 cases (7%) at the CCJ/cervical level and in 23/24 cases (96%) at the thoracolumbar level (p < 0.0001). CONCLUSIONS The authors reported detailed incidence rates of SAVSs in Japan. There were some differences in clinical characteristics of SAVSs in the upper spinal levels and those in the lower spinal levels.

Perimedullary Spinal Arteriovenous Malformation in an Elderly Female: A Case Report

Perimedullary spinal AVM is a rare type of spinal arteriovenous malformations. We present a case of 70 yrs female who presented with motor weakness in her bilateral limbs. Initial MRI was misinterpreted as ependymal myxoma; however, histopathology revealed spinal AVM. MRA or DSA should be conducted if AVM is suspected.

Open surgery of complex long segment (giant) glomus spinal arteriovenous malformation

Spinal arteriovenous malformation occurring in the pediatric population (under 15 years) initially complain of pain as the first symptom which is often over looked. In almost all, diagnosis is delayed resulting in weakness. Angiogram provides correct diagnosis in all cases. Radical microsurgical excision tends to offer best long-term result. Here we present a 7-year-old girl referred to us for lumbar puncture with provisional suspicion of meningitis. She had history of fever for two days and signs of meningism were present. On examination, she was stable and had complains of headache. Her previous history suggested she had continuous backache since childhood and had visited multiple centers previously for the problem. A detailed work up revealed a long segment spinal space occupying lesion. CT angiogram showed spinal arteriovenous malformation. Laminoplasty and open microsurgical excision of arteriovenous malformation was performed. Her hospital stay was uneventful and was discharged in stable condition. Early recognition, accurate diagnosis and prompt surgical treatment may result in significant improvement of neurological function.

Republished: Spinal arteriovenous malformation without endovascular arterial access: is a combined neurosurgical approach and direct venous puncture an option?

This case report describes a combined neurosurgical and endovascular approach for the treatment of a conus medullaris arteriovenous malformation resulting in considerable improvement in the patient’s neurological condition (modified Rankin Scale score 2).

Spinal arteriovenous malformation without endovascular arterial access: is a combined neurosurgical approach and direct venous puncture an option?

This case report describes a combined neurosurgical and endovascular approach for the treatment of a conus medullaris arteriovenous malformation resulting in considerable improvement in the patient’s neurological condition (modified Rankin Scale score 2).