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Hashikata H, Goto M, Maki Y, Nishida N, Ando M, Ishibashi R, Toda H, Iwasaki K. Intramedullary feeder aneurysm of a cervical epidural arteriovenous fistula causing myelopathy: a case report and literature review. Acta Neurochir (Wien) 2023; 165:3985-3990. [PMID: 37059919 DOI: 10.1007/s00701-023-05578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/31/2023] [Indexed: 04/16/2023]
Abstract
While a craniocervical junction (CCJ) epidural arteriovenous fistula (EDAVF) may present with hemorrhagic myelopathy from an associated feeder aneurysm on rare occasions, non-hemorrhagic myelopathy from such an aneurysm remains unreported. A woman in her late sixties presented with cervical myelopathy due to a non-hemorrhagic intramedullary aneurysm associated with CCJ-EDAVF. The intramedullary aneurysm originated from the spinal pial artery supplied by the anterior spinal artery. Direct surgical fistula coagulation and feeder obliteration resulted in the disappearance of the aneurysm and myelopathy improvement. This report illustrates the first case of a non-hemorrhagic intramedullary aneurysm associated with CCJ-EDAVF successfully treated with direct surgery.
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Affiliation(s)
- Hirokuni Hashikata
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, 2-4-20 Ogimachi Kita, Osaka, 530-8480, Japan.
| | - Masanori Goto
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, 2-4-20 Ogimachi Kita, Osaka, 530-8480, Japan
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minami, Chuo, Kobe, Hyogo, 650-0047, Japan
| | - Yoshinori Maki
- Department of Neurosurgery, Hikone Chuo Hospital, 421 Nishiima, Hikone, Shiga, 522-0054, Japan
- Department of Rehabilitation, Hikari Hospital, 3-35-1 Saikawa, Otsu, Shiga, 520-0002, Japan
| | - Namiko Nishida
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, 2-4-20 Ogimachi Kita, Osaka, 530-8480, Japan
| | - Mitsushige Ando
- Department of Neurosurgery, Shiga General Hospital, 5-4-30 Moriyama, Shiga, 524-8524, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, 2-4-20 Ogimachi Kita, Osaka, 530-8480, Japan
| | - Hiroki Toda
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, 2-4-20 Ogimachi Kita, Osaka, 530-8480, Japan
| | - Koichi Iwasaki
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, 2-4-20 Ogimachi Kita, Osaka, 530-8480, Japan
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Su H, Yu J. Treatment of high cervical arteriovenous fistulas in the craniocervical junction region. Front Neurol 2023; 14:1164548. [PMID: 37441609 PMCID: PMC10335834 DOI: 10.3389/fneur.2023.1164548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
The craniocervical junction (CCJ) is a complex region. Rarely, arteriovenous fistulas (AVFs) can occur in the CCJ region. Currently, it is accepted that CCJ AVFs should only refer to AVFs at the C1-C2 levels. It is reasonable to assume that high cervical CCJ AVFs are being referred to when discussing CCJ AVFs. High cervical CCJ AVFs can be divided into the following four types: dural AVF, radicular AVF, epidural AVF and perimedullary AVF. Until now, it was difficult to understand high cervical CCJ AVFs and provide a proper treatment for them. Therefore, an updated review of high cervical CCJ AVFs is necessary. In this review, the following issues are discussed: the definition of high cervical CCJ AVFs, vessel anatomy of the CCJ region, angioarchitecture of high cervical CCJ AVFs, treatment options, prognoses and complications. Based on the review and our experience, we found that the four types of high cervical CCJ AVFs share similar clinical and imaging characteristics. Patients may present with intracranial hemorrhage or congestive myelopathy. Treatment, including open surgery and endovascular treatment (EVT), can be used for symptomatic AVFs. Most high cervical CCJ AVFs can be effectively treated with open surgery. EVT remains challenging due to a high rate of incomplete obliteration and complications, and it can only be performed in superselective AVFs with simple angioarchitecture. Appropriate treatment can lead to a good prognosis.
