ABSTRACT
Resumen Introducción: La fístula dural arteriovenosa espinal (FDAVE) es una enfermedad vascular frecuentemente subdiagnosticada. El tratamiento puede ser microqui rúrgico o endovascular. Métodos: Estudio retrospectivo de una serie de pa cientes con FDAVE tratados por microcirugía entre los años 2010 y 2021. Fueron evaluados parámetros como edad, sexo, cuadro clínico pre y postoperatorio medido con las escalas de Aminoff-Logue y Rankin modificada (mRs). Los estudios diagnósticos se utilizaron para de terminar nivel lesional y resultados quirúrgicos. Resultados: Se incluyeron doce pacientes (10 hombres y 2 mujeres) con un promedio de edad de 60 años. El tiempo de evolución del cuadro clínico al diagnóstico fue menor a 12 meses salvo un caso de 32 meses. Las FDAVE fueron localizadas, 8 a nivel dorsal, 3 a nivel lumbar y una a nivel sacro. La arteria de Adamkiewicz se identificó en 5 casos en L1, 2 en D12, 2 en D10, 2 en D9 y un caso en D7. De los 12 pacientes operados, 3 fueron embolizados previamente; dos permanecieron estables en su evolución y 10 mejoraron uno o más puntos del mRs. No hubo complicaciones en el postoperatorio. Todos mostraron mejoría del edema medular en reso nancia magnética y la angiografía digital, luego de los 6 meses, fue negativa. El seguimiento promedio fue de 40 meses con un rango de 6 a 122 meses y ningún paciente presentó recidiva de la FDAVE. Conclusión: El tratamiento quirúrgico de las FDAVE es un método muy eficaz, de baja morbilidad y menor tasa de recurrencia comparado con el tratamiento en dovascular.
Abstract Introduction: Spinal dural arteriovenous fistula (SDA VF) is a rare vascular disease, of unknown etiology, fre quently underdiagnosed. Treatment can be microsurgical or endovascular. Methods: Retrospective and monocentric analysis of 12 SDAVF patients treated by microsurgery between 2010 and 2021. Parameters including age, sex, pre and postoperative clinical condition were analyzed according to modified Aminoff-Logue and Rankin scales. Diagnos tic studies such as magnetic resonance imaging (MRI), magnetic resonance angiogram (MRA) and spinal digital subtraction angiography (DSA), were evaluated for lesion level, as were surgical results. Results: Twelve patients (10 men and 2 women), average age: 60 years, were operated. The interval from symptom onset to diagnosis was <12 months in all cases except one (32 months). SDAVF locations were thoracic in 8 cases, between T6 and T12, 3 at lumbar spine (L1- L2) and at S1 in one case, with no difference regarding side. The Adamkiewicz artery was identified in 5 cases at L1, 2 at D12, 2 at D10, 2 at D9 and 1 at D7 (7 left-sided and 5 right-sided). Three of the 12 patients operated had undergone prior embolization. Postoperative neu rological outcomes showed: 2 patients remained stable and 10 improved one or more points on the mRs; no postoperative complications were observed. Follow-up MRI images improved in all cases and spinal DSA was negative at 6 months. Average follow-up was 40 months (range 6 to 122) and no patient presented recurrence. Conclusion: Microsurgical treatment of SDAVF proved to be efficient, with low morbidity and lower recurrence rates compared to endovascular results.
