Advertisement

Spinal Dural Arteriovenous Fistulas: A Review

  • Joshua Marcus
  • Justin Schwarz
  • I. Paul Singh
  • Dimitri Sigounas
  • Jared Knopman
  • Y. Pierre Gobin
  • Athos Patsalides
Cardiovascular Disease and Stroke (D Leifer and JE Safdieh, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Cardiovascular Disease and Stroke

Abstract

Spinal dural arteriovenous fistulas (SDAVF) are a rare pathologic entity with a diverse and often misleading clinical presentation. While digital subtraction spinal angiography remains the gold standard, recent advances in noninvasive vascular imaging have improved the diagnosis of SDAVF. As this condition can result in permanent spinal cord injury, all patients require treatment, which consists of surgical or endovascular occlusion of the fistula. Failure to recognize and treat SDAVF in a timely fashion can result in irreversible neurologic disability, including myelopathy, lower extremity weakness and bowel, bladder and sexual dysfunction. This article reviews the clinical features, pathogenesis, radiographic features and current treatment strategies for these complex lesions.

Keywords

Spinal dural arteriorvenous fistula SDAVF Myelopathy Spinal venous hypertension Foix-allajouanine syndrome Spinal magnetic resonance angiogram Spinal angiography 

Notes

Conflicts of Interest

Joshua Marcus declares no conflicts of interest.

Justin Schwarz declares that he has no conflicts of interest.

I. Paul Singh declares that he has no conflicts of interest.

Dimitri Sigounas declares that he has no conflicts of interest.

Jared Knopman declares that he has no conflicts of interest.

