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Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
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Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
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Ni H, Zheng Y, Lu S, Jia Z, Shi H, Liu S, Zhao L. Aneurysmal subarachnoid hemorrhage complicating spinal subarachnoid hematoma causing acute cauda equina syndrome: a case report. BMC Neurol 2024; 24:5. [PMID: 38166773 PMCID: PMC10759738 DOI: 10.1186/s12883-023-03404-2] [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: 05/31/2023] [Accepted: 09/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Spinal subarachnoid hematoma (SSH) is a known but rare entity that can cause cauda equina compression. The occurrence of SSH associated with aneurysmal subarachnoid hemorrhage has rarely been described in the literature. CASE PRESENTATION A 56-year-old woman presented with subarachnoid hemorrhage secondary to a ruptured middle cerebral artery aneurysm and was managed with coiling embolization without stent assistance. There was no history of either lumbar puncture or the use of anticoagulants. The patient developed severe lumbago radiating to bilateral legs nine days after the procedure. Subsequent magnetic resonance imaging demonstrated a SSH extending from L5 to S2 and wrapping around the cauda equina. The patient was treated with intravenous methylprednisolone (250 mg/day) for four consecutive days, followed by a taper of oral prednisolone (20 mg/day) until complete recovery. Magnetic resonance imaging at one month follow-up revealed complete resolution of the SSH. CONCLUSIONS Here, we report a case of acute cauda equina syndrome caused by a SSH after aneurysmal subarachnoid hemorrhage, which will facilitate timely intervention of patients with this disorder.
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Affiliation(s)
- Heng Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, 210029, Nanjing, China
| | - Yu Zheng
- Department of Radiology, The Affiliated YiXing Hospital of Jiangsu University, 75 Tongzhenguan Rd, 214200, Wuxi, China
| | - Shanshan Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, 210029, Nanjing, China
| | - Zhenyu Jia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, 210029, Nanjing, China
| | - Haibin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, 210029, Nanjing, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, 210029, Nanjing, China
| | - Linbo Zhao
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, Jiangsu Province, China.
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Kim S, Kim H, Kim JS, Hyun SJ, Kim KJ, Park KS. The utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: a historical control study. Clin Neurophysiol Pract 2022; 7:59-64. [PMID: 35243187 PMCID: PMC8881687 DOI: 10.1016/j.cnp.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/21/2021] [Accepted: 01/17/2022] [Indexed: 11/19/2022] Open
Abstract
Postoperative neurological complications are not rare in surgical treatment for spinal arteriovenous malformations (SAVMs). An in-group analysis showed that the accuracy of IONM for detecting postoperative neurological complications was relatively high. Multimodal IONM may reduce postoperative neurological complications in the surgical treatment for SAVMs.
Objective Methods Results Conclusions Significance
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Affiliation(s)
- Sooyoung Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Haelim Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Corresponding authors at: Department of Neurology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam-Si, Geonggi-Do, Republic of Korea.
| | - Seung-Jae Hyun
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Corresponding authors at: Department of Neurology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam-Si, Geonggi-Do, Republic of Korea.
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Trivino-Sanchez J, Ferreira-Pinto PHC, Simões EL, Carvalho FG, Menezes DR, Cruz TZ, Pontes JPM, Tavares ABW, Nigri F. Spinal dural arteriovenous fistula rupture after Rathke's cleft cyst endoscopic resection: Case report and literature review. Surg Neurol Int 2021; 12:455. [PMID: 34621570 PMCID: PMC8492439 DOI: 10.25259/sni_654_2021] [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: 06/30/2021] [Accepted: 08/11/2021] [Indexed: 11/11/2022] Open
Abstract
Background: Spinal dural arteriovenous fistula (SDAVF) is the most frequent vascular malformation of the spine and accounts for approximately 70% of all vascular spinal malformations. In rare cases, SDAVF rupture and subsequent subarachnoid hemorrhage or intramedullary hematoma may occur. The aim of this article is to present a fatal case of SDAVF rupture after a Rathke’s cleft cyst (RCC) endoscopic resection. Case Description: An 80-year-old female was referred to our hospital with a clinical presentation of bilateral reduction in visual acuity, bitemporal hemianopsia, and sellar magnetic resonance imaging (MRI) highly suggestive of RCC. After the first endonasal endoscopic surgery, the cyst was partially removed and vision improved. No signs of cerebrospinal fluid (CSF) leak were observed. After 1 year, the patient returned because of RCC recurrence and decreased visual acuity. In the second procedure, the lesion was totally resected and CSF leak was observed. A nasoseptal flap was rotated to cover the skull base defect. The patient developed subtle paraparesis followed by paraplegia on the 4th postoperative day. The dorsal spine MRI revealed a T3-T4 intramedullary hematoma. A dorsal laminectomy was performed and a SDAVF was observed. During microsurgery, at the right T3 nerve root level, an arteriovenous shunting point was identified, coagulated, and divided. The intramedullary hematoma was evacuated. The patient developed neurogenic and septic shock and died. Conclusion: Venous hypertension, venous wall fragility, and venous thrombosis seem to be the main factors involved in SDAVF rupture. In this particular case, reduction of the extravascular pressure and sudden variation in the pressure gradient caused by sustained CSF leak, also appeared to play an important role in SDAVF rupture. It may represent one more complication related to radical resection of RCC.