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3
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Mohammad Hosseini E, Rasekhi A, Vahdat N, Eghbal K, Jamali M, Rahmanian A, Sourani A, Foroughi M, Baradaran Mahdavi S. Dorsal intradural spinal arteriovenous fistula associated with giant intradural spinal aneurysm, a case report. Clin Case Rep 2023; 11:e7202. [PMID: 37064730 PMCID: PMC10099199 DOI: 10.1002/ccr3.7202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023] Open
Abstract
Arteriovenous fistula and spinal aneurysms like other vascular malformations can mimic radiculopathy and low back pain. Precise imaging work combined with a hybrid endovascular-microsurgical approach is the key element for the best clinical outcome.
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Affiliation(s)
| | - Alireza Rasekhi
- Department of RadiologyShiraz University of Medical SciencesShirazIran
| | - Noushin Vahdat
- Department of RadiologyUniversity of California San Diego (USCD) HealthCaliforniaSan DiegoUSA
- Department of RadiologyVeteran Administration Healthcare SystemSan DiegoCaliforniaUSA
| | - Keyvan Eghbal
- Neurosurgery DepartmentShiraz University of Medical SciencesShirazIran
| | - Mohammad Jamali
- Neurosurgery DepartmentShiraz University of Medical SciencesShirazIran
| | | | - Arman Sourani
- Department of NeurosurgeryIsfahan University of Medical SciencesIsfahanIran
| | - Mina Foroughi
- Student Research CommitteeIsfahan University of Medical SciencesIsfahanIran
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‐Communicable DiseaseIsfahan University of Medical SciencesIsfahanIran
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4
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Mizutani K, Akiyama T, Tomita H, Toda M. Role of endovascular treatment for ruptured aneurysms involving the anterior spinal artery at the craniocervical junction. J Neuroradiol 2023; 50:44-49. [PMID: 35490734 DOI: 10.1016/j.neurad.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 01/31/2023]
Abstract
Ruptured aneurysms at the craniocervical junction (CCJ) involving the anterior spinal artery (ASA) are rare and consist of heterogenous lesions with variable clinical entities. However, the standard therapeutic strategy for the lesions has not been well-established. Moreover, despite advances in modern neurointervention, reports describing endovascular treatment for this specific lesion have been few. Here, we report three cases of ruptured aneurysms on the pial tributary of the ASA at the CCJ, which were subsequently treated by transarterial glue injection or coil embolization. Endovascular treatment can be a therapeutic option, particularly for these ruptured aneurysms. Either transarterial glue injection or coil embolization can be effective depending on the type of etiology and the surrounding vasculature anatomy.
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Affiliation(s)
- Katsuhiro Mizutani
- Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan; Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga, Japan.
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan
| | - Hideyuki Tomita
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan
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Takai K, Endo T, Seki T, Inoue T, Koyanagi I, Mitsuhara T. Neurosurgical versus endovascular treatment of craniocervical junction arteriovenous fistulas: a multicenter cohort study of 97 patients. J Neurosurg 2022; 137:373-380. [PMID: 34972078 DOI: 10.3171/2021.10.jns212205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Craniocervical junction (CCJ) arteriovenous fistulas (AVFs) are treated using neurosurgical or endovascular options; however, there is still no consensus on the safest and most effective treatment. The present study compared the treatment results of neurosurgical and endovascular procedures for CCJ AVFs, specifically regarding retreatment, complications, and outcomes. METHODS This was a multicenter cohort study authorized by the Neurospinal Society of Japan. Data on consecutive patients with CCJ AVFs who underwent neurosurgical or endovascular treatment between 2009 and 2019 at 29 centers were analyzed. The primary endpoint was the retreatment rate by procedure. Secondary endpoints were the overall complication rate, the ischemic complication rate, the mortality rate, posttreatment changes in the neurological status, independent risk factors for retreatment, and poor outcomes. RESULTS Ninety-seven patients underwent neurosurgical (78 patients) or endovascular (19 patients) treatment. Retreatment rates were 2.6% (2/78 patients) in the neurosurgery group and 63% (12/19 patients) in the endovascular group (p < 0.001). Overall complication rates were 22% and 42% in the neurosurgery and endovascular groups, respectively (p = 0.084). Ischemic complication rates were 7.7% and 26% in the neurosurgery and endovascular groups, respectively (p = 0.037). Ischemic complications included 8 spinal infarctions, 2 brainstem infarctions, and 1 cerebellar infarction, which resulted in permanent neurological deficits. Mortality rates were 2.6% and 0% in the neurosurgery and endovascular groups, respectively (p > 0.99). Two patients died of systemic complications. The percentages of patients with improved modified Rankin Scale (mRS) scores were 60% and 37% in the neurosurgery and endovascular groups, respectively, with a median follow-up of 23 months (p = 0.043). Multivariate analysis identified endovascular treatment as an independent risk factor associated with retreatment (OR 54, 95% CI 9.9-300; p < 0.001). Independent risk factors associated with poor outcomes (a postoperative mRS score of 3 or greater) were a pretreatment mRS score of 3 or greater (OR 13, 95% CI 2.7-62; p = 0.001) and complications (OR 5.8; 95% CI 1.3-26; p = 0.020). CONCLUSIONS Neurosurgical treatment was more effective and safer than endovascular treatment for patients with CCJ AVFs because of lower retreatment and ischemic complication rates and better outcomes.