ABSTRACT
Introducción: la fístula dural arteriovenosa espinal (FDAVE) es una enfermedad vascular rara, de etiología desconocida y frecuentemente subdiagnosticada. El tratamiento puede ser microquirúrgico o endovascular. Material y Método: Análisis retrospectivo de una serie de 8 pacientes consecutivos con FDAVE tratados por microcirugía entre 2010 y 2020. Fueron evaluados parámetros como edad, sexo, cuadro clínico pre y postoperatorio medido con las escalas de Aminoff-Logue y Rankin modificada. Los estudios diagnósticos con RMN (Resonancia Magnética Nuclear), ARM (Angio Resonancia Magnética) y ADM (Angiografía Digital Medular) se utilizaron para determinar nivel lesional y resultados quirúrgicos. Resultados: Fueron operados 8 pacientes (7 masculinos y 1 femenino) con un promedio de edad de 58 años. El tiempo de evolución del cuadro clínico al diagnóstico fue menor a 12 meses salvo un caso de 32 meses. Las FDAVE fueron localizadas en: 6 a nivel dorsal entre D6 y D12, una en L2 y la última en S1 (5 derechas y 3 izquierdas). La arteria de Adamkiewicz se identificó en: 4 casos en L1, 2 en D12, 1 en D10 y un caso en D7 (6 izquierdas y 2 derechas). De los 8 pacientes operados, 3 fueron embolizados previamente. La evolución postoperatoria del cuadro neurológico fue: 2 de 8 permanecieron estables y 6 de 8 mejoraron uno o más puntos en la escala de Rankin modificada; no hubo complicaciones en el postoperatorio. Todos los pacientes mejoraron las imágenes en RMN diferida y la ADM luego de los 6 meses fue negativa. El seguimiento promedio fue de 48 meses con un rango de 11 a 116 meses, ningún paciente presentó recidiva de la FDAVE. Conclusiones: El tratamiento quirúrgico de las FDAVE es un método muy eficaz, de baja morbilidad y menor tasa de recurrencia comparado con el tratamiento endovascular.
Introduction: Spinal dural arteriovenous fistula (SDAVF) is a rare vascular disease, of unknown etiology and frequently underdiagnosed. Treatment can be microsurgical or endovascular. Material and Method: Retrospective analysis of a series of 8 SDAVF patients treated by microsurgery between 2010 and 2020. Parameters including age, sex, pre and postoperative clinical condition were analyzed according to modified Aminoff-Logue and modified Rankin scales. Diagnostic studies such as MRI (Magnetic Resonance Imaging), MRA (Magnetic Resonance Angiogram) and spinal DSA (Digital Subtraction Angiography), were evaluated for lesion level, as were surgical results. Results: Eight patients (7 male and 1 female), average age of 58 years were operated. The interval from symptom onset to diagnosis was less than 12 months in all cases except one (32 months). SDAVF locations were thoracic in 6 cases between T6 and T12, at L2 in one and at S1 in one case (5 on the right and 3 on the left). The Adamkiewicz artery was identified in: 4 cases at L1, 2 at D12, 1 at D10 and in one case at D7 (6 left-sided and 2 right-sided). Three of the 8 patients operated had undergone prior embolization. Postoperative neurological outcomes showed: 2 patients remained stable and 6 had improved one or more points on the modified Rankin scale; no postoperative complications were observed. Follow-up MRI images improved in all cases and spinal DSA was negative at six months. Average follow-up was 48 months (range 11 to 116 months), no patient presented recurrence. Conclusions: Microsurgical treatment of SDAVF proved to be efficient, with low morbidity and lower recurrence rates compared to endovascular results.
Subject(s)
Humans , Fistula , Spinal Cord Diseases , Vascular Diseases , Angiography , Central Nervous System Vascular Malformations , MicrosurgeryABSTRACT
Las fístulas arteriovenosas durales medulares son malformaciones vasculares adquiridas que constituyen una causa muy infrecuente de mielopatía progresiva (5-10 casos por millón de habitantes por año). La resonancia magnética es el estudio por imágenes de elección para su diagnóstico. A continuación presentamos el caso de una paciente femenina de 89 años, que consultó a la guardia de nuestra institución por un cuadro de paraparesia moderada asociada a parestesias e incontinencia urinaria posterior a esfuerzo físico. Se le diagnosticó una fístula arteriovenosa dural medular como causante de su cuadro. (AU)