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Affiliation(s)
- Jefferson Trivino-Sanchez
- Department of Neurosurgery Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Elington Lannes Simões
- Department of Neurosurgery Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Felipe Gonçalves Carvalho
- Department of Neurosurgery Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Diego Rodrigues Menezes
- Department of Neurosurgery Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Thaina Zanon Cruz
- Department of Neurosurgery Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Julia Pereira Muniz Pontes
- Department of Neurosurgery Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ana Beatriz Winter Tavares
- Department of Endocrine, Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Flavio Nigri
- Department of Neurosurgery Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Khalid SH, Khan Y, Bashir S, Awan SI, Mustafa S, Bari ME. Endovascular Management of Type III Perimedullary Spinal Arteriovenous Malformations in Pediatric Population. Pediatr Neurosurg 2021; 56:385-391. [PMID: 34077932 DOI: 10.1159/000516445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 04/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal arteriovenous malformations (AVMs) are a cause of 20-30 of all spinal vascular malformation. The treatment option for the AVM depends upon the type of AVM. Here, we present a case series to discuss the type, management, and post-operative conclusion of the spinal AVMs. METHOD Four patients with spinal AVMs were retrospectively reviewed. All 4 patients were with a nidus-type AVM. Treatment for all patients required embolization. Clinical features, imaging, treatment, and clinical results were observed. All 4 patient's clinical outcome was assessed using the Modified Ranked Scale. RESULT The follow-up after management showed that all four-patient recovered without any residual deficit. All four-patient scored zero (0) on the Modified Ranked Scale. CONCLUSION Pediatric spinal AVMs are rare and require complex multimodal approach to achieve favorable outcomes.
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Affiliation(s)
- Syed Hassan Khalid
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan,
| | - Yakoot Khan
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Sanaullah Bashir
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Saba Iqbal Awan
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Saleem Mustafa
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
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Huntoon K, Khandpur U, Dornbos D, Youssef PP. Spinal dural arteriovenous fistula masquerading as subdural hematoma. Surg Neurol Int 2020; 11:142. [PMID: 32547829 PMCID: PMC7294149 DOI: 10.25259/sni_160_2020] [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: 04/07/2020] [Accepted: 04/20/2020] [Indexed: 11/04/2022] Open
Abstract
Background This case highlights an angiographically occult spinal dural AVF presenting with a spinal subdural hematoma. While rare, it is important that clinicians be aware of this potential etiology of subdural hematomas before evacuation. Case Description A 79-year-old female presented with acute lumbar pain, paraparesis, and a T10 sensory level loss. The MRI showed lower cord displacement due to curvilinear/triangular enhancement along the right side of the canal at the T12-L1 level. The lumbar MRA, craniospinal CTA, and multivessel spinal angiogram were unremarkable. A decompressive exploratory laminectomy revealed a subdural hematoma that contained blood products of different ages, and a large arterialized vein exiting near the right L1 nerve root sheath. The fistula was coagulated and sectioned. Postoperatively, the patient regained normal function. Conclusion Symptomatic subdural thoracolumbar hemorrhages from SDAVF are very rare. Here, we report a patient with an acute paraparesis and T10 sensory level attributed to an SDAVF and subdural hematoma. Despite negative diagnostic studies, even including spinal angiography, the patient underwent surgical intervention and successful occlusion of the SDAVF.
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Affiliation(s)
- Kristin Huntoon
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Ohio, United States
| | - Umang Khandpur
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Ohio, United States
| | - David Dornbos
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Ohio, United States
| | - Patrick P Youssef
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Ohio, United States
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Hejčl A, Lodin J, Cihlář F, Sameš M. Spontaneous Subarachnoid Hemorrhage in a Patient with a Co-Existent Posterior Communicating Artery Aneurysm and Cervical Spine Aneurysm Associated with Ventral Arterio-Venous Fistula. Brain Sci 2020; 10:brainsci10020070. [PMID: 32012860 PMCID: PMC7071443 DOI: 10.3390/brainsci10020070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/19/2020] [Accepted: 01/23/2020] [Indexed: 12/31/2022] Open
Abstract
Severe spontaneous subarachnoid hemorrhage (SAH) is predominantly caused by aneurysm rupture, with non-aneurysmal vascular lesions representing only a minority of possible causes. We present the case of a 58-year old lady with a coincidental posterior communicating artery (PCom) aneurysm and a high cervical spine arterio-venous fistula associated with a small ruptured aneurysm. After the emergency clipping of the PCom aneurysm, additional diagnostic procedures—repeated digital subtraction angiography and spinal magnetic resonance imaging, revealed the actual cause of the SAH, a type-A ventral intradural fistula at cervical level C2/3. The fistula was treated micro surgically via a ventral approach using C3 somatectomy and C2-4 stabilization after the initial failure of endovascular therapy. Furthermore, the patient was treated for complications associated with severe SAH, including acute hydrocephalus and meningitis. In cases where the SAH pattern and perioperative findings do not suggest an intracranial aneurysm as the source of SAH, further diagnostic investigation is warranted to discover the real cause. Patients with severe non-aneurysmal SAH require a similar algorithm in diagnosing the cause of the hemorrhage as well as complex conditions such as ruptured aneurysms.