Y. Pierre Gobin declares that he has no conflicts of interest.

Athos Patsalides declares that he has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Merland JJ, Richie MC, Chiras J. Intraspinal extramedullary arteriovenous fistulae drinaing into the medullary veins. J Neuroradiol. 1980;7:271–320.PubMedGoogle Scholar
  2. 2.
    Schaat TJ, Salzman KL, Stevens EA. Sacral origin of a dural arteriovenous fistula: case report and review. Spine. 2002;27:893–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Van Dijk JM, TerBrugge KG, Willinsky RA, Farb RI, Wallace MC. Multidisciplinary management of spinal dural arteriovenous fistulas: clinical presentation and long-term follow-up in 49 patients. Stroke. 2002;33(6):1578–83.PubMedCrossRefGoogle Scholar
  4. 4.
    Gobin YP, Houdart E, Casasco A, et al. Endovascular therapy for arteriovenous malformations and fistulae in the spinal cord. Semin Interv Radiol. 1993;10:227–42.CrossRefGoogle Scholar
  5. 5.
    Aminoff MJ, Logue V. The prognosis of patients with spinal vascular malformations. Brain. 1974;97:211–8.PubMedCrossRefGoogle Scholar
  6. 6.
    • Wang D, Yang N, Zhang P, Xu S, Li X, Zhao P, Huang B, Li X. The diagnosis of spinal dural arteriovenous fistulas. Spine (Phila Pa 1976). 2013 Feb 1. [Epub ahead of print] This article provides insight into radiologic signs for SDAVF and current advances in imaging techniques for diagnosis. Google Scholar
  7. 7.
    •• Kirsch M, Berg-Dammer E, Musahl C, Bazner H, Kuhne D, Henkes H. Endovascular management of spinal dural arteriovenous fistulas in 78 patients. Neuroradiology 2013 Jan 19. This article provides evidence of equal efficacy of endovascular treatment when compared to surgical treatment, a relatively recent development. Google Scholar
  8. 8.
    Aviv RI, Shad A, Tomlinson G, et al. Cervical dural arteriovenous fistulae manifesting as subarachnoid hemorrhage: report of two cases and literature review. AJNR Am J Neuroradiol. 2004;25:854–8.PubMedGoogle Scholar
  9. 9.
    Koch C, Gottschalk S, Giese A. Dural arteriovenous fistula of the lumbar spine presenting with subarachnoid hemorrhage. Case report and review of the literature. J Neurosurg. 2004;100(4 Suppl Spine):385–91.PubMedGoogle Scholar
  10. 10.
    Willinsky R, TerBrugge K, Lasjaunias P, et al. The variable presentations of craniocervical and cervical dural arteriovenous malformations. Surg Neurol. 1990;34:118–23.PubMedCrossRefGoogle Scholar
  11. 11.
    Jellema K, Tijssen CC, van Gijn J. Spinal dural arteriorvenous fistulae: clinical features and long-term results. Neurosurgery. 2008;62:159–66.CrossRefGoogle Scholar
  12. 12.
    Narvid J, Hetts SW, Larsen D, Neuhaus J, Singh TP, McSwain H, et al. Spinal dural arteriovenous fistulae: clinical features and long-term results. Neurosurgery. 2008;62(1):159–66.PubMedCrossRefGoogle Scholar
  13. 13.
    Gobin YP. Classification and endovascular treatment of spinal cord arteriovenous malformations and fistulas. J Stroke Cerebrovasc Dis. 1997;6:282–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Patsalides A, Santillan A, Knopman J, Tsiouris AJ, Riina HA, Gobin YP. Endovascular management of spinal dural arteriovenous fistulas. J NeuroIntervent Surg. 2011;3:80–4.CrossRefGoogle Scholar
  15. 15.
    Krings T. Vascular malformations of the spine and spinal cord: anatomy, classification, treatment. Klin Neuroradiol. 2010;20:5–24.CrossRefGoogle Scholar
  16. 16.
    Kai Y, Hamada J, Morioka M, et al. Arteriovenous fistulas at the cervicomedullary junction presenting with subarachnoid hemorrhage: six case reports with special reference to the angiographic pattern of venous drainage. AJNR Am J Neuroradiol. 2005;26:1949–54.PubMedGoogle Scholar
  17. 17.
    Hassler W, Thron A, Grote EH. Hemodynamics of spinal dural arteriovenous fistulas. An intraoperative study. J Neurosurg. 1989;70:360–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Hurst RW, Kenyon LC, Lavi E, et al. Spinal dural arteriovenous fistula: the pathology of venous hypertensive myelopathy. Neurology. 1995;45:1309–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Jellema K, Tijssen CC, van Gijn J. Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder. Brain. 2006;129:3150–64.PubMedCrossRefGoogle Scholar
  20. 20.
    Foix C, Alajouanine T. La myélite nécrotique subaguie. Rev Neurol. 1926;2:1–42.Google Scholar
  21. 21.
