scholarly journals Thoracolumbar progressive myelopathy due to extra-dural arteriovenous fistula

2021 ◽  
Author(s):  
Stella de Angelis Trivellato ◽  
Joao Lucas Gomes Salgado ◽  
Hendrick Henrique Fernandes Gramasco ◽  
Guilherme Drumond Jardini Anastacio ◽  
Daniel Fabiano Barbosa Dos Santos ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Progressive Myelopathy ◽  
Spinal Vascular Malformations ◽  
Shunt Occlusion ◽  
Thoracolumbar Region ◽  
Grade Ii ◽  
The Right ◽  
Inferior Limb

Context: Arteriovenous dural fistulas are the most common spinal vascular malformations and constitute a reversible cause of progressive myelopathy. This disease affects elderly men and are classically found at the thoracolumbar region. Case report: A 69year-old man was admitted to the Neurology outpatient clinic with weakness in his left inferior limb for the past 10 years; 2 years before the evaluation, the weakness progressed also to the right inferior limb, causing inability to walk, and 1 year after the patient noticed urinary incontinence and sexual dysfunction. Physical evaluation showed grade-II paraparesis with spastic hypertonia; hypoesthesia below T-10 dermatome; hyperreflexia with clonus and Babinski sign in inferior limbs. Investigation with MRI showed abnormal hypersignal within spinal cord from T6-T7 to the medullary cone; CSF sample had hyper protein count without pleocytosis. Before the hypothesis of non- compressive, non-inflammatory and non-infectious myelopathy, we performed a spinal angiography – which diagnosed a dural arteriovenous fistula at the level of T8 connecting spinal with extradural vessels. The patient was then treated by endovascular therapy with fistula embolization. Conclusion: Although being the most common vascular spinal malformation, arteriovenous dural fistulas are rare and underdiagnosed because of their nonspecific symptoms. The aim of treatment is the shunt occlusion but its prognosis depends on the duration and intensity of symptoms before treatment. This report’s aim is to exemplify a typical case of this condition.

scholarly journals A case of recurrent cavernous sinus dural arteriovenous fistula arising after superselective shunt occlusion and detected by venous arterial spin labeling

2021 ◽  
Vol 12 ◽  
pp. 594
Author(s):  
Hiromu Sunada ◽  
Ryosuke Maeoka ◽  
Ichiro Nakagawa ◽  
Hiroyuki Nakase ◽  
Hideyuki Ohnishi
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Arterial Spin Labeling ◽  
Dural Arteriovenous Fistula ◽  
Spin Labeling ◽  
Digital Subtraction ◽  
Resonance Imaging ◽  
Shunt Occlusion ◽  
Paradoxical Worsening ◽  
The Right

Background: Superselective shunt occlusion (SSSO) for cavernous sinus dural arteriovenous fistula (CSDAVF) avoids the risk of cranial nerve palsy, unlike entire sinus packing, but requires paying attention to recurrence. Distinguishing between true and paradoxical worsening of postoperative ophthalmic symptoms using a less-invasive modality is often difficult. Here, we report a case of true worsening of neuro-ophthalmic symptom by recurrent CSDAVF detected by venous-arterial spin labeling (ASL) on magnetic resonance imaging. Case Description: A 55-year-old woman with neither contributory medical history nor previous head trauma presented with neuro-ophthalmic symptoms and pulsatile tinnitus. Digital subtraction angiography (DSA) revealed CSDAVF with multiple shunted pouches. She underwent successful transvenous SSSO, but neuroophthalmic symptom worsened after SSSO and venous-ASL revealed increased signal intensity in the right superior orbital vein (SOV). DSA confirmed recurrent CSDAVF and additional transvenous embolization was performed. Neuro-ophthalmic symptoms and venous-ASL hyperintensity on SOV improved postoperatively. Conclusion: Venous-ASL is noninvasive and seems useful for detecting true worsening of neuro-ophthalmic symptoms of recurrent CSDAVF.

scholarly journals Balloon-assisted transarterial embolization of type 1 spinal dural arteriovenous fistula

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1
Author(s):  
Brian Lee ◽  
Vivek A. Mehta ◽  
William J. Mack ◽  
Matthew S. Tenser ◽  
Arun P. Amar
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Mri Imaging ◽  
Spinal Dural Arteriovenous Fistula ◽  
Lower Extremity Weakness ◽  
Segmental Artery ◽  
Spinal Vascular Malformations

Type 1 spinal dural arteriovenous fistula (dAVF) constitute the vast majority of all spinal vascular malformations. Here we present the case of a 71-year-old male with progressive myelopathy, lower-extremity weakness and numbness, and urinary incontinence. MRI imaging of the thoracic spine demonstrated cord edema, and catheter spinal angiography confirmed a type 1 spinal dAVF. The fistula was supplied by small dural branches of the left L-2 segmental artery. Angiographic cure was achieved with a one-stage procedure in which coils were used to occlude the distal segmental vessels, followed by balloon-assisted embolization with Onyx.The video can be found here: http://youtu.be/8aehJbueH0U.

