Analysis of spinal angiograms that missed diagnosis of spinal vascular diseases with venous hypertensive myelopathy: the non-technical factors

Abstract

Purpose

Spinal DSA is the “gold standard” technique to identify the spinal vascular diseases with venous hypertensive myelopathy (VHM). However, sometimes spinal DSA can find nothing in patients with confirmed spinal vascular anomalies. Many of the reasons are avoidable technical factors. Nevertheless, there are also some non-technical factors. The objective of this study was to identify the non-technical factors.

Methods

The cause of the missed findings was found as the non-technical factors in 14 patients. The clinical records and radiological findings of the 14 patients were reviewed.

Results

The so-called standard spinal angiography can found nothing in the 14 patients. Additional angiography was performed and detected the lesions. Eight patients were found lesions supplied by carotid arteries or iliac arteries, including 2 cranial DAVF with internal carotid artery blood supply, 3 cranial DAVF with external carotid artery blood supply and 2 pelvic AVF with internal iliac artery blood supply and 1 pelvic AVM with internal iliac artery blood supply. Six patients were caused by stenosis of spinal draining vein, including 3 stenosis of the third lumbar veins and 3 stenosis of left renal veins combined with the reno–spinal trunk.

Conclusions

In order to avoid the missed findings of spinal vascular diseases with VHM, the technical factors should be reduced by performing a rigorous comprehensive angiography. To reduce the non-technical factors, the angiography of the internal iliac artery, the carotid artery systems and spinal draining veins should be performed in some special cases if the routine spinal angiography can find nothing.

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Abbreviations

AVF:

Arteriovenous fistula;

DAVF:

Dural arteriovenous fistula;

VHM:

Venous hypertensive myelopathy

AVM:

Arteriovenous malformation

References

  1. 1.

    Hassler W, Thron A, Grote EH (1989) Hemodynamics of spinal dural arteriovenous fistulas: an intraoperative study. J Neurosurg 70:360–370

    Article  CAS  Google Scholar 

  2. 2.

    Wrobel CJ, Oldfield EH, Di Chiro G, Tarlov EC, Baker RA, Doppman JL (1988) Myelopathy due to intracranial dural arteriovenous fistulas draining intrathecally into spinal medullary veins: Report of three cases. J Neurosurg 69:934–939

    Article  CAS  Google Scholar 

  3. 3.

    Hurst RW, Kenyon LC, Lavi E, Raps EC, Marcotte P (1995) Spinal dural arteriovenous fistula: the pathology of venous hypertensive myelopathy. Neurology 45:1309–1313

    Article  CAS  Google Scholar 

  4. 4.

    Kataoka H, Miyamoto S, Nagata I et al (2001) Venous congestion is a major cause of neurological deterioration in spinal arteriovenous malformations. Neurosurgery 48:1224–1229

    PubMed  CAS  Google Scholar 

  5. 5.

    Oldfield EH, Di Chiro G, Quindlen EA, Rieth KG, Doppman JL (1983) Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula. J Neurosurg 59:1019–1030

    Article  CAS  Google Scholar 

  6. 6.

    Symon L, Kuyama H, Kendall B (1984) Dural arteriovenous malformations of the spine: clinical features and surgical results in 55 cases. J Neurosurg 60:238–247

    Article  CAS  Google Scholar 

  7. 7.

    Mirich DR, Kucharczyk W, Keller MA, Deck J (1991) Subacute necrotizing myelopathy: MR imaging in four pathologically proved cases. AJNR Am J Neuroradiol 12:1077–1083

    PubMed  CAS  Google Scholar 

  8. 8.

    Klekamp J, Samii M (1993) Introduction of a score system for the clinical evaluation of patients with spinal processes. Acta Neurochir (Wien) 123:221–223

    CAS  Google Scholar 

  9. 9.

    Aminoff MJ, Barnard RO, Logue V (1974) The pathophysiology of spinal vascular malformations. J Neural Sci 23:255–263

    Article  CAS  Google Scholar 

  10. 10.

    Jellinger K (1978) Pathology of spinal vascular malformations and vascular tumors, 1st edn. Springer, Berlin, pp 18–44

    Google Scholar 

  11. 11.

    Gillilan LA (1970) Veins of the spinal cord. anatomic details; suggested clinical applications. Neurology 20:860–868

    Article  CAS  Google Scholar 

  12. 12.

    Okada S, Chang C, Chang G, Yue JJ (2016) Venous hypertensive myelopathy associated with cervical spondylosis. Spine J 16(11):e751–e754

    Article  Google Scholar 

  13. 13.

    Krishnan C, Malik JM, Kerr DA (2004) Venous hypertensive myelopathy as a potential mimic of transverse myelitis. Spinal Cord 42(4):261–264

    Article  CAS  Google Scholar 

  14. 14.

    Auler MA, Al-Okaili R, Rumboldt Z (2005) Transient traumatic spinal venous hypertensive myelopathy. AJNR Am J Neuroradiol 26(7):1655–1658

    PubMed  Google Scholar 

  15. 15.

    Larsson EM, Desai P, Hardin CW, Story J, Jinkins JR (1991) Venous infarction of the spinal cord resulting from dural arteriovenous fistula: MR imaging findings. AJNR Am J Neuroradiol 12:739–743

    PubMed  CAS  Google Scholar 

  16. 16.

    Barreras P, Heck D, Greenberg B, Wolinsky JP, Pardo CA, Gailloud P (2017) Analysis of 30 spinal angiograms falsely reported as normal in 18 patients with subsequently documented spinal vascular malformations. AJNR Am J Neuroradiol. 38(9):1814–1819

    Article  CAS  Google Scholar 

  17. 17.

    Frantz P, Jardin A, Aboulker J, Küss R (1986) Responsibility of the left renal vein and inferior vena cava in certain cases of myelitis and syringomyelia. value of ligation of the venous reno–spinal trunk. Apropos of 30 cases. Ann Urol (Paris). 20(2):137–141

    PubMed  CAS  Google Scholar 

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No funds were received in support of this study.

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Correspondence to Lianting Ma.

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Xie, T., Pan, L., Yang, M. et al. Analysis of spinal angiograms that missed diagnosis of spinal vascular diseases with venous hypertensive myelopathy: the non-technical factors. Eur Spine J 29, 2441–2448 (2020). https://doi.org/10.1007/s00586-020-06422-7

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Keywords

  • Myelopathy
  • Venous hypertension
  • Spinal angiography
  • Spinal cord