Abstract
Introduction
Perimedullary arteriovenous fistula (AVF) has shunt on the spinal cord surface and it can be treated with surgery, or endovascular embolization. Intramedullary arteriovenous malformation (AVM) has its nidus in the cord and is difficult to treat either by surgery or endovascular technique. We report our experience with endovascular embolization in the treatment of perimedullary AVF and intramedullary AVM.
Methods
Four consecutive cases of spinal perimedullary AVF and six intramedullary AVM were retrospectively reviewed. These cases were evaluated and treated at Beijing Tiantan Hospital, China, over a 2-year period. A review of previously reported cases was also performed.
Results
There was no significant difference in the presentations (P = 0.348), level of lesions (P = 0.350), arterial suppliers (P = 0.801), and associated vascular anomalies between perimedullary AVF and intramedullary AVM, except for age (P = 0.014) and treatment modalities (P = 0.003). The patients with perimedullary AVFs were younger in our cases; the age at onset of symptoms averaged 25.8 years compared to 31.7 years for intramedullary AVMs. There was a significant male predominance for both lesions, and a significantly higher incidence of subarachnoid hemorrhage than in spinal dural AVFs. Regarding treatment, endovascular coil embolization is frequently used in perimedullary AVF and liquid embolic agent is an effective therapeutic choice in intramedullary AVM.
Conclusion
Perimedullary AVF and intramedullary AVM are dissimilar with dural AVF in clinical characteristics. Our experience suggests that the endovascular treatment of spine perimedullary AVFs and intramedullary AVMs is feasible and effective. Endovascular treatment for intramedullary AVMs is still challenging, the main problem is acute ischemia injury of the spinal cord.
Similar content being viewed by others
Abbreviations
- AVM:
-
Arteriovenous malformation
- AVF:
-
Arteriovenous fistula
References
Veznedaroglu E, Nelson PK, Jabbour PM, Rosenwasser RH (2006) Endovascular treatment of spinal cord arteriovenous malformations. Neurosurgery 59(5 Suppl 3):S202–S213
Kim LJ, Spetzler RF (2006) Classification and surgical management of spinal arteriovenous lesions: arteriovenous fistulae and arteriovenous malformations. Neurosurgery 59(5 Suppl 3):S195–S201
Zozulya YP, Slin’ko EI, Al-Qashqish II (2006) Spinal arteriovenous malformations: new classification and surgical treatment. Neurosurg Focus 20(5):E7
Kikuchi Y, Miyasaka K (1998) Treatment strategy of spinal arteriovenous malformations based on a simple classification. J Clin Neurosci 5(Suppl):16–19
Nogueira RG, Dabus G, Rabinov JD, Ogilvy CS, Hirsch JA, Pryor JC (2009) Onyx embolization for the treatment of spinal dural arteriovenous fistulae: initial experience with long-term follow-up. Technical case report. Neurosurgery 64:E197–E198
Sherif C, Gruber A, Bavinzski G, Standhardt H, Widhalm G, Gibson D, Richling B, Knosp E (2008) Long-term outcome of a multidisciplinary concept of spinal dural arteriovenous fistulae treatment. Neuroradiology 50:67–74
Kim DJ, Willinsky R, Geibprasert S, Krings T, Wallace C, Gentili F, Terbrugge K (2010) Angiographic characteristics and treatment of cervical spinal dural arteriovenous shunts. AJNR Am J Neuroradiol 31:1512–1515
Gu XC, Yang YM, Yuan QG, Sha C, Jiang HZ (2008) Microsurgical treatment of spinal cavernous malformation. Zhonghua Yi Xue Za Zhi 88:1621–1623, Chinese
da Costa L, Dehdashti AR, terBrugge KG (2009) Spinal cord vascular shunts: spinal cord vascular malformations and dural arteriovenous fistulas. Neurosurg Focus 26:E6
