Spinal dural arteriovenous fistula (SDAVF) variant with dual perimedullary and epidural drainage

Case Report

Abstract

Purpose

A spinal dural arteriovenous fistula (SDAVF) is an abnormal connection between a radiculomeningeal artery and a radiculomedullary vein (RMV) characteristically draining into the perimedullary venous system. We present an observation of SDAVF draining simultaneously into the perimedullary and epidural venous systems.

Methods

A 67-year-old man presented with lower extremity weakness and sphincter dysfunction. MRI documented a longitudinally extensive myelopathy with parenchymal enhancement and flow-voids on T2-weighted images. Spinal angiography revealed the presence of two SDAVFs, at left T9 and right L1.

Results

The right L1 SDAVF was treated endovascularly. Superselective angiography of the main feeder, a right T12 radiculomeningeal branch, documented an unusual drainage pattern, with contrast flowing both retrogradely towards the perimedullary venous system and antegradely into the epidural plexus. The meningeal branch was embolized using a liquid embolic agent with adequate penetration of the embolic material into the proximal segment of the draining vein. The left T9 SDAVF was surgically resected, as the radicular artery supplying the fistula also provided the artery of Adamkiewicz.

Conclusions

Dual drainage of the right L1 SDAVF into the perimedullary and epidural venous systems allowed to locate the site of the arteriovenous shunt at the point of transdural passage of the RMV, a narrowed segment also known to represent an anti-reflux mechanism. The potential role played by the topographical relationship between the shunt and the anti-reflux mechanism of the RMV in the formation and clinical expression of SDAVFs is discussed.

Keywords

Spinal vascular malformation Spinal angiography Spinal venous thrombosis Etiology 

References

  1. 1.
    Aminoff MJ, Barnard RO, Logue V (1974) The pathophysiology of spinal vascular malformations. J Neurol Sci 23:255–263CrossRefPubMedGoogle Scholar
  2. 2.
    Aminoff MJ, Logue V (1974) Clinical features of spinal vascular malformations. Brain J Neurol 97:197–210CrossRefGoogle Scholar
  3. 3.
    Benhaiem N, Poirier J, Hurth M (1983) Arteriovenous fistulae of the meninges draining into the spinal veins. A histological study of 28 cases. Acta Neuropathol 62:103–111CrossRefPubMedGoogle Scholar
  4. 4.
    Chaudhary MY, Sachdev VP, Cho SH, Weitzner I Jr, Puljic S, Huang YP (1982) Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR Am J Neuroradiol 3:13–19PubMedGoogle Scholar
  5. 5.
    Gailloud P (2014) The arrow-tipped loop is a marker of radiculomedullary vein thrombosis linked to the anti-reflux mechanism-angiographic anatomy and clinical implications. Neuroradiology 56:859–864CrossRefPubMedGoogle Scholar
  6. 6.
    Kendall BE, Logue V (1977) Spinal epidural angiomatous malformations draining into intrathecal veins. Neuroradiology 13:181–189CrossRefPubMedGoogle Scholar
  7. 7.
    Kohno M, Takahashi H, Ide K, Ishijima B, Yamada K, Nemoto S (1996) A cervical dural arteriovenous fistula in a patient presenting with radiculopathy. Case report. J Neurosurg 84:119–123CrossRefPubMedGoogle Scholar
  8. 8.
    Logue V (1979) Angiomas of the spinal cord: review of the pathogenesis, clinical features, and results of surgery. J Neurol Neurosurg Psychiatry 42:1–11CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    McCutcheon IE, Doppman JL, Oldfield EH (1996) Microvascular anatomy of dural arteriovenous abnormalities of the spine: a microangiographic study. J Neurosurg 84:215–220CrossRefPubMedGoogle Scholar
  10. 10.
    Merland JJ, Riche MC, Chiras J (1980) Intraspinal extramedullary arteriovenous fistulae draining into the medullary veins. J Neuroradiol 7:271–320PubMedGoogle Scholar
  11. 11.
    Tadié M, Hemet J, Aaron C, Bianco C, Creissard P, Huard P (1979) Le dispositif protecteur anti-reflux des veines de la moelle. Neurochirurgie 25:28–30Google Scholar
  12. 12.
    Tadié M, Hemet J, Aaron C, Bianco C, Huard P (1978) Les veines radiculaires de drainage de la moelle ont-elles un dispositif de sécurité anti-reflux? Bull l’Acad Natl Méd 162:550–554Google Scholar
  13. 13.
    Tadié M, Hemet J, Freger P, Clavier E, Creissard P (1985) Morphological and functional anatomy of spinal cord veins. J Neuroradiol 12:3–20PubMedGoogle Scholar
  14. 14.
    van der Kuip M, Hoogland PV, Groen RJ (1999) Human radicular veins: regulation of venous reflux in the absence of valves. Anat Rec 254:173–180CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Division of Interventional NeuroradiologyThe Johns Hopkins HospitalBaltimoreUSA

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