    Do HM, Jensen ME, Cloft HJ, et al. Dural arteriovenous fistula of the cervical spine presenting with subarachnoid hemorrhage. AJNR Am J Neuroradiol. 1999;20:348–50.PubMedGoogle Scholar
  22. 22.
    Fassett DR, Rammos SK, Patel P, et al. Intracranial subarachnoid hemorrhage resulting from cervical spine dural arteriovenous fistulas: literature review and case presentation. Neurosurg Focus. 2009;26:E4.PubMedCrossRefGoogle Scholar
  23. 23.
    Guo LM, Zhou HY, Xu JW, et al. Dural arteriovenous fistula at the foramen magnum presenting with subarachnoid hemorrhage: case reports and literature review. Eur J Neurol. 2010;17:684–91.PubMedCrossRefGoogle Scholar
  24. 24.
    Takahashi K, Hayashi S, Ootani T, et al. Dural arteriovenous fistula manifesting as subarachnoid hemorrhage at the craniocervical junction. A case report. No Shinkei Geka. 2008;36:901–6.PubMedGoogle Scholar
  25. 25.
    Houdart E, Gobin YP, Casasco A, et al. A proposed angiographic classification of intracranial arteriovenous fistulae and malformations. Neuroradiology. 1993;35:381–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Mascalchi M, Mangiafico S, Marin E. Hematomyelia complicating a spinal dural arteriovenous fistula. Report of a case. J Neuroradiol. 1998;25:140–3.PubMedGoogle Scholar
  27. 27.
    Gilbertson JR, Miller GM, Goldman MS, et al. Spinal dural arteriovenous fistulas: MR and myelographic findings. AJNR Am J Neuroradiol. 1995;16:2049–57.PubMedGoogle Scholar
  28. 28.
    Da Costa L, Dehdashti AR, TerBrugge KG. Spinal cord vascular shunts: spinal cord vascular malformations and dural arteriovenous fistulas. Neurosurg Focus. 2009;26(1):E6.PubMedCrossRefGoogle Scholar
  29. 29.
    • Muralidharan R, Saladino A, Lanzino G, Atkinson JL, Rabinstein AA. The clinical and radiological presentation of spinal dural arteriovenous fistula. Spine (Phila Pa 1976). 2011;36(25):E1641–7. This article provides useful and current information on post-treatment outcomes and identifies possible useful prognostic factors, including absence of sensory level and presence of exertional claudication.CrossRefGoogle Scholar
  30. 30.
    Miller TR, Eskey CJ, Mamourian AC. Absence of abnormal vessels in the subarachnoid space on conventional magnetic resonance imaging in patients with spinal dural arteriovenous fistulas. Neurosurg Focus. 2012;32(5):E15.PubMedCrossRefGoogle Scholar
  31. 31.
    Niimi Y, Berenstein A, Setton A, et al. Embolization of spinal dural arteriovenous fistulae: results and follow-up. Neurosurgery. 1997;40:675–82. discussion 682–3.PubMedCrossRefGoogle Scholar
  32. 32.
    Song JK, Gobin YP, Duckwiler GR, et al. N-butyl 2-cyanoacrylate embolization of spinal dural arteriovenous fistulae. AJNR Am J Neuroradiol. 2001;22:40–7.PubMedGoogle Scholar
  33. 33.
    Aghakhani N, Parker F, David P, et al. Curable cause of paraplegia: spinal dural arteriovenous fistulae. Stroke. 2008;39:2756–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Bowen BC, Fraser K, Kochan JP, et al. Spinal dural arteriovenous fistulas: evaluation with MR angiography. AJNR Am J Neuroradiol. 1995;16:2029–43.PubMedGoogle Scholar
  35. 35.
    Luetmer PH, Lane JI, Gilbertson JR, et al. Preangiographic evaluation of spinal dural arteriovenous fistulas with elliptic centric contrast-enhanced MR angiography and effect on radiation dose and volume of iodinated contrast material. AJNR Am J Neuroradiol. 2005;26:711–8.PubMedGoogle Scholar
  36. 36.
    Binkert CA, Kollias SS, Valavanis A. Spinal cord vascular disease: characterization with fast three-dimensional contrast-enhanced MR angiography. AJNR Am J Neuroradiol. 1999;20:1785–93.PubMedGoogle Scholar
  37. 37.
    Yamaguchi S, Nagayama T, Eguchi K, Takeda M, Arita K, Kurisu K. Accuracy and pitfalls of multidetector-row computed tomography in detecting spinal dural arteriovenous fistulas. J Neurosurg Spine. 2010;12(3):243–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Osanai T, Hida K, Asano T, et al. The Multi-detector-row CT angiography for diagnosis of spinal dural arteriovenous fistula. No Shinkei Geka. 2012;40:695–703.PubMedGoogle Scholar
  39. 39.
    Boeckh-Behrens T, Bitterling H, Schichor C, Bruckmann H, Seelos K. Improved localization of spinal AV fistulas using contrast-enhanced MR angiography at 3T. Rofo. 2010;182(1):53–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Krings T, Geibprasert S. Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2009;30:639–48.PubMedCrossRefGoogle Scholar
  41. 41.