Lad SP, Santarelli JG, Patil CG, Steinberg GK, Boakye M (2009) National trends in spinal arteriovenous malformations. Neurosurg Focus 26(1):1–5
Avanzo M, Romanelli P (2009) Spinal radiosurgery: technology and clinical outcomes. Neurosurg Rev 32:1–13
Aminoff MJ, Logue V (1974) The prognosis of patients with spinal vascular malformations. Brain 97:211–218
Van Swieten J, Koudstaal P, Visser M, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607
Casasco A, Guimaraens L, Cuellar H, Theron J, Heredero J (2010) Direct percutaneous venous puncture and embolization of giant perimedullary arteriovenous fistulas. AJNR Am J Neuroradiol 32:E10–E13
Meng X, Zhang H, Wang Y, Ye M, He C, Du J, Ling F (2010) Perimedullary arteriovenous fistulas in pediatric patients: clinical, angiographical, and therapeutic experiences in a series of 19 cases. Childs Nerv Syst 26:889–896
Cho KT, Lee DY, Chung CK, Han MH, Kim HJ (2005) Treatment of spinal cord perimedullary arteriovenous fistula: embolization versus surgery. Neurosurgery 56:232–241
Oran I, Parildar M, Derbent A (2005) Treatment of slow-flow (type I) perimedullary spinal arteriovenous fistulas with special reference to embolization. AJNR Am J Neuroradiol 26:2582–2586
Rodesch G, Hurth M, Alvarez H, Tadie M, Lasjaunias P (2005) Spinal cord intradural arteriovenous fistulae: anatomic, clinical, and therapeutic considerations in a series of 32 consecutive patients seen between 1981 and 2000 with emphasis on endovascular therapy. Neurosurgery 57:973–983
Kai Y, Hamada J, Morioka M, Yano S, Mizuno T, Kuratsu J (2005) Arteriovenous fistulas at the cervicomedullary junction presenting with subarachnoid hemorrhage: six case reports with special reference to the angiographic pattern of venous drainage. AJNR Am J Neuroradiol 26:1949–1954
Gil-Salú JL, López-López JA, Fernández-Roche JA, Rodríguez-Piñero A, Espinosa-Quirós JR, Reche FJ (2004) The treatment of intradural arteriovenous fistulas in the spine: two case reports. Rev Neurol 39:427–430
Thiex R, Williams A, Smith E, Scott RM, Orbach DB (2010) The use of Onyx for embolization of central nervous system arteriovenous lesions in pediatric patients. AJNR Am J Neuroradiol 31:112–120
Corkill RA, Mitsos AP, Molyneux AJ (2007) Embolization of spinal intramedullary arteriovenous malformations using the liquid embolic agent, Onyx: a single-center experience in a series of 17 patients. J Neurosurg Spine 7:478–485
Rohany M, Shaibani A, Arafat O, Walker MT, Russell EJ, Batjer HH, Getch CC (2007) Spinal arteriovenous malformations associated with Klippel-Trenaunay-Weber syndrome: a literature search and report of two cases. AJNR Am J Neuroradiol 28:584–589
Cullen S, Alvarez H, Rodesch G, Lasjaunias P (2006) Spinal arteriovenous shunts presenting before 2 years of age: analysis of 13 cases. Childs Nerv Syst 22:1103–1110
Hayashi K, Takahata H, Nakamura M (2004) Two cases of spinal arteriovenous malformation presenting with subarachnoid hemorrhage. No Shinkei Geka 32:605–611
Tissen TP (2002) Use of different endovascular treatments for arteriovenous malformations of the spinal cord. Hz Vopr Neirokhir Im N N Burdenko 3:29–37
Ushikoshi S, Hida K, Kikuchi Y, Iwasaki Y, Miyasaka K, Abe H (2006) Treatment of intramedullary arteriovenous malformations of the spinal cord. Interv Neuroradiol 6(Suppl 1):203–207
Niimi Y, Sala F, Deletis V, Setton A, de Camargo AB, Berenstein A (2004) Neurophysiologic monitoring and pharmacologic provocative testing for embolization of spinal cord arteriovenous malformations. AJNR Am J Neuroradiol 25:1131–1138
