Surgical treatment of spinal extradural arteriovenous fistula with parenchymal drainage: report on 5 cases.

Abstract:

BACKGROUND AND IMPORTANCE:Spinal extradural arteriovenous fistula (SEDAVF) with parenchymal drainage (type A) is a rare clinical entity that causes venous congestive myelopathy. Treatment includes endovascular and open microsurgical interventions. We reviewed the clinical records of patients treated for a type A SEDAVF to evaluate the feasibility of our treatment strategy. CLINICAL PRESENTATION:Between 2004 and 2010, 5 patients with a type A SEDAVF were treated at our institutes (4 men and 1 woman; mean age, 60 years). We performed endovascular transvenous embolization (TVE) when lesions were accessible transvenously; otherwise, microsurgical perimedullary drainer occlusion was performed. Follow-up ranged from 23 to 94 months (mean, 45.8 months). One patient was treated with TVE, and the remaining 4 were treated with microsurgical drainer occlusion. After a simple intradural drainer occlusion, an epidural venous lake was completely thrombosed in 2 patients. In 1 patient, postoperative angiography revealed that a part of the epidural component had persisted; however, the patient has been asymptomatic. In the remaining case with multiple intradural draining veins, sole drainer occlusion was not sufficient. A second surgery was required to meticulously coagulate the venous lake. As a consequence, parenchymal drainers disappeared. Overall, all patients stabilized or improved neurologically and experienced no recurrence. CONCLUSION:To treat a type A SEDAVF, either TVE or microsurgical intradural drainer occlusion can be used for satisfactory long-term results with minimal surgical risks. For a case with multiple intradural draining veins, detachment of the venous lake should be considered.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Niizuma K,Endo T,Sato K,Takada S,Sugawara T,Mikawa S,Tominaga T

doi

10.1227/NEU.0000000000000189

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

onsE287-3; discussion onsE293-4

issue

2 Suppl Operative

eissn

0148-396X

issn

1524-4040

journal_volume

73

pub_type

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