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Affiliation(s)
- Keisuke Takai
- 1Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Toshiki Endo
- 2Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan
- 3Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Toshitaka Seki
- 4Department of Neurosurgery, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Tomoo Inoue
- 2Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan
- 3Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Izumi Koyanagi
- 5Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Hokkaido, Japan; and
| | - Takafumi Mitsuhara
- 6Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Japan
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Okazaki T, Ohara Y, Matsuoka H, Shimoji K, Kogure K, Kikuchi N, Kimura T, Nakajima S, Tani S, Mizuno J, Arai H, Oishi H. Cervical Extradural Arteriovenous Fistula without Intradural Drainage Successfully Treated with Endovascular Treatment Using Both Transvenous and Transarterial Approach: Case Report and Review of Literatures. NMC Case Rep J 2022; 8:335-342. [PMID: 35079485 PMCID: PMC8769398 DOI: 10.2176/nmccrj.cr.2020-0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/21/2020] [Indexed: 11/20/2022] Open
Abstract
The classification of spinal extradural arteriovenous fistulas (AVFs) was reported based on a case series treated by microsurgery in 2009 and endovascular interventions in 2011. The present report describes a patient with extradural AVFs at the cervical spine manifesting gradual progressive radiculomyelopathy of bilateral upper extremities. Magnetic resonance imaging (MRI) revealed a mass sign from C1 to C4 at the right ventral side and the spinal cord was deviated to the left and indicated as a flow void sign. Diagnostic angiography revealed an extradural AVFs located at the C1-C4 level that was supplied by bilateral radicular artery from the vertebral artery (VA) and right ascending cervical artery (ACA). The shunting points were recognized multiply at C2/3 and C3/4 levels on the right. The transvenous embolization to the enlarged extradural venous plexus around the shunting points via right hypoglossal canal and the transarterial embolization against multi-feeders of the branch of left radicular artery, right ACA achieved complete occlusion of the lesions. His symptom was gradually recovered, and angiography performed 2 weeks after embolization showed no recurrence. When the arteriovenous shunts in the upper cervical spine were high flow shunts, transvenous approach via the hypoglossal canal might be one option for the treatment of spinal extradural AVFs.