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Affiliation(s)
- Aleš Hejčl
- Department of Neurosurgery, J.E. Purkinje University, Masaryk Hospital, Sociální péče 12A, 40113 Ústí nad Labem, Czech Republic (M.S.)
- International Clinical Research Center, St. Anne’s University Hospital, 38975 Brno, Czech Republic
- Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Vídeňská 1083, 14220 Prague, Czech Republic
- Correspondence: ; Tel.: +420-777-232-793; Fax: +420-477-112-880
| | - Jan Lodin
- Department of Neurosurgery, J.E. Purkinje University, Masaryk Hospital, Sociální péče 12A, 40113 Ústí nad Labem, Czech Republic (M.S.)
| | - Filip Cihlář
- Department of Radiology, J. E. Purkinje University, Masaryk Hospital, 40113 Ústí nad Labem, Czech Republic;
| | - Martin Sameš
- Department of Neurosurgery, J.E. Purkinje University, Masaryk Hospital, Sociální péče 12A, 40113 Ústí nad Labem, Czech Republic (M.S.)
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Kim H, Lee YS, Kang HJ, Lee MS, Suh SJ, Lee JH, Kang DG. A Rare Case of Subarachnoid Hemorrhage caused by Ruptured Venous Varix Due to Dural Arteriovenous Fistula at the Foramen Magnum Fed Solely by the Ascending Pharyngeal Artery. J Cerebrovasc Endovasc Neurosurg 2018; 20:120-126. [PMID: 30370246 PMCID: PMC6196141 DOI: 10.7461/jcen.2018.20.2.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 11/23/2022] Open
Abstract
Dural arteriovenous fistula (D-AVF) at the foramen magnum is an extremely rare disease entity. It produces venous hypertension, and can lead to progressive cervical myelopathy thereafter. On the other hand, the venous hypertension may lead to formation of a venous varix, and it can rarely result in an abrupt onset of subarachnoid hemorrhage (SAH) when the venous varix is ruptured. The diagnosis of D-AVF at the foramen magnum as a cause of SAH may be difficult due to its low incidence. Furthermore, when the D-AVF is fed solely by the ascending pharyngeal artery (APA), it may be missed if the external carotid angiography is not performed. The outcome could be fatal if the fistula is unrecognized. Herein, we report on a rare case of SAH caused by ruptured venous varix due to D-AVF at the foramen magnum fed solely by the APA. A review of relevant literatures is provided, and the treatment modalities and outcomes are also discussed.
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Affiliation(s)
- Hyunjun Kim
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Yoon-Soo Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Ho-Jun Kang
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Min-Seok Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Sang-Jun Suh
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Jeong-Ho Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Dong-Gee Kang
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
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Ghadirpour R, Nasi D, Iaccarino C, Romano A, Motti L, Farneti M, Pascarella R, Servadei F. Intraoperative Neurophysiological Monitoring in Surgical Treatment of Spinal Dural Arteriovenous Fistulas: Technique and Results. Asian J Neurosurg 2018; 13:595-606. [PMID: 30283511 PMCID: PMC6159052 DOI: 10.4103/ajns.ajns_209_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective and Background: Data on intraoperative neurophysiological monitoring (IOM) during surgery of spinal dural arteriovenous fistulas (SDAVFs) are lacking. The purpose of this study was to evaluate the role of IOM during microsurgery for SDAVFs. Materials and Methods: From March 2007 to March 2013, 12 patients had microsurgery with IOM for SDAVFs. The IOM included somatosensory-evoked potentials, motor-evoked potentials (MEPs), and – in selected cases – D-Waves. All patients were evaluated at admission and at follow-up (6, 12, and 24 months) with Aminoff–Logue Disability Scale for Gait-Aminoff–Logue Disability Scale (G-ALS) and Micturition-Aminoff–Logue Disability Scale (M-ALS). Statistical Analysis Used: Logistic regression was used for detecting the clinical risk factors influencing neurological functions after the treatment. Results: During surgery, we registered the absence of significant modifications of evoked potentials in nine cases (75%), while improvement of MEPs occurred in three cases (25%). No false-negative case was registered, and IOM predicted the absence of new postoperative neurological deficit in all patients. At 24-month follow-up, nine patients improved their overall neurological status, while three patients remained stable. At univariate analysis, Aminoff–Logue Disability Scales for Gait and Micturition (G + M-ALS) score at 24-month follow-up was directly associated with the duration of symptom before the surgery (P = 0.024), preoperative G-ALS (P = 0.02), M-ALS (P = 0.022), and G + M-ALS scores (P = 0.045), and improvement of IOM after occlusion of the fistula (P = 0.025). Conclusions: In our series, no significant worsening of evoked potentials occurred and subsequently the surgical strategy was not changed by IOM. However, no false-negative case was registered, and IOM predicted the absence of new postoperative neurological deficit in all patients. Patients with improvement of IOM parameters after occlusion of the fistula had greater chances of postsurgical improvement at the univariate analysis.
