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Original research
Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF)
  1. Yudhi Adrianto1,2,
  2. Ku Hyun Yang1,
  3. Hae-Won Koo1,
  4. Wonhyoung Park1,
  5. Sung Chul Jung1,
  6. Jie Eun Park1,
  7. Kwang-Kuk Kim3,
  8. Sang Ryong Jeon4,
  9. Dae Chul Suh1
  1. 1Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  2. 2Departement of Neurology, Soetomo General Hospital/Airlangga University Hospital, Airlangga University Medical Faculty, Surabaya, Indonesia
  3. 3Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  4. 4Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  1. Correspondence to Dr Dae Chul Suh, Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; dcsuh{at}amc.seoul.kr

Abstract

Background/objective The concomitant origin of the anterior spinal artery (ASA) or the posterior spinal artery (PSA) from the feeder of a spinal dural arteriovenous fistula (SDAVF) is rare and the exact incidence is not known. We present our experience with the management of SDAVFs in such cases.

Methods In 63 patients with SDAVF between 1993 and 2015, the feeder origin of the SDAVF was evaluated to determine whether it was concomitant with the origin of the ASA or PSA. Embolization was attempted when the patient did not want open surgery and an endovascular approach was regarded as safe and possible. The outcome of the procedure was evaluated as complete, partial, or no obliteration. The clinical outcome was evaluated by Aminoff–Logue (ALS) gait and micturition scale scores.

Results Nine patients (14%) had a concomitant origin of the ASA or PSA with the feeder. There were two cervical, five thoracic, and two lumbar level SDAVFs. A concomitant origin of the feeder was identified with the ASA (n=7) and PSA (n=2). Embolization was performed in four patients and open surgery was performed in five. Embolization resulted in complete obliteration in three patients and partial obliteration in one. Using the ALS gait and micturition scale, the final outcome improved in six while three cases remained in an unchanged condition over 2–148 months.

Conclusions The concomitant origin of the ASA or PSA with the feeder occurs occasionally. Complete obliteration of the fistula can be achieved either by embolization or open surgery. Embolization can be carefully performed in selected patients who are in a poor condition and do not want to undergo open surgery.

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