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Affiliation(s)
- Toshiyuki Okazaki
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Yukoh Ohara
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan.,Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hidenori Matsuoka
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazunari Kogure
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Nahoko Kikuchi
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Takaoki Kimura
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Shintaro Nakajima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Tani
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Junichi Mizuno
- Center for Minimally Invasive Spinal Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hidenori Oishi
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
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Zhang K, Li C, Hou K, Yu J. Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend? Front Neurol 2021; 12:761006. [PMID: 34764934 PMCID: PMC8576071 DOI: 10.3389/fneur.2021.761006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
The cervical anterior spinal artery (ASA) is a very important artery arising from the intracranial vertebral artery (VA). It can play different roles in endovascular treatment (EVT) of spinal vascular diseases. The current understanding of these roles is incomplete; therefore, we performed this review. We found that cervical ASA can be involved in many spinal vascular diseases, such as arteriovenous fistula (AVF), arteriovenous malformation (AVM), and aneurysm, and can serve as a collateral channel in proximal VA occlusion. In AVF and AVM, when the cervical ASA is involved, it often plays the role of an accomplice or victim because it acts as the feeder or as a bystander that does not provide blood flow to the AVF and AVM. In cervical ASA aneurysm, the ASA is a victim. During EVT of VA aneurysms or stenoses, the cervical ASA ostia can be covered or occluded, resulting in ASA ischemia. In this situation, the ASA is a victim. In VA occlusion or the subclavian steal phenomenon, the cervical ASA can serve as a collateral channel to provide blood flow to the posterior circulation. In this case, the ASA plays the role of a friend. According to the role of the cervical ASA in spinal vascular diseases, EVT should be determined “case by case.” Most importantly, when EVT is performed to treat these diseases, the cervical ASA axis must be preserved. Therefore, understanding the role of the cervical ASA in spinal vascular diseases is crucial.
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Affiliation(s)
- Kun Zhang
- Department of Cerebrovascular Disease, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Chao Li
- Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Kun Hou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Shima S, Sato S, Motizuki T, Niimi Y. Endovascular treatment for ruptured cervical anterior spinal artery aneurysm caused by occlusive disease of bilateral vertebral arteries: A case report and literature review. Clin Neurol Neurosurg 2021; 208:106862. [PMID: 34391976 DOI: 10.1016/j.clineuro.2021.106862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
A cervical anterior spinal artery (ASA) aneurysm not concomitant with vascular malformations is extremely rare, and is treated by conservative management or direct surgery in most cases. The endovascular treatment approach for these lesions is not well-documented. We present a case of a ruptured flow-related cervical ASA aneurysm due to the occlusive disease of the bilateral vertebral arteries (VA) treated by endovascular therapy. A 77-year-old woman with acute onset of headache and right hemiparesis was transferred to our hospital. Computed tomography revealed subarachnoid hemorrhage thick in the posterior fossa. A cerebral angiogram showed tandem stenosis of the left VA and the occlusion of the right VA at the V4 segment, with an enlarged C4 radiculomedullary artery and a subsequent aneurysm on the ASA. VA angiography revealed retrograde flow through the lesion and ASA axis to posterior circulation, suggesting a flow-related etiology of the aneurysm. We embolized the aneurysm using a flow-directed microcatheter and coils, preserving the ASA axis. Then, we dilated the VA stenosis using stents to prevent aneurysm recurrence by reducing hemodynamic stress on the ASA.
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Affiliation(s)
- Shogo Shima
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan; Department of Neuroendovascular therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan.
| | - Shinsuke Sato
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan; Department of Neuroendovascular therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
| | - Tatsuki Motizuki
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
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Intramedullary Hemorrhage Caused by Lumbosacral Epidural Arteriovenous Fistula with Dual Retrograde Perimedullary Venous Draining Routes: A Case Report and Review of the Literature. World Neurosurg 2020; 143:295-307. [DOI: 10.1016/j.wneu.2020.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 11/20/2022]
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10
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Park JS, Kwon MY, Lee CY. Cervical spinal extradural arteriovenous fistula successfully treated using transarterial balloon-assisted coil embolization. J Cerebrovasc Endovasc Neurosurg 2020; 22:182-189. [PMID: 32971577 PMCID: PMC7522392 DOI: 10.7461/jcen.2020.22.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
We present the case of a patient who developed compressive radiculopathy that was found to be associated with a spinal extradural arteriovenous fistula. The fistula was successfully obliterated with transarteiral balloon-assisted coiling, after which the patient was symptom-free. Although spinal extradural arteriovenous fistula is rare, this pathology should be considered in the differential diagnosis of spinal radiculopathy or myelopathy. Endovascular treatment appears to have been successful in resolving the symptoms associated with this pathology.
