Classification of vascular lesions affecting the spinal cord

Intracranial and Spinal Dural Arterio-Venous Fistula (DAVF): A Surgical Series of 107 Patients

INTRODUCTION

Dural arteriovenous fistulas (DAVFs) is a challenging condition in vascular neurosurgery. Development of new endovascular techniques has progressively modified treatment strategies; however, surgery is still considered a valid option of treatment of this pathology.

MATERIALS AND METHODS

From a retrospective analysis of our database, we selected 107 patients who underwent surgical treatment for DAVFs. Patients were grouped into five categories according to the Borden and Cognard classifications. Patients and treatment characteristics/outcome is reported.

RESULTS

At admission, 30 (28 %) patients presented with intracranial hemorrhage. Fifteen (14 %) had seizure, whereas nearly half of the patients presented with non-aggressive symptoms, including headache (10, 9.3 %), cognitive impairment (8, 7.5 %), gait disturbance, and imbalance (8, 7.5 %). The majority of patients underwent surgical treatment of fistulas; in some cases, we elected combined surgical-endovascular (obliteration) treatment.

CONCLUSIONS

Management of DAVF requires a multidisciplinary assessment and treatment strategies including surgical, endovascular, and radiosurgical treatment. The data reported confirmed that surgical treatment of DAVFs is associated with a good clinical and radiological (complete occlusion of the fistula) outcome in all cases, with a low rate of complications.

Arteriovenous malformation of the filum terminale: an exceptional case

Arteriovenous malformations (AVMs) of the spine display a variety of different locations, angioarchitectures, and clinical presentations. The authors describe an exceptional case of a filum terminale AVM that is not described in any classification and discuss the origin and management of this malformation. A 59-year-old woman was admitted in June 2012 for cauda equina syndrome. Magnetic resonance imaging and spinal angiography revealed an AVM of the filum terminale, located below the conus medullaris, fed by the anterior spinal artery. After an unsuccessful attempt to reach the nidus with a microcatheter, the AVM was resected. At 20 months after surgery, the patient was fully independent and radiological images confirmed the exclusion of the malformation. AVMs that originate from the filum terminale are exceptional. According to updated classifications, AVMs of the filum terminale should be categorized as a separate entity.

Management of spinal dural arterio-venous fistulas. Report of 12 cases and review of literature

INTRODUCTION

Spinal cord arteriovenous malformations and fistulae are rare vascular lesions than can lead to myelopathy that is at many instances overlooked during diagnosing the cause of progressive myelopathy and weakness. Treatment options involve either endovascular embolization, surgical disconnection or a combination of both. This study aims to evaluate various treatment methods for sDAVFs and the outcome of these methods.

METHODS

This study involved 12 patients suffering from symptoms attributed to spinal dural arteriovenous fistulas; 11 were male and one was a female patient, with ages ranging between 50 years and 71 years. All patients presented with progressive spastic paraparesis of varying grades, and 6 had sphincter disturbances prior to treatment. Patients were evaluated by Aminoff-Logue motor disability scale.

RESULTS

Three were managed by endovascular embolization and 9 by surgical disconnection. Three patients showed full recovery after treatment, 7 patients showed no change in their neurological status following treatment, and 2 patients showed partial recovery after treatment.

CONCLUSION

Spinal AVF is a rare curable cause of spinal myelopathy if managed promptly. Good angiographic studies prior to treatment decision are a must, in order to plan the best approach according to the angioarchitecture of the fistula whether it will allow endovascular embolization or will surgery be more feasible.