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Itsekzon-Hayosh Z, Hendriks EJ, O'Reilly ST, Al Shahrani R, Agid R, Nicholson P, Terbrugge K, Radovanovic I, Andrade H, Schaafsma JD, Krings T. Thoracolumbar spinal dural arteriovenous fistulae present with longer arteriovenous transit compared to cranial and cervical dural fistulae. Interv Neuroradiol 2023:15910199221149096. [PMID: 36604849 DOI: 10.1177/15910199221149096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Thoraco-lumbar spinal dural arteriovenous fistulae represent a rare subset of central nervous system vascular malformations. One of the unique features of spinal dural arteriovenous fistulae is their extremely low propensity to cause hemorrhage (either parenchymal or subarachnoid), with a distinct clinical presentation of myelopathy secondary to spinal venous congestion. The exact mechanism for this unique presentation is still unclear. METHODS Following institutional review board approval, we retrospectively analyzed our prospectively maintained database of spinal dural arteriovenous fistulae and cranial (cr) DAVF cases presenting between 2008 and 2021. For all cases, angiograms were reviewed and arteriovenous transit times were calculated. Patient demographics, angiographic features, and clinical and radiological outcomes were assessed. RESULTS In total, 66 patients presenting with confirmed thoracolumbar spinal dural arteriovenous fistulaes were identified and compared to patients presenting with cervical spinal dural arteriovenous fistulaes (n = 10), ruptured crDAVFs (n = 32) and unruptured crDAVFs (n = 20). Mean age in the target group was 66 ± 13 versus 57-62 in the other groups, p < 0.05 on one-way analysis of variance; with 80% males versus 50%-65% in other groups. Mean arteriovenous transit time in the thoracolumbar group measured 1.98 s ± 0.96 versus 0.25-0.5 s range in other groups (p < 0.0001 on one-way analysis of variance). CONCLUSION Prolonged arteriovenous transit times may represent a distinct feature of thoracolumbar spinal dural arteriovenous fistulaes. This may, amongst other factors, play a role in the observed lesser likelihood of hemorrhagic complications compared to other dural arteriovenous shunts.
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Affiliation(s)
- Ze'ev Itsekzon-Hayosh
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
- Departments of Neurology and Neurovascular Disorders, Sheba Medical Center, Affiliated to Tel Aviv University, Sackler Faculty of Medicine, Ramat Gan, Israel
| | - Eef J Hendriks
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Sean T O'Reilly
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Rabab Al Shahrani
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Karel Terbrugge
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Ivan Radovanovic
- Department of Neurosurgery, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Hugo Andrade
- Department of Neurosurgery, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Joanna D Schaafsma
- Department of Medicine, Division of Neurology, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
- Department of Neurosurgery, 26625Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
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