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Standard of practice: embolization of spinal arteriovenous fistulae, spinal arteriovenous malformations, and tumors of the spinal axis
  1. Sandra Narayanan1,
  2. Robert W Hurst2,
  3. Todd A Abruzzo3,
  4. Felipe C Albuquerque4,
  5. Kristine A Blackham5,
  6. Ketan R Bulsara6,
  7. Colin P Derdeyn7,
  8. Chirag D Gandhi8,
  9. Joshua A Hirsch9,
  10. Daniel P Hsu10,
  11. Muhammad Shazam Hussain11,
  12. Mahesh V Jayaraman12,
  13. Philip M Meyers13,
  14. Athos Patsalides14,
  15. Charles J Prestigiacomo15
  1. 1Department of Neurosurgery and Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
  2. 2Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA
  4. 4Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  5. 5University Hospitals Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
  6. 6Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
  7. 7Department of Radiology, Washington University, St Louis, Missouri, USA
  8. 8Neurological Institute of New Jersey, New Jersey Medical School, Newark, New Jersey, USA
  9. 9Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  10. 10Interventional Neuroradiology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA
  11. 11Cleveland Clinic Stroke Program, Cleveland Clinic, Cleveland, Ohio, USA
  12. 12Warren Alpert School of Medical at Brown University, Providence, Rhode Island, USA
  13. 13Department of Radiology and Neurological Surgery, Columbia University, New York, USA
  14. 14Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College New York, New York, USA
  15. 15Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
  1. Correspondence to Dr S Narayanan, Department of Neurosurgery and Neurology, Wayne State University/Detroit Medical Center, 4160 John R, #930, Detroit, MI 48201, USA; snarayanan{at}

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Spinal vascular malformations include a heterogeneous group of pathological/anatomical entities with congenital and acquired etiologies that induce spinal cord dysfunction, primarily through intradural extramedullary drainage and enlargement of the coronal venous plexus, resulting in venous hypertension and/or a direct mass effect. These lesions are rare, comprising approximately 5% of neurovascular disorders. Clinical manifestations are pain or venous congestive myelopathy, usually in the thoracolumbar spine. This may progress to hemorrhage from vascular thrombosis and necrotizing myelopathy (Foix–Alajouanine syndrome).1 Due to the differing hemodynamics, pathophysiology, and treatment considerations, a thorough knowledge of the various types of spinal dural arteriovenous fistulas (dAVFs) and arteriovenous malformations (AVMs) is essential.


The first descriptions of the single coiled dural vessel form of spinal dAVF with intradural extramedullary venous drainage were published by Kendall and Logue in 1977.2 Type I spinal dAVFs (also known as angioma racemosum venosum) are the most common and comprise 56% of all spinal lesions in the spinal vascular malformation database at the University of Toronto.3 They occur nearly 3–4 times as frequently in men. These generally low flow lesions may be further divided into type I-A (single feeder dAVFs) and I-B (≥2 arterial feeders).4 Although they are typically supplied via radicular arteries, anterior spinal artery feeders have also been reported.5 Type II spinal AVMs (also known as angioma racemosum arteriovenosum) are characterized by a compact, glomus-type, totally intramedullary nidus. They have no gender predominance but are symptomatic in younger patients. Type III (juvenile or metameric) spinal AVMs are highly complex intramedullary lesions that frequently extend into the extramedullary, epidural, or even extraspinal compartments. Vascular …

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  • Contributors Each author made a substantial contribution to the concept and content of this standards document.

  • Competing interests None.

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