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Affiliation(s)
- Jung-Sik Park
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Min-Yong Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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11
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Ruptured Isolated Aneurysm of a Coronal Branch of the Anterior Spinal Artery: Case Report and Discussion of Treatment Strategies. World Neurosurg 2020; 145:119-126. [PMID: 32949802 DOI: 10.1016/j.wneu.2020.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Isolated spinal artery aneurysms are an extremely rare cause of subarachnoid hemorrhage. A limited number of case reports and case series have been reported in the literature. Treatment options include conservative management, surgical clipping/trapping, and endovascular procedures. Owing to the uncertain natural history of these lesions, there is no consensus about the optimal treatment. CASE DESCRIPTION A 64-year-old man presented with subarachnoid hemorrhage from a ruptured anterior spinal artery aneurysm at the C1 level. Following initial conservative management, surgical treatment was proposed owing to an increase in lesion size at angiographic follow-up. A partially thrombosed aneurysm was found during surgery, suggesting that spontaneous resolution of the aneurysm was occurring. Despite initial worsening of neurological symptoms, the patient gradually recovered after rehabilitation. CONCLUSIONS Treatment decisions for spinal aneurysms should be made on a case-by-case basis, the goal being to offer the patient the best option, while avoiding exposure to unnecessary invasive procedures. As spontaneous resolution of a spinal artery aneurysm is unpredictable, our case highlights the importance of performing a perioperative vascular study if surgery is planned.
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12
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Yoshida K, Sato S, Inoue T, Ryu B, Shima S, Mochizuki T, Kuwamoto K, Okada Y, Niimi Y. Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm. Interv Neuroradiol 2020; 26:170-177. [PMID: 31488023 PMCID: PMC7507230 DOI: 10.1177/1591019919874571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/09/2019] [Indexed: 11/16/2022] Open
Abstract
Arteriovenous fistulas at the craniocervical junction are rare vascular malformations with frequent hemorrhagic presentations, which may have a concurrent pial feeder aneurysm. A 65-year-old man presented with subarachnoid hemorrhage and angiography showed an epidural arteriovenous fistula at the C-2 level with an anterior spinal feeder aneurysm without perimedullary venous drainage. Transarterial coil embolization of the ruptured aneurysm and partial Onyx embolization of the shunt led to thrombosis of the aneurysm. However, three years later angiography showed an increased shunt flow and recurrence of the aneurysm. Transvenous embolization of the shunt using coils and Onyx yielded complete obliteration of the shunt, thus leading to occlusion of the aneurysm. This case demonstrates that partial transarterial embolization of arteriovenous fistula leaves a risk of rebleeding, whereas complete obliteration of the shunt with a transvenous approach can lead to disappearance of the flow-related aneurysm without embolization of the aneurysm itself.
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Affiliation(s)
- Keisuke Yoshida
- Department of Neuroendovascular Therapy, St. Lukes International Hospital, Tokyo, Japan
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Sato
- Department of Neuroendovascular Therapy, St. Lukes International Hospital, Tokyo, Japan
- Department of Neurosurgery, St. Lukes International Hospital, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St. Lukes International Hospital, Tokyo, Japan
| | - Bikei Ryu
- Department of Neuroendovascular Therapy, St. Lukes International Hospital, Tokyo, Japan
- Department of Neurosurgery, St. Lukes International Hospital, Tokyo, Japan
| | - Shogo Shima
- Department of Neurosurgery, St. Lukes International Hospital, Tokyo, Japan
| | - Tatsuki Mochizuki
- Department of Neurosurgery, St. Lukes International Hospital, Tokyo, Japan
| | - Kentaro Kuwamoto
- Department of Neurosurgery, St. Lukes International Hospital, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, St. Lukes International Hospital, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Lukes International Hospital, Tokyo, Japan
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13
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Mansour A, Endo T, Inoue T, Sato K, Endo H, Fujimura M, Tominaga T. Clipping of an anterior spinal artery aneurysm using an endoscopic fluorescence imaging system for craniocervical junction epidural arteriovenous fistula: technical note. J Neurosurg Spine 2019; 31:279-284. [PMID: 31026820 DOI: 10.3171/2019.1.spine18983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/29/2019] [Indexed: 01/12/2023]
Abstract
The authors report the case of a 78-year-old man with a craniocervical junction epidural arteriovenous fistula who presented with subarachnoid hemorrhage from a ruptured anterior spinal artery (ASA) aneurysm. Because endovascular embolization was difficult, a posterolateral approach was chosen and a novel endoscopic fluorescence imaging system was utilized to clip the aneurysm. The fluorescence imaging system provided clear and magnified views of the ventral spinal cord simultaneously with the endoscope-integrated indocyanine green videoangiography, which helped safely obliterate the ASA aneurysm. With the aid of this novel imaging system, surgeons can appreciate and manipulate complex vascular pathologies of the ventral spinal cord through a posterolateral approach, even when the lesion is closely related to the ASA.