Spinal dural arteriovenous fistulas (SDAVF) are acquired spinal vascular malformations and a rare cause of progressive myelopathy (5-10 new cases per year and per 1 million inhabitants). Magnetic resonance imaging is the diagnosis modality of choice. We present a case of a 89-year-old female patient who consulted the emergency department of our institution because of paraparesis and lower extremities paresthesias associated with urinary incontinence post physical effort. With the final diagnosis of spinal dural arteriovenous fistula, as a cause of the clinical symptoms. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Arteriovenous Fistula/diagnostic imaging , Dura Mater/abnormalities , Paresthesia , Atrial Fibrillation/complications , Spinal Cord Diseases/diagnostic imaging , Tobacco Use Disorder/complications , Urinary Incontinence , Arteriovenous Fistula/etiology , Arteriovenous Fistula/epidemiology , Low Back Pain/complications , Aortic Aneurysm, Abdominal/complications , Paraparesis , Fecal Incontinence , Hypertension/complications , Hypesthesia , Erectile Dysfunction , Anticoagulants/therapeutic useABSTRACT
Hie medical records of 2 case∗ of spinal dural arteriovenous fistula (SDAVF) treated in the hybrid operating room were analyzed retrospective])- and die relevant literatures were reviewed to evaluate the clinical value of intraoperative 9pinal digital subtraction angiography (SDSA) combined with image fusion technology. Both case9 were diagnosed by spinal angiograms before operation. Both fistulas were accurately found at thoracic level and surgically disconnected in the hybrid operating room. The modified Aminoff- Loguc scores (mALS) was used to evaluate the spinal function. Intraoperative SDSAs were performed immcdiaicly after disconnections, and the fistulas were showed to be completely disappeared. The duration of intraoperative SDSAs and Image fusion for fistula localization were 70 and 60minutes respectively. No SDSA-redated complications happened. "Hie clinical symptoms of both patients improved variously during 12-14 months of follow-up. The decreasing of mALS were 6 and 5 points respectively. Our experience indicated that intraoperative SDSA combining image fusion technology was helpful for precisely localizing the fistulas of SDAVF,making their surgeries less invasive and the surgical disconnections more reliable.
ABSTRACT
Spinal dural arteriovenous fistula (SDAVF) is difficult to make early diagnosis for non-specific clinical manifestations and imaging features. A patient of SDAVF with lower limb paraplegia exacerbation after intravenous methylprednisolone was reported. The patient was mainly characterized by low back pain and numbness of bilateral lower limbs. He was misdiagnosed as lumbar disc herniation and acute myelitis. After intravenous methylprednisolone 1 000 mg for more than 10 hours, the patient's lower limb weakness aggravated significantly than before. Later spinal angiogram confirmed SDAVF. The author summarized the clinical and imaging characteristics of SDAVF,and analyzed the diagnosis and treatment of the disease with literature review.
ABSTRACT
Spinal dural arteriovenous fistula is a rare vascular lesion of the spinal cord associated with progressive myelopathy. Symptoms include progressive gait dysfunction, weakness, sensory loss, and bowel and bladder dysfunction. Because these symptoms overlap with other common causes of myelopathy and the disease is rare, spinal dural arteriovenous fistula is often not suspected and the time to diagnosis is long. We report the case of a 60-year-old woman who presented with progressive lower limb weakness and gait disturbance diagnosed as spinal dural arteriovenous fistula involving a fractured L1 vertebral body.
Subject(s)
Female , Humans , Middle Aged , Central Nervous System Vascular Malformations , Fistula , Gait , Lower Extremity , Spinal Cord , Spinal Cord Diseases , Urinary BladderABSTRACT
Spinal dural arteriovenous fistula (SDAVF) is rare but still the most commonly encountered vascular malformation of the spinal cord. A 31-year-old male developed gait disturbance due to weakness of his lower extremities, voiding difficulty and sexual dysfunction with a progressive course since 3 months. He showed areflexia in both knees and ankles. Electromyographic findings were suggestive of multiple root lesions involving bilateral L2 to S4 roots of moderate degree. Magnetic resonance images showed high signal intensity with an ill-defined margin in T2-weighted images and intensely enhanced by a contrast agent through the lumbosacral spinal cord. Selective spinal angiography confirmed a dural arteriovenous fistula with a nidus at the L2 vertebral level. After selective endovascular embolization, his symptoms drastically improved except sexual dysfunction. We report a rare case of cauda equina syndrome due to spinal arteriovenous fistula with drastic improvement after endovascular embolization.