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Affiliation(s)
- Reza Ghadirpour
- Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.,Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy
| | - Davide Nasi
- Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.,Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy
| | - Corrado Iaccarino
- Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.,Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy
| | - Antonio Romano
- Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.,Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy
| | - Luisa Motti
- Department of Neurophysiology, IRCCS "Arcispedale Santa Maria Nuova," Reggio Emilia, Italy
| | - Marco Farneti
- Department of Neurosurgery, "S. Anna" University Hospital, Ferrara, Italy
| | - Rosario Pascarella
- Department of Neuroradiology, IRCCS "Arcispedale Santa Maria Nuova," Reggio Emilia, Italy
| | - Franco Servadei
- Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.,Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy
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Han J, Cao D, Wang H, Ji Y, Kang Z, Zhu J. Spinal dural arteriovenous fistula presenting with subarachnoid hemorrhage: A case report. Medicine (Baltimore) 2018; 97:e0513. [PMID: 29668636 PMCID: PMC5916701 DOI: 10.1097/md.0000000000010513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Subarachnoid hemorrhage (SAH) is a common and serious disease and one of the most important differential diagnoses in the emergency department. PATIENT CONCERNS A 39-year-old female patient with a 12 years' history of migraine, presented with a sudden headache combined with motor aphasia. Physical examination suggested probable positive neck resistance. SAH was confirmed by magnetic resonance imaging. In addition, spinal digital subtraction angiography and spinal vascular computed tomography angiography indicated spinal arteriovenous malformation (SAVM). DIAGNOSES The final diagnosis was spinal dural arteriovenous fistula presenting with SAH. INTERVENTIONS Following diagnosis, appropriate drugs were administered, but the therapeutic effect was poor. Then the patient was then transferred to a superior hospital where she was treated with interventional embolization. OUTCOMES Through 2 years of follow-up, intermittent migraine was found in the patient, but the symptoms of occipital pain, nausea, and vomiting did not occur again. LESSONS For patients who have been diagnosed with SAH but have no definite cause, we should pay attention to the etiological screening of SAH, and the possibility of the spinal cord SAH should be vigilant. The pain in the chest and back and the signs of spinal cord may be an important breakthrough in patients with spinal cord SAH, and medical history and physical examination are particularly important.
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Affiliation(s)
| | | | | | | | - Zhilei Kang
- Department of Magnetic Resonance, Harrison International Peace Hospital, Hengshui, Hebei, China
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Jeng Y, Chen DYT, Hsu HL, Huang YL, Chen CJ, Tseng YC. Spinal Dural Arteriovenous Fistula: Imaging Features and Its Mimics. Korean J Radiol 2015; 16:1119-31. [PMID: 26357504 PMCID: PMC4559784 DOI: 10.3348/kjr.2015.16.5.1119] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 06/17/2015] [Indexed: 12/12/2022] Open
Abstract
Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation, however it is still rare and underdiagnosed. Magnetic resonance imaging findings such as spinal cord edema and dilated and tortuous perimedullary veins play a pivotal role in the confirmation of the diagnosis. However, spinal angiography remains the gold standard in the diagnosis of SDAVF. Classic angiographic findings of SDAVF are early filling of radicular veins, delayed venous return, and an extensive network of dilated perimedullary venous plexus. A series of angiograms of SDAVF at different locations along the spinal column, and mimics of serpentine perimedullary venous plexus on MR images, are demonstrated. Thorough knowledge of SDAVF aids correct diagnosis and prevents irreversible complications.