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Affiliation(s)
- Ahmed Mansour
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine
- 4Department of Neurosurgery, Menoufia University Graduate School of Medicine, Menoufia, Egypt
| | - Toshiki Endo
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine
- 2Department of Neurosurgery, Kohnan Hospital
| | - Tomoo Inoue
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | - Kenichi Sato
- 3Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan; and
| | - Hidenori Endo
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | | | - Teiji Tominaga
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine
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Donauer E, Aguilar Pérez M, Jangid N, Tomandl B, Ganslandt O, Henkes H. Spontaneous Cervical Intramedullary and Subarachnoid Hemorrhage due to a Sulco-Commissural Artery Aneurysm. Clin Neuroradiol 2019; 29:777-781. [PMID: 30874845 PMCID: PMC6884427 DOI: 10.1007/s00062-019-00772-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/26/2019] [Indexed: 12/28/2022]
Affiliation(s)
- E Donauer
- Klinik für Neurochirurgie und Frührehabilitation, MediClin Krankenhaus Plau am See, Quetziner Str. 88, 19395, Plau am See, Germany
| | - M Aguilar Pérez
- Neuroradiologische Klinik, Kopf- und Neurozentrum, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - N Jangid
- Klinik für Neurochirurgie und Frührehabilitation, MediClin Krankenhaus Plau am See, Quetziner Str. 88, 19395, Plau am See, Germany
| | - B Tomandl
- Klinik für Radiologie und Neuroradiologie, Klinikum Christophsbad, Faurndauer Straße 6-28, 73035, Göppingen, Germany
| | - O Ganslandt
- Neurochirurgische Klinik, Kopf- und Neurozentrum, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - H Henkes
- Neuroradiologische Klinik, Kopf- und Neurozentrum, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany. .,Medizinische Fakultät, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
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15
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16
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Ruptured Fusiform Aneurysm of the Anterior Spinal Artery. Clin Neuroradiol 2018; 28:613-616. [DOI: 10.1007/s00062-018-0684-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/22/2018] [Indexed: 12/18/2022]
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17
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Successful Surgical Resection of Spinal Artery Aneurysms: Report of 3 Cases. World Neurosurg 2018; 109:171-178. [DOI: 10.1016/j.wneu.2017.09.174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 12/19/2022]
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18
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Jung SC, Song Y, Cho SH, Kim J, Noh SY, Lee SH, Sheen JJ, Rhim SC, Jeon SR, Suh DC. Endovascular management of aneurysms associated with spinal arteriovenous malformations. J Neurointerv Surg 2017. [DOI: 10.1136/neurintsurg-2017-013150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BackgroundSpinal aneurysms are rare among spinal arteriovenous malformations (SAVMs). There are few reports of endovascular management of spinal aneurysms associated with SAVM.ObjectiveTo present endovascular management of aneurysms associated with SAVM.MethodsOf 91 patients with SAVMs,eight (9%) presented with aneurysms. Of these, three were male and five were female with a median age of 18 years (range 11–38). We evaluated the presenting pattern, lesion level, type of the target aneurysm related to the presenting pattern and AVM nidus, and the result obtained after embolization or open surgery. Clinical status was evaluated by Aminoff–Logue (ALS) gait and micturition scale scores.ResultsThe presenting patterns were subarachnoid hemorrhage (SAH, n=3) or mass effect caused by extrinsic (n=4) or intrinsic (n=1) cord compression. Aneurysms were located in four cervical, two thoracic, and two lumbar enlargement areas. There were two prenidal (arterial), three nidal, and three postnidal (venous) aneurysms. The mean diameter of the aneurysms was 9 mm (range 3–27). Glue embolization (n=6), open surgery (n=1), and combined surgery and embolization (n=1) was performed to obliterate the aneurysms. Obliteration of the target aneurysms resulted in improvement of symptoms and clinical stabilization of SAVMs in all patients during a mean of 55 months (range 7–228) of follow-up.ConclusionsIdentification of a symptomatic aneurysm should be associated with clinical presentation pattern. Targeted obliteration of the aneurysm by embolization and/or surgery resulted in improvement of symptoms and stabilization of SAVM.