True Aneurysm on the Posterior Meningeal Artery Associated With a Dural Arteriovenous Fistula

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. E876-E877 ◽  
Author(s):  
Kenji Muro ◽  
Joseph G. Adel ◽  
Numa R. Gottardi-Littell ◽  
Christopher C. Getch ◽  
H. Hunt Batjer
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Unusual Case ◽  
Vascular Malformations ◽  
Management Plan ◽  
En Bloc ◽  
True Aneurysm ◽  
The Right ◽  
Posterior Meningeal Artery ◽  
Meningeal Artery

Abstract BACKGROUND We report an unusual case of a true dural aneurysm arising from the posterior meningeal artery that fed a symptomatic dural arteriovenous fistula located at the right transverse-sigmoid sinus junction. CLINICAL PRESENTATION A 29-year-old right-handed white woman presented with aneurysmal dilatation of hypertrophied posterior meningeal artery feeding a partially treated dural arteriovenous fistula. INTERVENTION The aneurysm, which measured approximately 3 mm in width and 5 mm in length, was located in the intracranial space with a thin-walled dome projecting toward the cerebellum. Its afferent and efferent vessels were identified, secured, and the lesion was excised en bloc. CONCLUSION A thorough evaluation of all diagnostic studies should be performed for patients with vascular malformations to help identify these or other unusual lesions that may aid in the risk stratification process and management plan.

Spinal dural arteriovenous fistula associated with a spinal perimedullary fistula

2006 ◽  
Vol 4 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Timo Krings ◽  
Volker A. Coenen ◽  
Martin Weinzierl ◽  
Marcus H. T. Reinges ◽  
Michael Mull ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Venous Drainage ◽  
Elevated Pressure ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Dural Arteriovenous Fistulas

✓ Among spinal cord vascular malformations, dural arteriovenous fistulas (DAVFs) must be distinguished from intradural malformations. The concurrence of both is extremely rare. The authors report the case of a 35-year-old man who suffered from progressive myelopathy and who harbored both a DAVF and an intradural perimedullary fistula. During surgery, both fistulas were identified, confirmed, and subsequently obliterated. The fistulas were located at two levels directly adjacent to each other. Although the incidence of concurrent spinal DAVFs is presumed to be approximately 2%, the combination of a dural and an intradural fistula is exceedingly rare; only two other cases have been reported in the literature. One can speculate whether the alteration in venous drainage caused by the (presumably congenital) perimedullary fistula could possibly promote the production of a second dural fistula due to elevated pressure with concomitant venous stagnation and subsequent thrombosis. The authors conclude that despite the rarity of dual pathological entities, the clinician should be aware of the possibility of the concurrence of more than one spinal fistula in the same patient.

Angio-RM post-trattamento delle malformazioni vascolari spinali

1997 ◽  
Vol 10 (2_suppl) ◽  
pp. 174-176
Author(s):  
G. Ferrito ◽  
M. Mascalchi ◽  
F. Scazzeri ◽  
D. Prosetti ◽  
P. Petruzzi ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arteriovenous Fistula ◽  
Phase Contrast ◽  
Mr Angiography ◽  
Dural Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Post Treatment ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Dural Arteriovenous Fistulas

