Spinal arteriovenous fistulae in patients with hereditary hemorrhagic telangiectasia

A case report and systematic review of the literature

Waleed Brinjikji, Deena Nasr, Harry J. Cloft, Vivek N. Iyer, Giuseppe Lanzino

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Although rare, spinal arteriovenous malformations (AVMs) are thought to be more prevalent in the hereditary Hereditary Hemorrhagic Telangiectasia (HHT) population. Methods We report a case of a spinal AVM in a 37-year-old female with HHT treated with endovascular embolization. In addition, we report findings from a systematic review of the literature on the clinical characteristics, angioarchitecture, and clinical outcomes of HHT patients with spinal AVMs. Results The patient is a 37 year-old female with definite HHT who presented with a one-year history of progressive gait difficulty. The spinal fistula was incidentally detected on chest computed tomography (CT). Spinal angiography demonstrated a large perimedullary arteriovenous fistula was supplied by a posterolateral spinal artery. The fistula was treated with detachable coils. The patient made a complete neurological recovery. Our systematic review yielded 25 additional cases of spinal AVMs in HHT patients. All fistulae were perimedullary (100.0%). Treatments were described in 24 of the 26 lesions. Endovascular-only treatment was performed in 16 cases (66.6%) and surgical-only treatment was performed in five cases (20.8%). Complete or near-complete occlusion rates were 86.7% (13/15) for endovascular treated cases, 100.0% (4/4) for surgery and 66.6% (2/3) for combined treatments. Overall, 80.0% of patients (16/20) reported improvement in function following treatment, 100.0% (5/5) in the surgery group and 84.6% (11/13) reported improvement in the endovascular group. Conclusions Spinal fistulae in HHT patients are usually type IV perimedullary fistulae. Both endovascular and surgical treatments appeared to be effective in treating these lesions. However, it is clear that endovascular therapy has become the preferred treatment modality.

Original languageEnglish (US)
Pages (from-to)354-361
Number of pages8
JournalInterventional Neuroradiology
Volume22
Issue number3
DOIs
StatePublished - 2016

Fingerprint

Hereditary Hemorrhagic Telangiectasia
Arteriovenous Fistula
Arteriovenous Malformations
Fistula
Therapeutics
Gait
Angiography
Thorax
Arteries
Tomography

Keywords

  • Hereditary hemorrhagic telangiectasia
  • spinal fistula

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Spinal arteriovenous fistulae in patients with hereditary hemorrhagic telangiectasia : A case report and systematic review of the literature. / Brinjikji, Waleed; Nasr, Deena; Cloft, Harry J.; Iyer, Vivek N.; Lanzino, Giuseppe.

In: Interventional Neuroradiology, Vol. 22, No. 3, 2016, p. 354-361.

Research output: Contribution to journalArticle

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abstract = "Background Although rare, spinal arteriovenous malformations (AVMs) are thought to be more prevalent in the hereditary Hereditary Hemorrhagic Telangiectasia (HHT) population. Methods We report a case of a spinal AVM in a 37-year-old female with HHT treated with endovascular embolization. In addition, we report findings from a systematic review of the literature on the clinical characteristics, angioarchitecture, and clinical outcomes of HHT patients with spinal AVMs. Results The patient is a 37 year-old female with definite HHT who presented with a one-year history of progressive gait difficulty. The spinal fistula was incidentally detected on chest computed tomography (CT). Spinal angiography demonstrated a large perimedullary arteriovenous fistula was supplied by a posterolateral spinal artery. The fistula was treated with detachable coils. The patient made a complete neurological recovery. Our systematic review yielded 25 additional cases of spinal AVMs in HHT patients. All fistulae were perimedullary (100.0{\%}). Treatments were described in 24 of the 26 lesions. Endovascular-only treatment was performed in 16 cases (66.6{\%}) and surgical-only treatment was performed in five cases (20.8{\%}). Complete or near-complete occlusion rates were 86.7{\%} (13/15) for endovascular treated cases, 100.0{\%} (4/4) for surgery and 66.6{\%} (2/3) for combined treatments. Overall, 80.0{\%} of patients (16/20) reported improvement in function following treatment, 100.0{\%} (5/5) in the surgery group and 84.6{\%} (11/13) reported improvement in the endovascular group. Conclusions Spinal fistulae in HHT patients are usually type IV perimedullary fistulae. Both endovascular and surgical treatments appeared to be effective in treating these lesions. However, it is clear that endovascular therapy has become the preferred treatment modality.",
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