Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas

Deena Nasr, Waleed Brinjikji, Michelle J. Clarke, Giuseppe Lanzino

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVE: Spinal epidural arteriovenous fistulas (SEDAVFs) constitute a rare but treatable cause of vascular myelopathy and are a different subtype from the more common Type I spinal dural AVFs. The purpose of this study was to review a consecutive series of SEDAVFs from a single institution and report on the clinical presentations, functional status, and treatment outcomes. METHODS: The authors identified all SEDAVFs treated at their institution from 2005 to 2015. SEDAVFs were defined as spinal AVFs in which the fistulous connection occurred in the epidural venous plexus. The clinical presentation, functional status, immediate treatment outcomes, and long-term neurological outcomes were analyzed. RESULTS: Twenty-four patients with SEDAVFs were included in this study. The patients' mean age at presentation was 66.9 years. The most common presenting symptoms were pain and numbness (22 patients, 91.7%), followed by lowerextremity weakness (21 patients, 87.5%). The mean duration of symptoms prior to diagnosis was 11.8 months. Eighteen patients (75.0%) were treated with endovascular therapy alone, 4 (16.7) with surgery, and 2 (8.3%) with a combination of techniques. There was 1 major treatment-related complication (4.2%). Fifteen patients (62.5%) had improvement in disability, and 12 patients (54.5%) had improvement in sensory symptoms. CONCLUSIONS: SEDAVFs often present with lower-extremity motor dysfunction and sensory symptoms. With the availability of newer liquid embolic agents, these lesions can be effectively treated with endovascular techniques. Surgery is also effective at treating these lesions, especially in situations where endovascular embolization fails or is not safe and in patients presenting with mass effect from compressive varices.

Original languageEnglish (US)
Pages (from-to)613-620
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume26
Issue number5
DOIs
StatePublished - May 1 2017

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Arteriovenous Fistula
Endovascular Procedures
Hypesthesia
Spinal Cord Diseases
Varicose Veins
Blood Vessels
Lower Extremity
Pain
Therapeutics

Keywords

  • Embolization
  • Spinal vascular malformation
  • Vascular disorders

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas. / Nasr, Deena; Brinjikji, Waleed; Clarke, Michelle J.; Lanzino, Giuseppe.

In: Journal of Neurosurgery: Spine, Vol. 26, No. 5, 01.05.2017, p. 613-620.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: Spinal epidural arteriovenous fistulas (SEDAVFs) constitute a rare but treatable cause of vascular myelopathy and are a different subtype from the more common Type I spinal dural AVFs. The purpose of this study was to review a consecutive series of SEDAVFs from a single institution and report on the clinical presentations, functional status, and treatment outcomes. METHODS: The authors identified all SEDAVFs treated at their institution from 2005 to 2015. SEDAVFs were defined as spinal AVFs in which the fistulous connection occurred in the epidural venous plexus. The clinical presentation, functional status, immediate treatment outcomes, and long-term neurological outcomes were analyzed. RESULTS: Twenty-four patients with SEDAVFs were included in this study. The patients' mean age at presentation was 66.9 years. The most common presenting symptoms were pain and numbness (22 patients, 91.7{\%}), followed by lowerextremity weakness (21 patients, 87.5{\%}). The mean duration of symptoms prior to diagnosis was 11.8 months. Eighteen patients (75.0{\%}) were treated with endovascular therapy alone, 4 (16.7) with surgery, and 2 (8.3{\%}) with a combination of techniques. There was 1 major treatment-related complication (4.2{\%}). Fifteen patients (62.5{\%}) had improvement in disability, and 12 patients (54.5{\%}) had improvement in sensory symptoms. CONCLUSIONS: SEDAVFs often present with lower-extremity motor dysfunction and sensory symptoms. With the availability of newer liquid embolic agents, these lesions can be effectively treated with endovascular techniques. Surgery is also effective at treating these lesions, especially in situations where endovascular embolization fails or is not safe and in patients presenting with mass effect from compressive varices.",
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