Twenty-five patients with spinal vascular malformations demonstrated by spinal arteriography (21 dural arteriovenous fistulas, 2 perimedullary arteriovenous fistulas and 2 intramedullary arteriovenous malformations) underwent MR imaging and contrast enhanced phase-contrast MR angiography before and after endovascular (n?18) or surgical (n=7) treatment. In 3 patients with dural arteriovenous fistula treated with glue embolization, early post-treatment MR angiography showed persistence of flow in the perimedullary vessels. The patency of the fistula was confirmed by spinal arteriography or surgery in all three patients. In two other patients with dural arteriovenous fistulas treated with glue injection, delayed MR angiography showed flow in perimedullary vessels which was not observable in early post-treatment MR angiography controls. Reopening (“recurrence”) of the fistula was confirmed by arteriography in one patient. In the remaining 16 patients with dural arteriovenous fistula, post-treatment MR angiography showed disappearance of flow in the perimedullary vessels consistent with obliteration of the fistula. This finding was associated with persistent intramedullary signal changes and contrast enhancement in 13 patients and perimedullary contrast enhancing vessels in 6 patients. Arteriography in one of the latter patients showed exclusion of the fistula confirming the result of the posttreatment MR angiography study. In the 4 patients with high flow spinal vascular malformations, all treated with endovascular approach, early post-treatment MR angiography showed reduction or disappearance of flow in the abnormal vessels. This remained unchanged in two patients, where as increased flow in the same vessels was demonstrated by further follow-up MR angiography studies in two patients. Phase contrast MR angiography is a useful complement to MR imaging in the post-treatment evaluation of spinal vascular malformations. An early post-treatment MR-angiography control is recommended as it enables prompt identification of treatment failures and may constitute a reference term for lesion monitoring over time.

scholarly journals Extraspinal Type I Dural Arteriovenous Fistula with a Lumbosacral Lipomyelomeningocele: A Case Report and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Khaled M. Krisht ◽  
Michael Karsy ◽  
Wilson Z. Ray ◽  
Andrew T. Dailey
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Endovascular Embolization ◽  
Rapid Decline ◽  
Type I ◽  
Av Fistula ◽  
Spinal Vascular Malformations

Seven cases of adult spinal vascular malformations presenting in conjunction with spinal dysraphism have been reported in the literature. Two of these involved male patients with a combined dural arteriovenous fistula (DAVF) and lipomyelomeningocele. The authors present the third case of a patient with an extraspinal DAVF and associated lipomyelomeningocele in a lumbosacral location. A 58-year-old woman with rapid decline in bilateral motor function 10 years after a prior L4-5 laminectomy and cord detethering for diagnosed tethered cord underwent magnetic resonance imaging showing evidence of persistent cord tethering and a lipomyelomeningocele. Diagnostic spinal angiogram showed a DAVF with arterial feeders from bilateral sacral and the right internal iliac arteries. The patient underwent Onyx embolization of both feeding right and left lateral sacral arteries. At 6-month follow-up, MRI revealed decreased flow voids and new collateralized supply to the DAVF. The patient underwent successful lipomyelomeningocele exploration, resection, AV fistula ligation, and cord detethering. This report discusses management of this patient as well as the importance of endovascular embolization followed by microsurgery for the treatment of cases with combined vascular and dysraphic anomalies.

Gradual dilatation of an occluded transverse sinus associated with dural arteriovenous fistula after balloon angioplasty with sinus packing: A case report

2021 ◽  
pp. 197140092110415
Author(s):  
Takuya Osuki ◽  
Hiroyuki Ikeda ◽  
Tomoko Hayashi ◽  
Silsu Park ◽  
Minami Uezato ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Balloon Angioplasty ◽  
Dural Arteriovenous Fistula ◽  
Executive Dysfunction ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Shunt Flow ◽  
Symptomatic Epilepsy ◽  
The Right

Background There is no consensus as to whether balloon angioplasty alone or stent placement is effective for sinus occlusion associated with dural arteriovenous fistula (DAVF). Herein, we first report a case of transverse sinus occlusion associated with DAVF in which gradual sinus dilatation was observed after balloon angioplasty with embolization of the affected sinus with shunt flow. Case presentation A 69-year-old man presented with executive dysfunction. Magnetic resonance imaging revealed left transverse sinus–sigmoid sinus DAVF with occlusion of the left jugular vein and right transverse sinus. Before endovascular treatment, the patient had symptomatic epilepsy and subarachnoid hemorrhage. Retrograde leptomeningeal venous drainage disappeared with packing of the left transverse sinus–sigmoid sinus. Subsequently, balloon angioplasty of the right occluded transverse sinus was performed to maintain the normal venous drainage and remaining shunt outflow. Dilatation of the right transverse sinus was poor immediately after surgery. However, angiography after 10 days and 6 months revealed gradual dilatation of the right transverse sinus. Conclusion Sinus occlusion, which is thought to be caused by sinus hypertension associated with DAVF rather than chronic organized thrombosis or thrombophilia, may dilate over time after balloon angioplasty and shunt flow reduction if occluded sinus is necessary for facilitating normal venous drainage.

