Diagnostic and surgical management of spinal dural arteriovenous fistulas

Thomas T. Lee, Erika B. Gromelski, Brian C. Bowen, Barth A Green

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

OBJECTIVE: A retrospective review was conducted to compare magnetic resonance (MR) and conventional spinal angiographic images and to investigate the outcome of our treatment protocol for patients with spinal dural arteriovenous fistulas (DAVFs). MATERIALS AND METHODS: Nine patients with a diagnosis of DAVF based on clinical myelopathy and preoperative MR imaging (MRI) and MR angiography (MRA) findings were treated at our institution by the senior author (BAG). All nine patients initially presented with progressive myelopathy. Preoperative MRI revealed T2-weighted signal abnormalities in all patients, and MRA was diagnostic in all patients. Each patient underwent a laminectomy and ligation of the arterialized draining vein. Selective spinal angiograms were used to confirm the level of fistula immediately before the surgical procedure was performed and to document complete obliteration after clip ligation of the medullary draining vein. Follow-up MRI and MRA were performed approximately 2 months postoperatively. RESULTS: MRI T2-weighted signal hyperintensity improved after surgery in all nine patients. Postoperatively, progression of motor weakness and gait difficulty was halted and some improvement was observed in all patients. No patient was neurologically normal, however. To date, there has been no clinical or MRA evidence of recurrence in any patient. CONCLUSION: Preoperative MRA and intraoperative spinal x-ray angiography present as an effective combination for diagnosing and intraoperatively confirming DAVF. Both T1-weighted enhancement and T2-weighted signal hyperintensity on MR images improved after the obliteration of the DAVFs and correlated with clinical improvement in all nine patients. MRA provides adequate visualization and localization of spinal DAVFs and may serve as a useful noninvasive tool for diagnosing and following patients with spinal DAVFs in the future.

Original languageEnglish
Pages (from-to)242-247
Number of pages6
JournalNeurosurgery
Volume43
Issue number2
DOIs
StatePublished - Aug 1 1998

Fingerprint

Central Nervous System Vascular Malformations
Angiography
Spinal Cord Diseases
Ligation
Veins
Magnetic Resonance Spectroscopy
Laminectomy
Magnetic Resonance Angiography
Clinical Protocols
Gait
Surgical Instruments
Fistula

Keywords

  • Magnetic resonance angiography (MRA)
  • Magnetic resonance imaging (MRI)
  • Spinal dural arteriovenous fistula (DAVF)
  • Surgical ligation
  • T2-weighted hyperintensity

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Diagnostic and surgical management of spinal dural arteriovenous fistulas. / Lee, Thomas T.; Gromelski, Erika B.; Bowen, Brian C.; Green, Barth A.

In: Neurosurgery, Vol. 43, No. 2, 01.08.1998, p. 242-247.

Research output: Contribution to journalArticle

Lee, Thomas T. ; Gromelski, Erika B. ; Bowen, Brian C. ; Green, Barth A. / Diagnostic and surgical management of spinal dural arteriovenous fistulas. In: Neurosurgery. 1998 ; Vol. 43, No. 2. pp. 242-247.
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AB - OBJECTIVE: A retrospective review was conducted to compare magnetic resonance (MR) and conventional spinal angiographic images and to investigate the outcome of our treatment protocol for patients with spinal dural arteriovenous fistulas (DAVFs). MATERIALS AND METHODS: Nine patients with a diagnosis of DAVF based on clinical myelopathy and preoperative MR imaging (MRI) and MR angiography (MRA) findings were treated at our institution by the senior author (BAG). All nine patients initially presented with progressive myelopathy. Preoperative MRI revealed T2-weighted signal abnormalities in all patients, and MRA was diagnostic in all patients. Each patient underwent a laminectomy and ligation of the arterialized draining vein. Selective spinal angiograms were used to confirm the level of fistula immediately before the surgical procedure was performed and to document complete obliteration after clip ligation of the medullary draining vein. Follow-up MRI and MRA were performed approximately 2 months postoperatively. RESULTS: MRI T2-weighted signal hyperintensity improved after surgery in all nine patients. Postoperatively, progression of motor weakness and gait difficulty was halted and some improvement was observed in all patients. No patient was neurologically normal, however. To date, there has been no clinical or MRA evidence of recurrence in any patient. CONCLUSION: Preoperative MRA and intraoperative spinal x-ray angiography present as an effective combination for diagnosing and intraoperatively confirming DAVF. Both T1-weighted enhancement and T2-weighted signal hyperintensity on MR images improved after the obliteration of the DAVFs and correlated with clinical improvement in all nine patients. MRA provides adequate visualization and localization of spinal DAVFs and may serve as a useful noninvasive tool for diagnosing and following patients with spinal DAVFs in the future.

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