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Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas: a systematic review and meta-analysis
  1. Jun-Soo Byun1,2,
  2. Anderson Chun On Tsang2,3,
  3. Christopher Alan Hilditch2,
  4. Patrick Nicholson,
  5. Yi-Bin Fang4,
  6. Timo Krings2,5,
  7. Vitor Mendes Pereira2,5,
  8. Giuseppe Lanzino6,
  9. Waleed Brinjikji2,6
  1. 1 Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
  2. 2 Division of Neuroradiology, University of Toronto, Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
  3. 3 Division of Neurosurgery, Department of Surgery, The University of Hong Kong, Hong Kong, China
  4. 4 Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
  5. 5 Division of Neurosurgery, University of Toronto, Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
  6. 6 Department of Radiology & Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Jun-Soo Byun, Division of Neuroradiology, Toronto Western Hospital, Toronto, ON M5T2S8, Canada; flightdr61{at}


Background and purpose Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study was to perform a systematic review of the demographics, clinical presentation and treatment results of thoracolumbar SEDAVFs.

Materials and methods Pubmed, Scopus and Web of Science databases were searched from January 2000 to January 2018 for articles on treatment of SEDAVFs. Pooled data of individual patients were analyzed for demographic and clinical features of SEDAVFs as well as treatment outcomes.

Results There were 125 patients from 11 studies included. Mean age was 63.5 years. There was a male sex predilection (69.6%). Sensory symptoms including pain or numbness were the most frequently presenting symptoms. Fistula location was the lumbosacral spine in 79.2% and the thoracic spine in 20.8%. Involvement of intradural venous drainage was more common than extradural venous drainage only (89.6% vs 10.4%). Of the 123 treated patients, endovascular therapy was performed in 67.5% of patients, microsurgery in 23.6%, and combined treatment in 8.9%. The overall complete obliteration rate was 83.5% and did not differ between groups. Clinical symptoms improved in 70.7% of patients, were stable in 25%, and worsened in 1.7% with no difference between treatment modalities.

Conclusions Thoracic and lumbosacral SEDAVFs often present with symptoms secondary to congestive myelopathy or compressive symptoms. Both endovascular and microsurgical treatments were associated with high obliteration rates and good clinical outcomes.

  • arteriovenous malformation
  • epidural
  • fistula
  • spine

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  • Contributors J-SB screened articles, collected data, drafted paper. He is guarantor. ACOT and CAH monitored data collection and revised the draft paper. PN collected data and revised the paper. Y-BF, TK, VMP, and GL supervised and revised the paper. WB screened articles, wrote the statistical analysis plan, and analyzed the data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.