scholarly journals Spontaneous resolution of a tentorial dural arteriovenous fistula fed by the artery of Wollschlaeger and Wollschlaeger after embolization of the main shunting point

2021 ◽  
Vol 12 ◽  
pp. 413
Author(s):  
Ryota Ishibashi ◽  
Yoshinori Maki ◽  
Hiroyuki Ikeda ◽  
Masaki Chin
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vascular Lesion ◽  
Endovascular Embolization ◽  
Vascular Events ◽  
Residual Shunt ◽  
Inferior Surface ◽  
Type Iii ◽  
Meningeal Arteries ◽  
The Right

Background: Tentorial dural arteriovenous fistula (TDAVF) is a rare intracranial vascular shunt. A TDAVF can be supplied by the Artery of Wollschlaeger and Wollschlaeger (AWW). However, a limited number of cases of TDAVF fed by the AWW have been reported to date. Case Description: A 70-year-old woman complaining of the right motor weakness underwent magnetic resonance imaging. A vascular lesion beneath the cerebellar tentorium was incidentally found with chronic infarction of the left corona radiata. Angiographically, the vascular lesion was a TDAVF supplied by the bilateral posterior meningeal arteries. No other apparent feeders were detected. The TDAVF had a shunting point on the inferior surface of the cerebellar tentorium with venous retrograde flow (Borden type III, Cognard type III). To prevent vascular events, endovascular embolization was performed using n-butyl-2-cyanoacrylate. Following embolization of the shunting point, a residual shunt fed by the AWW was identified. The shunt supplied by the AWW was not observed preoperatively. Follow-up angiography performed 1 week later revealed spontaneous disappearance of the residual shunt. The patient was followed-up in our outpatient clinic, and no recurrence of the TDAVF was confirmed postoperatively. Conclusion: Detection of mild feeding from the AWW to a TDAVF can be elusive preoperatively. Following embolization of the main shunting point, residual shunting from the AWW can resolve spontaneously.

scholarly journals Progressive Myelopathy From a Craniocervical Junction Dural Arteriovenous Fistula

Stroke ◽  
2021 ◽  
Author(s):  
Ryan M. Naylor ◽  
Britney Topinka ◽  
Lorenzo Rinaldo ◽  
Jaclyn Jacobi ◽  
Bryan Neth ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Craniocervical Junction ◽  
Progressive Myelopathy

scholarly journals Dural Arteriovenous Fistula at the Anterior Condylar Confluence

2008 ◽  
Vol 14 (3) ◽  
pp. 303-312 ◽  
Author(s):  
S. Miyachi ◽  
T. Ohshima ◽  
T. Izumi ◽  
T. Kojima ◽  
J Yoshida
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Three Dimensional ◽  
Drainage Pattern ◽  
Hypoglossal Canal ◽  
Shunt Occlusion ◽  
Meningeal Arteries ◽  
Anterior Condylar Vein ◽  
Angiographic Findings

We reviewed the records of eight patients with a dural arteriovenous fistula (DAVF) close to the hypoglossal canal and determined the angioarchitecture of the clinical entity at the anterior condylar confluence. Eight patients with DAVF received endovascular treatment at our institute over the past five years. Imaging with selective three-dimensional angiography and thin-slice computed tomography were used to identify the fistula and evaluate the drainage pattern. Based on the angiographic findings, the ascending pharyngeal artery was the main feeder in all cases, and the occipital, middle meningeal, posterior auricular, and posterior meningeal arteries also supplied the DAVF to varying degrees. Contralateral contribution was found in five patients. The main drainage route was the external vertebral plexus via the lateral condylar veins in four patients, the inferior petrosal sinus in three patients, and the internal jugular vein via the connecting emissary veins in one patient. Selective angiography identified the shunt point at the anterior condylar confluence close to the anterior condylar vein. Shunt occlusion with transvenous coil packing was performed in all cases; transarterial feeder embolization was also used in three patients. Two patients treated with tight packing of the anterior condylar vein developed temporary or prolonged hypoglossal palsy. Based on our results, the main confluence of the shunt is located at the anterior condylar confluence connecting the anterior condylar vein and multiple channels leading to the extracranial venous systems. To avoid postoperative nerve palsy, the side of the anterior condylar vein in the hypoglossal canal should not be densely packed with coils. Evaluating the angioarchitecture using the selective three-dimensional angiography and tomographic imaging greatly helps to determine the target and strategy of endovascular treatment for these DAVF.

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