    Krings T, Lasjaunias PL, Hans FJ, et al. Imaging in spinal vascular disease. Neuroimaging Clin N Am. 2007;17:57–72.PubMedCrossRefGoogle Scholar
  42. 42.
    Jellema K, Tijssen CC, Sluzewski M, et al. Spinal dural arteriovenous fistulas—an underdiagnosed disease. A review of patients admitted to the spinal unit of a rehabilitation center. J Neurol. 2006;253:159–62.PubMedCrossRefGoogle Scholar
  43. 43.
    Brunereau L, Gobin YP, Meder JF, et al. Intracranial dural arteriovenous fistulas with spinal venous drainage: relation between clinical presentation and angiographic findings. AJNR Am J Neuroradiol. 1996;17:1549–54.PubMedGoogle Scholar
  44. 44.
    Gobin YP, Rogopoulos A, Aymard A, et al. Endovascular treatment of intracranial dural arteriovenous fistulas with spinal perimedullary venous drainage. J Neurosurg. 1992;77:718–23.PubMedCrossRefGoogle Scholar
  45. 45.
    Patsalides A, Tzatha E, Stubgen JP, et al. Intracranial dural arteriovenous fistula presenting as an enhancing lesion of the medulla. J Neurointerv Srg. 2010;2(4):390–3.CrossRefGoogle Scholar
  46. 46.
    Cenzato M, Debernadi A, Stefini R, D’Aliberti G, Piparo M, Talamonti G, et al. Spinal dural arteriovenous fistulas: outcome and prognostic factors. Neurosurg Focus. 2012;32(5):E11.PubMedCrossRefGoogle Scholar
  47. 47.
    Ruiz-Juretschke F, Perez-Calvo JM, Castro E, Garcia-Leal R, Mateo-Sierra O, Fortea F, et al. A single-center, long-term study of spinal dural arteriovenous fistulas with multidisciplinary treatment. J Clin Neurosci. 2011;18(12):1662–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Hall WA, Oldfield EH, Doppman JL. Recanalization of spinal arteriovenous malformations following embolization. J Neurosurg. 1989;70(5):714–20.PubMedCrossRefGoogle Scholar
  49. 49.
    Andres RH, Barth A, Guzman R, Remonda L, El-Koussy M, Seiler RW, et al. Endovascular and surgical treatment of spinal dural arteriovenous fistulas. Neuroradiology. 2008;50(10):869–76.PubMedCrossRefGoogle Scholar
  50. 50.
    Steinmetz MP, Chow MM, Krishnaney AA, Andrews-Hinders D, Benzel EC, Masaryk TJ, et al. Outcome after the treatment of spinal dural arteriovenous fistulae: a contemporary single-institution series and meta-analysis. Neurosurgery. 2004;55:77–88.PubMedCrossRefGoogle Scholar
  51. 51.
    •• Wakao N, Imagama S, Ito Z, Ando K, Hirano K, Tauchi R, et al. Clinical outcome of treatments for spinal dural arteriovenous fistulas: results of multivariate analysis and review of the literature. Spine. 2012;37(6):482–8. This meta-analysis provides evidence of equal efficacy of endovascular treatment when compared to surgical treatment, a relatively recent development.PubMedCrossRefGoogle Scholar
  52. 52.
    Ropper AE, Gross BA, Du R. Surgical treatment of Type I spinal dural arteriovenous fistulas. Neurosurg Focus. 2012;32(5):E3.PubMedCrossRefGoogle Scholar
  53. 53.
    Sivakumar W, Zada G, Yashar P, Giannotta SL, Teitelbaum G, Larsen DW. Endovascular management of spinal dural arteriovenous fistulas. A review. Neurosurg Focus. 2009;26(5):E15.PubMedCrossRefGoogle Scholar
  54. 54.
    Sherif C, Gruber A, Bavinzski G, Standhardt H, Widhalm G, Gibson D, et al. Long-term outcome of a multidisciplinary concept of spinal dural arteriovenous fistulae treatment. Neuroradiology. 2008;50(1):67–74.PubMedCrossRefGoogle Scholar
  55. 55.
    Shinoyama M, Endo T, Takahash T, Shimizu H, Takahashi A, Suzuki M, et al. Long-term outcome of cervical and thoracolumbar dural arteriovenous fistulas with emphasis on sensory disturbance and neuropathic pain. World Neurosurg. 2010;73(4):401–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Kaufmann TJ, Morris JM, Saladino A, Mandrekar JN, Lanzino G. Magnetic resonance imaging findings in treated spinal dural arteriovenous fistulas: lack of correlation with clinical outcomes. J Neurosurg Spine. 2011;14(4):548–54.PubMedCrossRefGoogle Scholar
  57. 57.
    Prieto R, Pascual JM, Gutierrez R, Santos E. Recovery from paraplegia after the treatment of spinal dural arteriovenous fistula: a case report and review of the literature. Acta Neurochir (Wien). 2009;151(11):1385–97.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Joshua Marcus
    • 1
  • Justin Schwarz
    • 1
  • I. Paul Singh
    • 1
  • Dimitri Sigounas
    • 1
  • Jared Knopman
    • 1
  • Y. Pierre Gobin
    • 1
  • Athos Patsalides
    • 1
  1. 1.Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical CenterNew YorkUSA

Personalised recommendations