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Affiliation(s)
- Ying Jeng
- Department of Radiology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan. ; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 23561, Taiwan
| | - David Yen-Ting Chen
- Department of Radiology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan
| | - Hui-Ling Hsu
- Department of Radiology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan
| | - Yen-Lin Huang
- Department of Radiology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan
| | - Chi-Jen Chen
- Department of Radiology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan
| | - Ying-Chi Tseng
- Department of Radiology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan
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12
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Visocchi M, La Rocca G, Signorelli F, Roselli R, Jun Z, Spallone A. 10 Levels thoracic no-intrumented laminectomy for huge spontaneous spinal subdural hematoma removal. Report of the first case and literature review. Int J Surg Case Rep 2015; 15:57-62. [PMID: 26318128 PMCID: PMC4601942 DOI: 10.1016/j.ijscr.2015.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/04/2015] [Accepted: 06/27/2015] [Indexed: 11/04/2022] Open
Abstract
In this article, reporting on the case of a huge 10 levels spontaneous spinal subdural hematoma treated with decompressive thoracic no-instrumented laminectomy in a 45-year-old woman with good neurological recovery, we would like to underline the importance of a timely surgical decompression as the mainstay option in the management of strongly symptomatic spontaneous idiopathic acute spinal subdural hematomas. To our knowledge, 10 levels thoracic laminectomy for a SSDH removal have never been described. We performed “conservative” laminectomy by sparing of articular processes with no need to posterior fixation also considering the intrinsic stability of thoracic chest.
Introduction Spontaneous idiopathic acute spinal subdural hematoma (SSDH) is a rare cause of acute back pain followed by signs and symptoms of nerve root and/or spinal cord compression, frequently associated with coagulopathies, blood dyscrasias and arterio-venous malformations. Standard management includes non-operative treatment and timely (within 24 h) surgical decompression. Presentation of case We report on the case of a huge 10 levels SSDH treated with decompressive thoracic no-instrumented laminectomy in a 45-year-old woman with good neurological recovery (from ASIA A to D). Discussion Spontaneous SSDHs without detectable structural lesion or anticoagulant therapy are very rare. Among 26 cases documented the literature harbouring SSDHs, the thoracic spine was found to be the preferred site, and the compression was usually extending over several vertebral levels. Nonoperative treatment for SSDH may be justified in presence of minimal neurologic deficits, otherwise, early decompressive laminectomy along with evacuation of hematoma are considered the treatment of choice in presence of major deficits. Conclusion To our knowledge, the present case is the most extensive laminectomy for a SSDH removal never described before. No postoperative instability occurs in 10 levels thoracic laminectomy in case the articular processes are spared. When major neurological deficits are documented, early decompressive laminectomy with evacuation of hematoma should be considered the best treatment for SSDH.
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Affiliation(s)
| | - Giuseppe La Rocca
- Institute of Neurosurgery, Catholic University School of Medicine of Rome, Italy
| | - Francesco Signorelli
- Institute of Neurosurgery, Catholic University School of Medicine of Rome, Italy.
| | - Romeo Roselli
- Institute of Neurosurgery, Catholic University School of Medicine of Rome, Italy
| | - Zhong Jun
- Department of Neurosurgery, Xin Hua Hospital, Shanghai University, China
| | - A Spallone
- Neurosurgical Unit, Department of Neurosciences, Neurological Centre of Latium, Rome, Italy
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Hamdan A, Padmanabhan R. Intramedullary hemorrhage from a thoracolumbar dural arteriovenous fistula. Spine J 2015; 15:e9-16. [PMID: 25463404 DOI: 10.1016/j.spinee.2014.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 09/19/2014] [Accepted: 10/07/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal dural arteriovenous fistulas (AVFs) are acquired lesions presenting typically with neurologic deficits secondary to chronic congestive myelopathy. The low-flow and low-volume nature of these lesions makes hemorrhage very unlikely, and intramedullary hemorrhage caused by thoracolumbar dural AVFs is exceedingly rare. PURPOSE The purpose of this study was to report a case of intramedullary hemorrhage caused by a thoracolumbar dural AVF. STUDY DESIGN/SETTING The study design included a case report and review of literature. METHODS A case of intramedullary hemorrhage from a thoracolumbar dural AVF was reported, and the literature regarding hemorrhagic presentations of dural AVF was reviewed. RESULTS A 66-year-old woman presented with a sudden onset of abdominal pain, paraplegia, sensory loss below the costal margins, and urinary retention. Magnetic resonance imaging scan showed intramedullary hemorrhage with abnormal flow voids raising suspicion of an intramedullary AV malformation. However, subsequent selective spinal angiography demonstrated a spinal dural AVF fed by the T7 intercostal artery and a varix within the draining vein. Complete obliteration of the dural AVF and the varix was achieved via embolization. As far as we are aware, there are only two other similar cases in the literature. Literature review revealed that presentation of thoracolumbar dural AVFs with hemorrhage is frequently associated with accelerated venous flow and the presence of a venous varix. CONCLUSIONS Although very unusual, a spinal dural AVF may present with intramedullary hemorrhage, and hemorrhage in such conditions may be associated with an accelerated venous flow and the presence of a venous varix.