Rodesch G, Hurth M, Alvarez H, Lasjaunias P (1997) Embolisation of spinal cord arteriovenous malformations with glue through the anterior spinal axis. Review of 20 cases. Interv Neuroradiol 3:131–143
Rodesch G, Pongpech S, Alvarez H, Zerah M, Hurth M, Sebire G, Lasjaunias P (1995) Spinal cord arteriovenous malformations in a pediatric population children below 15 years of age. The place of endovascular management. Interv Neuroradiol 1:29–42
Hall WA, Oldfield EH, Doppman JL (1989) Recanalization of spinal arteriovenous malformations following embolization. J Neurosurg 70:714–720
Cogen P, Stein BM (1983) Spinal cord arteriovenous malformations with significant intramedullary components. J Neurosurg 59:471–478
Hilal SK, Sane P, Michelson WJ, Kosseim A (1978) The embolization of vascular malformations of the spinal cord with low-viscosity silicone rubber. Neuroradiology 16:430–433
Rosenblum B, Oldfield EH, Doppman JL, Di Chiro G (1987) Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM’s in 81 patients. J Neurosurg 67:795–802
Warakaulle DR, Aviv RI, Niemann D, Molyneux AJ, Byrne JV, Teddy P (2003) Embolisation of spinal dural arteriovenous fistulae with Onyx. Neuroradiology 45:110–112
Ling F (1993) Classification and embolization of spinal cord arterial–venous malformation. Zhonghua Wai Ke Za Zhi 31:13–16, Chinese
Riché MC, Modenesi-Freitas J, Djindjian M, Merland JJ (1982) Arteriovenous malformations (AVM) of the spinal cord in children. A review of 38 cases. Neuroradiology 22(4):171–180
Djindjian R, Merland JJ, Djindjian M, Houdart R (1978) Embolization in the treatment of medullary arteriovenous malformations in 38 cases (author’s transl). Neuroradiology 16:428–429, Article in French
Strom RG, Derdeyn CP, Moran CJ, Cross DT, Esper GJ, Mazumdar A, Al-Lozi M, Lopate G, Pestronk A (2006) Frequency of spinal arteriovenous malformations in patients with unexplained myelopathy. Neurology 66:928–931
Grote EH, Voigt K (1999) Clinical syndromes, natural history, and pathophysiology of vascular lesions of the spinal cord. Neurosurg Clin N Am 10:17–45
Ferch RD, Morgan MK, Sears WR (2001) Spinal arteriovenous malformations: a review with case illustrations. J Clin Neurosci 8:299–304
Rodesch G, Hurth M, Alvarez H, Ducot B, Tadie M, Lasjaunias P (2004) Angio-architecture of spinal cord arteriovenous shunts at presentation. Clinical correlations in adults and children. The Bicêtre experience on 155 consecutive patients seen between 1981–1999. Acta Neurochir Wien 146:217–227
Martin RA, Howard FM Jr, Salamone CR, Reese DF (1977) Spinal cord vascular malformations with symptoms during menstruation. Report of two cases. J Neurosurg 47:626–629
Aydin K, Sencer S, Sencer A, Terzibaşioglu E, Minareci O (2004) Angiography-induced closure of perimedullary spinal arteriovenous fistula. Br J Radiol 77:969–973
Lee K, Strozyk D, Rahman C, Lee LK, Fernandes EM, Claassen J, Badjatia N, Mayer SA, Pile-Spellman J (2010) Acute spinal cord ischemia: treatment with intravenous and intra-arterial thrombolysis, hyperbaric oxygen and hypothermia. Cerebrovasc Dis 29:95–98
Detweiler PW, Porter RW, Spetzler RF (1999) Spinal arteriovenous malformations. Neurosurg Clin N Am 10:89–100
Ferch RD, Morgan MK, Sears WR (2001) Spinal arteriovenous malformations: a review with case illustrations. J Clin Neurosci. 8:299–304
Conflict of interest
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lv, X., Li, Y., Yang, X. et al. Endovascular embolization for symptomatic perimedullary AVF and intramedullary AVM: a series and a literature review. Neuroradiology 54, 349–359 (2012). https://doi.org/10.1007/s00234-011-0880-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-011-0880-0