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Spine
Case series
Clinical presentation and treatment of 26 spinal epidural arteriovenous fistulas: a single-center experience
  1. Charles Beaman1,
  2. Amir Molaie2,
  3. Yasmin Ghochani2,
  4. Keiko Fukuda1,
  5. Catherine Peterson1,
  6. Naoki Kaneko1,
  7. May Nour1,
  8. Viktor Szeder1,
  9. Geoffrey P Colby3,
  10. Satoshi Tateshima1,
  11. Reza Jahan1,
  12. Gary Duckwiler1
  1. 1Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
  2. 2Department of Neurology, UCLA Medical Center, Los Angeles, California, USA
  3. 3Departments of Neurosurgery and Radiology, UCLA Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr Charles Beaman, Department of Radiology, UCLA Medical Center, Los Angeles, California, USA; cbbeaman{at}gmail.com

Abstract

Background Spinal epidural arteriovenous fistulas (SEDAVFs) are rarely diagnosed vascular malformations that can cause spinal cord compression and congestive myelopathy.

Methods This is a single-center, retrospective case series of patients with SEDAVFs who underwent observation or treatment at UCLA medical center between 1993 and 2023.

Results Between 1993 and 2023 a total of 26 patients at UCLA were found to have a SEDAVF. The median age at treatment was 59 years (range 4 months to 91 years). Compared with sacral, lumbar, and thoracic SEDAVFs, patients with cervical SEDAVF were younger (41 years vs 63 years, P=0.016) and more likely to be female (66.7% vs 14.3%, P=0.006). Possible triggers for development of SEDAVFs may be prior spinal surgery or trauma (n=4), turning the neck (n=1), lifting a heavy box (n=1), a prolonged period of bending over (n=1), and neurofibromatosis type 1 (n=1). Of the 22 patients treated endovascularly, 18 (82%) were angiographically cured on the first attempt without complications. One patient underwent surgical treatment alone and had a failed surgery on the first attempt, and developed a surgical site infection after the second successful attempt at treatment. Of the 16 patients with adequate clinical follow-up, 11 (69%) demonstrated early improved clinical outcome (eg, improved strength on examination, absent bruit).

Conclusions SEDAVFs are a rarely diagnosed disease that can be treated effectively and safely with endovascular embolization in most cases. Patients with sacral, lumbar, and thoracic SEDAVFs were older and more often male compared to patients with cervical SEDAVFs.

  • Spine
  • Cervical
  • Spinal cord
  • Fistula
  • Epidural

https://doi.org/10.1136/jnis-2024-021471

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    Footnotes

    • Twitter @charlesbeaman

    • Contributors CB conceived the project, collected data, and wrote the manuscript. AM and YG collected and organized data. KF, CP, NK, MN, GPC, RJ, VS, and ST conducted cases and critically revised the manuscript. GD and CB reviewed the cases and imaging.

    • 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.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.