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Affiliation(s)
- Alhafidz Hamdan
- Department of Neurosurgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough TS4 3BW, UK
| | - Rajeev Padmanabhan
- Department of Neuroradiology, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough TS4 3BW, UK.
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14
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TOI H, MATSUBARA S, WATANABE S, YAMASHITA T, UNO M. Paraspinal Arteriovenous Fistula Presenting With Subarachnoid Hemorrhage and Acute Progressive Myelopathy -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:846-9. [DOI: 10.2176/nmc.51.846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hiroyuki TOI
- Department of Neurosurgery, Kawasaki Medical School
| | | | | | | | - Masaaki UNO
- Department of Neurosurgery, Kawasaki Medical School
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15
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Kim DJ, Willinsky R, Geibprasert S, Krings T, Wallace C, Gentili F, Terbrugge K. Angiographic characteristics and treatment of cervical spinal dural arteriovenous shunts. AJNR Am J Neuroradiol 2010; 31:1512-5. [PMID: 20413606 DOI: 10.3174/ajnr.a2109] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Spinal DAVSs of the cervical level are rare lesions. The purpose of this study is to describe the clinical and angiographic characteristics of cervical spinal DAVSs. From a prospectively collected database including 449 cases of brain and spinal DAVSs, lesions located at the cervical level were selected. The clinical presentation, angiographic characteristics, and treatment outcome were assessed. Twelve cases of spinal DAVSs were identified at the level of the cervical spinal canal (male to female ratio = 8:4; mean age = 56.5 years). Five patients (41.7%) presented with hemorrhage including SAH (n = 4) and cerebellar hemorrhage (n = 1). Coincidental spinal DAVSs with cranial DAVSs or brain AVMs were noted in 5 cases (41.7%). The spinal DAVS was the symptomatic lesion in 10 cases and was incidentally discovered during evaluation for SAH from a coincidental lesion in 2 cases. Combined endovascular and surgical resection resulted in symptomatic improvement in 10 patients. In conclusion, DAVSs of the cervical spine are rare lesions which often present with hemorrhage and are frequently associated with complex coincidental vascular lesions. Combined endovascular and surgical treatment will result in good outcome.
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Affiliation(s)
- D J Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
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16
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Mitsuhashi Y, Aurboonyawat T, Pereira VM, Geibprasert S, Toulgoat F, Ozanne A, Lasjaunias P. Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas. Clinical article. J Neurosurg 2009; 111:889-99. [PMID: 19425886 DOI: 10.3171/2009.1.jns08840] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Dural arteriovenous fistulas (DAVFs) with leptomeningeal venous reflux generally pose a high risk of aggressive manifestations including hemorrhage. Among DAVFs, there is a peculiar type that demonstrates direct drainage into the bridging vein rather than the dural venous sinus. The purpose of this study was to investigate the characteristics of DAVFs that drain directly into the petrosal vein or the bridging vein of the medulla oblongata. METHODS Eleven consecutive cases of DAVFs that drained directly into the petrosal vein and 6 that drained directly into the bridging vein of the medulla were retrospectively reviewed. These cases were evaluated and/or treated at Hospital de Bicêtre in Paris, France, over a 27-year period. A review of previously reported cases was also performed. RESULTS Both of these "extrasinusal"-type DAVFs demonstrated very similar characteristics. There was a significant male predominance (p < 0.001) for this lesion, and a significantly higher incidence of aggressive neurological manifestations including hemorrhage or venous hypertension than in DAVFs of the transverse-sigmoid or cavernous sinus (p < 0.001). This finding was considered to be attributable to leptomeningeal venous reflux. Regarding treatment, endovascular embolization (either transarterial or transvenous) is frequently difficult, and surgery may be an effective therapeutic choice in many instances. CONCLUSIONS Embryologically, both the petrosal vein and the bridging vein of the medulla are cranial homologs of the spinal cord emissary bridging veins that drain the pial venous network. The authors believe that DAVFs in these locations may be included in a single category with spinal DAVFs because of their similar clinical characteristics.
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Affiliation(s)
- Yutaka Mitsuhashi
- Service de Neuroradiologie Diagnostique et Therapeutique, Hospital de Bicêtre, Paris, France.
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17
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Lee SH, Kim KT, Kim SM, Jo DJ. Extensive spinal cord infarction after surgical interruption of thoracolumbar dural arteriovenous fistula presenting with subarachnoid hemorrhage. J Korean Neurosurg Soc 2009; 46:60-4. [PMID: 19707496 DOI: 10.3340/jkns.2009.46.1.60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Revised: 02/23/2009] [Accepted: 07/02/2009] [Indexed: 01/07/2023] Open
Abstract
Nontraumatic intracranial subarachnoid hemorrhage (SAH) attributable to the thoracolumbar dural arteriovenous fistulas (DAVFs) has been extremely rare. A 41-year-old male patient was admitted with severe acute headache, neck stiffness, and pronounced low-back pain radiating to both legs. The T2-weighted MR imaging showed irregular signal void and enlarged, varix like pouch formation with spinal cord compression at the T11-12 level. The angiogram revealed a DAVF.We report a DAVF case with SAH that revealed an extensive infarction from C5 to the conus medullaris after undergoing operative treatment.