Subject(s)
Adult , Animals , Humans , Male , Angiography , Ankle , Arteriovenous Fistula , Cauda Equina , Central Nervous System Vascular Malformations , Gait , Knee , Lower Extremity , Magnetic Resonance Spectroscopy , Polyradiculopathy , Spinal Cord , Vascular MalformationsABSTRACT
The authors report a case of spinal dural arteriovenous fistula (SDAVF) that is supplied by a lateral sacral artery. A 73-year-old male presented with gait disturbance that had developed 3 years ago. Spinal magnetic resonance imaging suggested a possible SDAVF. Selective spinal angiography including the vertebral arteries and pelvic vessels showed the SDAVF fed by left lateral sacral artery. The patient was subsequently treated with glue embolization. Three days after the embolization procedure, his gait disturbance was much improved.
Subject(s)
Aged , Humans , Male , Adhesives , Angiography , Arteries , Central Nervous System Vascular Malformations , Gait , Magnetic Resonance Imaging , Vertebral ArteryABSTRACT
Spinal dural arteriovenous fistulas are rare abnormal connections of arteries and veins on the surface of the dura. A male presenting with myelopathy, which had a slowly progressive course for about 28 months, was diagnosed by magnetic resonance imaging and selective angiography. After surgical coagulation and excision, his symptoms were mildly improved. We report here on a man who underwent a surgical procedure for his myelopathy that was due to spinal arteriovenous fistula. Although it is unusual, spinal arteriovenous fistula should be considered when making a differential diagnosis of myelopathy.
Subject(s)
Humans , Male , Angiography , Arteries , Arteriovenous Fistula , Central Nervous System Vascular Malformations , Diagnosis, Differential , Magnetic Resonance Imaging , Spinal Cord Diseases , VeinsABSTRACT
A case was presented of a 41-year-old male with progressive claudication and numbness in the lower extremities. A MRI showed swelling of the spinal cord with an intramedullary high signal intensity on a T2-weighted image. The patient was diagnosed with transverse myelitis and was started on intravenous steroids. However, there were no significant effects with the steroid treatment. An angiography showed a spinal dural arteriovenous fistula fed by a T11 radicular artery. An endovascular embolization was performed and the claudication and numbness were improved. We report a case of spinal dural arteriovenous fistula misdiagnosed as transverse myelitis.
Subject(s)
Adult , Humans , Male , Angiography , Arteries , Central Nervous System Vascular Malformations , Hypesthesia , Lower Extremity , Magnetic Resonance Imaging , Myelitis, Transverse , Spinal Cord , SteroidsABSTRACT
The authors report a rare case of spinal dural arteriovenous fistula (DAVF) that supplied by lateral sacral artery. A 71-year-old female initially presented with paraparesis and boring pain on lower extremities. Though magnetic resonance imaging suggested a possible spinal DAVF, routine angiographic evaluation was negative. Thereafter, the patient deteriorated progressively and became paraplegic. Definite diagnosis was made through selective pelvic angiogram. The patient was subsequently treated with embolization using mixture of glue and lipiodol. On three months after the embolization, the patient remained paraplegic, but her leg pain was improved remarkably.
Subject(s)
Aged , Female , Humans , Adhesives , Arteries , Central Nervous System Vascular Malformations , Diagnosis , Ethiodized Oil , Leg , Lower Extremity , Magnetic Resonance Imaging , ParaparesisABSTRACT
The spinal dural arteriovenous fistula is a common vascular malformation with unclear etiology and unspecific clinical presentations.An early diagnosis is important for the treatment,therefore the authors reviewed and comprehanded the pathology,diagnosis and treatment of this AVM.
ABSTRACT
Spinal dural arteriovenous fistulas are rare abnormal connections of artery and vein within the dura, at the level of the intervertebral foramen. A 57-year-old male developed weakness in both lower extremities and sphincteric dysfunction, which had stepwisely, progressive and fluctuating course since 6 months ago. He showed areflexia in both ankle & right knee. T-spine MRI showed high signal intensity with ill defined margin in T2WI and intensely enhanced by con-trast agent through lower thoracic and lumbosacral spinal cord. Selective spinal angiography revealed a dural arteriove-nous fistula with a nidus at thoracolumbar vertebral level, supplied by the internal iliac artery and enlarged medullary veins. Superselective angiographic embolization was done. Clinically, his symptoms has been ameliorated. We report a rare case of thoracic myelopathy due to spinal dural arteriovenous fistulas exclusively supplied by the branches of internal iliac artery.