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Arai N, Akiyama T, Yoshida K. The Coexistence of Extradural Arteriovenous Fistula and Soft Tissue Arteriovenous Malformation Within the Same Metamere. World Neurosurg 2016; 98:877.e1-877.e7. [PMID: 27890761 DOI: 10.1016/j.wneu.2016.11.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spinal arteriovenous shunts are a common spinal vascular disorder. However, they can have a misleading clinical presentation and poor prognosis. They are classified into 4 types according to shunt points and drainage route, among which extradural arteriovenous fistula (eAVF) is the most rare, comprising only 1% of all spinal arteriovenous shunts. We report an extremely rare case of coexistent eAVF at the craniocervical junction and soft tissue arteriovenous malformation within the same metamere. CASE DESCRIPTION A 30-year-old man presented with neck pain. T2-weighted magnetic resonance imaging revealed a flow void at the right craniocervical junction compressing the spinal cord. Angiography revealed eAVF at the craniocervical junction. The patient was treated via transvenous embolization. After the procedure, shunt flow and symptoms markedly decreased. During the operation, an extracranial arteriovenous malformation under the occipital skin was detected immediately after occluding the shunt point. CONCLUSIONS This case indicates that transvenous embolization can be an effective treatment for eAVF and supports some hypotheses of arteriovenous malformation development. Additionally, it emphasizes the importance of examining a lesion with multiple modalities, including angiography, three-dimensional angiography, and cone-beam computed tomography, to understand the anatomy of the lesion.
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Affiliation(s)
- Nobuhiko Arai
- Department of Neurosurgery, Keio University Hospital, Tokyo, Japan.
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University Hospital, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University Hospital, Tokyo, Japan
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20
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Brinjikji W, Yin R, Nasr DM, Lanzino G. Spinal epidural arteriovenous fistulas. J Neurointerv Surg 2016; 8:1305-1310. [PMID: 26790829 DOI: 10.1136/neurintsurg-2015-012181] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 01/30/2023]
Abstract
Spinal epidural arteriovenous fistulas (SEDAVFs) are rare complex lesions often presenting with protean clinical manifestations secondary to compressive symptoms or congestive myelopathy. The imaging manifestations of SEDAVFs on MR angiography/MRI include high T2 signal in the spinal cord, vascular engorgement of the epidural space, and prominent intradural vascular flow voids. Given the complexity of these lesions, they are best characterized anatomically on catheter angiography where careful inspection of arterial feeders and venous drainage patterns can be performed. The imaging hallmark of an SEDAVF on angiography is the presence of a dilated epidural venous pouch through which spinal and paraspinal veins are secondarily opacified. In the lower thoracic and lumbar spine, SEDAVFs are usually located in the ventral epidural space and fed mainly by the anteriorly coursing epidural arteries. In the cervical and upper thoracic spine, SEDAVFs and their feeding arteries are more typically located laterally in the spinal canal. Current treatment options include transarterial or transvenous endovascular embolization with liquid embolic agents or coils, and surgical resection/disconnection of the fistula. Further research is needed to better characterize how and why these lesions form and to identify the best treatment modalities.
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Affiliation(s)
| | - Rong Yin
- Department of Neurology, The General Hospital of Lanzhou Military Command, Lanzhou, China
| | - Deena M Nasr
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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