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Affiliation(s)
- Sang-Hun Lee
- Department of Orthopaedic Surgery, Spine Center, Kyung Hee University East West Neomedical Center, Seoul, Korea
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18
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Kim JS, Lee SH. Spontaneous spinal subarachnoid hemorrhage with spontaneous resolution. J Korean Neurosurg Soc 2009; 45:253-5. [PMID: 19444355 DOI: 10.3340/jkns.2009.45.4.253] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 04/02/2009] [Indexed: 12/20/2022] Open
Abstract
Spontaneous spinal subarachnoid hematoma (SSH) is a rare entity to cause spinal cord or nerve root compression and is usually managed as surgical emergencies. We report a case of spontaneous SSH manifesting as severe lumbago, which demonstrated nearly complete clinical resolution with conservative treatment. A 58-year-old female patient developed a large SSH, which was not related to blood dyscrasia, anticoagulation, lumbar puncture, or trauma. Patient had severe lumbago but no neurologic deficits. Because of absence of neurologicl deficits, she was treated conservatively. Follow-up magnetic resonance (MR) image showed complete resolution. Conservative treatment of SSH may be considered if the patient with spontaneous SSH has no neurologic deficits.
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Affiliation(s)
- Jin-Sung Kim
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
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19
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Germans MR, Pennings FA, Sprengers MES, Vandertop WP. Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage. J Neurol 2009; 255:1910-5. [PMID: 19159064 DOI: 10.1007/s00415-009-0021-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 05/28/2008] [Accepted: 06/03/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In patients with non-traumatic subarachnoid hemorrhage (SAH) and no evidence for a cerebral aneurysm on angiography, a frequent cause of the hemorrhage is perimesencephalic hemorrhage or other cerebral vascular pathology. In some patients no cause is found. The exact incidence of a spinal vascular malformation (SVM) as the origin for the SAH is not known. We assessed the occurrence of SVM in angiogram-negative, non-perimesencephalic subarachnoid hemorrhage (NPSAH). METHODS 47 patients (from a consecutive cohort of 632) were identified with an angiogramnegative, non-perimesencephalic subarachnoid hemorrhage and 42 of these were analyzed by performing MR-imaging of the complete spinal neuraxis with additional spinal angiography on indication. RESULTS In four patients a spinal vascular malformation was identified as the cause of the SAH, indicating an incidence of 9 % of SVM in NPSAH, and an incidence of 1 % of SVM in all patients with SAH. INTERPRETATION Systematic analysis of angiogram-negative, non-perimesencephalic subarachnoid hemorrhage by MR imaging of the complete spinal neuraxis yields a higher incidence of SVM than previously documented. We recommend MR imaging of the complete spinal neuraxis in patients with a non-perimesencephalic subarachnoid hemorrhage in whom no cause for the hemorrhage has been found.
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Affiliation(s)
- M R Germans
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Fassett DR, Rammos SK, Patel P, Parikh H, Couldwell WT. Intracranial subarachnoid hemorrhage resulting from cervical spine dural arteriovenous fistulas: literature review and case presentation. Neurosurg Focus 2009; 26:E4. [DOI: 10.3171/foc.2009.26.1.e4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cervical dural arteriovenous fistulas (dAVFs) are a rare cause of intracranial subarachnoid hemorrhage (SAH) but should be considered when other sources are not found. Subarachnoid hemorrhage caused by dAVF is thought to occur as a result of venous hypertension in most cases. The clinical presentation, acute onset of severe headache, is similar to that in patients with other causes of SAH; however, severe neurological deficits (Hunt and Hess Grade IV and V SAH) have not been reported in SAH caused by cervical dAVFs. Patients with this type of SAH commonly report suboccipital headache, neck pain, and nausea, and thus these hemorrhages can be easily dismissed as perimesencephalic SAH. Vigilant evaluation with 4-vessel cerebral angiography, including selective catherization of both proximal vertebral arteries, should be performed. The practice of unilateral vertebral artery injection with reflux into the contralateral vertebral and posterior inferior cerebellar arteries has the potential to overlook cervical dAVF. Magnetic resonance imaging may be useful to evaluate for other causes of SAH but is probably not sensitive for the identification of a cervical dAVF. Surgical treatment of this lesion has an excellent outcome.
