Spinal extradural arteriovenous malformations with parenchymal drainage: venous drainage variability and implications in clinical manifestations
- 1 January 2009
- journal article
- clinical trial
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Neurosurgical Focus
- Vol. 26 (1), E5
- https://doi.org/10.3171/foc.2009.26.1.e5
Abstract
Although nontraumatic spinal arteriovenous malformations and fistulas (AVMs and AVFs) restricted to the epidural space are rare, they can lead to significant neurological morbidity. Careful diagnostic imaging is essential to their detection and the delineation of the pathological anatomy. Aggressive endovascular and open operative treatment can provide arrest and reversal of neurological deficits. The authors report on 6 cases of extradural AVMs/AVFs causing progressive myelopathy. Clinical findings, diagnostic evaluation, treatment, and outcome are discussed. Special consideration is given to the anatomy of the lesions and the operative techniques used to treat them. A review of the literature concerning extradural vascular malformations is also presented. All 6 cases of extradural AVMs had an extradural fistulous location with intradural medullary venous drainage. These cases illustrate progressive myelopathy through cord venous congestion (hypertension) that can be caused by an extradural nidus or fistula. In 4 cases, a large epidural lake was identified on angiography. At surgery, the epidural lake was obliterated and medullary drainage interrupted. All patients had stabilization of their neurological deficits and successful obliteration of the AVM/AVF was obtained. Extradural AVMs and AVFs are a poorly described entity with published clinical experience limited to sporadic case reports and small series. Although these lesions have a purely extradural location of arteriovenous shunting and early venous drainage, they can be responsible for acute and progressive neurological symptoms similar to those caused by their dural-based intradural counterparts. With careful imaging recognition of the pathological anatomy, surgical and endovascular techniques can be used for the treatment of extradural AVMs affording effective and durable obliteration with stabilization or reversal of neurological symptoms. Venous drainage directly correlates the pathologic mechanisms of presentation. Specific attention must be paid intraoperatively to the epidural lake common to both variants so that recurrence is avoided.Keywords
This publication has 9 references indexed in Scilit:
- Modified classification of spinal cord vascular lesionsJournal of Neurosurgery: Spine, 2002
- Spinal epidural vascular malformation presenting in association with a spontaneously resolved acute epidural hematomaJournal of Neurosurgery, 1998
- Neurologic manifestations of spinal epidural arteriovenous malformationsNeurology, 1998
- Spinal epidural arteriovenous fistula with intramedullary refluxJournal of Neurosurgery, 1997
- Cervical Epidural Hematoma Secondary to an Extradural Vascular Malformation in an InfantNeurosurgery, 1995
- Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulasJournal of Neurosurgery, 1995
- Epidural arteriovenous fistula with perimedullary venous drainage: case reportNeuroradiology, 1994
- Spinal extradural arteriovenous malformation presenting with recurrent hemorrhage and intermittent paraplegia: case report and review of the literatureSurgical Neurology, 1994
- Cervical Epidural Arteriovenous Malformation Occurring with a Spinal NeurofibromaJournal of Neurosurgery, 1967