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Affiliation(s)
| | | | - Pankti Patel
- 2University of Illinois College of Medicine atPeoria, Peoria, Illinois; and
| | - Harsh Parikh
- 2University of Illinois College of Medicine atPeoria, Peoria, Illinois; and
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Endovascular and surgical treatment of spinal dural arteriovenous fistulas. Neuroradiology 2008; 50:869-76. [PMID: 18587568 DOI: 10.1007/s00234-008-0425-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 06/08/2008] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The aim of this retrospective study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas (SDAVFs) that were treated with surgery, catheter embolization, or surgery after incomplete embolization. METHODS The study included 21 consecutive patients with SDAVFs of the thoracic, lumbar, or sacral spine who were treated in our institution from 1994 to 2007. Thirteen patients were treated with catheter embolization alone. Four patients underwent hemilaminectomy and intradural interruption of the fistula. Four patients were treated by endovascular techniques followed by surgery. The clinical outcome was assessed using the modified Aminoff-Logue scale (ALS) for myelopathy and the modified Rankin scale (MRS) for general quality of life. Patient age ranged from 44 to 77 years (mean 64.7 years). RESULTS Surgical as well as endovascular treatment resulted in a significant improvement in ALS (-62.5% and -31.4%, respectively, p < 0.05) and a tendency toward improved MRS (-50% and -32%, respectively) scores. Patients that underwent surgery after endovascular treatment due to incomplete occlusion of the fistula showed only a tendency for improvement in the ALS score (-16.7%), whereas the MRS score was not affected. CONCLUSION We conclude that both endovascular and surgical treatment of SDAVFs resulted in a good and lasting clinical outcome in the majority of cases. In specific situations, when a secondary neurosurgical approach was required after endovascular treatment to achieve complete occlusion of the SDAVF, the clinical outcome was rather poor. The best first line treatment modality for each individual patient should be determined by an interdisciplinary team.
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Kan P, Stevens EA, Warner J, Couldwell WT. Resolution of an anterior-inferior cerebellar artery feeding aneurysm with the treatment of a transverse-sigmoid dural arteriovenous fistula. Skull Base 2007; 17:205-10. [PMID: 17973034 DOI: 10.1055/s-2007-970559] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 27-year-old man developed an unruptured anterior-inferior cerebellar artery (AICA) feeding aneurysm from a transverse-sigmoid dural arteriovenous malformation. The patient, with a known history of left transverse and sigmoid sinus thrombosis, presented with pulse-synchronous tinnitus. Angiography revealed an extensive dural arteriovenous fistula (AVF), with feeders from both the extracranial and intracranial circulations, involving the right transverse sinus, the torcula, and the left transverse/sigmoid sinuses. Multimodal endovascular and open surgical therapy was used to manage the lesion. Before a planned second-stage treatment for the left sigmoid sinus component, the dural AVF improved significantly. During this interval, however, a small flow-related aneurysm developed on the left AICA feeding the petrous dural region. The aneurysm resolved after resection of the involved sigmoid sinus. This is the first reported case of an unruptured feeding-artery aneurysm in an intracranial dural AVF that resolved spontaneously with treatment of the dural AVF. Until more is known about the natural history, the decisions of when and whether to treat an unruptured dural AVF feeding-artery aneurysm must be made on an individual basis.
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Affiliation(s)
- Peter Kan
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
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van Beijnum J, Straver DCG, Rinkel GJE, Klijn CJM. Spinal arteriovenous shunts presenting as intracranial subarachnoid haemorrhage. J Neurol 2007; 254:1044-51. [PMID: 17401739 PMCID: PMC2779417 DOI: 10.1007/s00415-006-0485-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 11/01/2006] [Indexed: 01/19/2023]
Abstract
Background In approximately 5% of patients with intracranial subarachnoid haemorrhage (SAH), the cause is another than a ruptured aneurysm or perimesencephalic haemorrhage. One of these causes is a spinal arteriovenous shunt (SAVS). The aim of this study was to investigate the characteristics of patients with SAVS who present with intracranial SAH without symptoms and signs suggesting a spinal cause. Methods We systematically reviewed the literature and searched the SAH database of the University Medical Center Utrecht, The Netherlands, for patients with SAVS presenting with intracranial SAH and studied the characteristics of patients with SAVS whose clinical presentation mimicked intracranial SAH caused by rupture of a saccular aneurysm. Results Thirty-five patients were identified after a review of the literature. In our SAH database, comprising 2142 patients included in the period 1985–2004, we found one patient (0.05%, 95 % CI 0.006–0.3%). SAH due to SAVS occurred at any age (4–72 years). The SAVS was located at the craniocervical junction in 14 patients, at the cervical level in 11, and at the thoracolumbar level in the remaining 11 patients. The majority of patients (n = 26, 72%) had no disabling deficits at discharge or follow-up. Conclusion Rupture of a SAVS presenting as intracranial SAH is rare and can occur at any age. The SAVS can be located not only at the craniocervical junction or cervical level but also in the thoracolumbar region. Most patients with SAVS presenting as intracranial SAH have a good recovery.
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Affiliation(s)
- J van Beijnum
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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