Treatment of giant intradural (perimedullary) arteriovenous fistulas

Van V. Halbach, Randall T. Higashida, Christopher F. Dowd, Kenneth W. Fraser, Michael S. Edwards, Stanley L. Barnwell

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

TEN PATIENTS WITH giant intradural spinal arteriovenous fistulas (perimedullary Types II and III) were treated with embolization alone (three patients) or in combination with surgery (seven patients). Their ages at the time of treatment ranged from 2 to 40 years, with a mean of 19.5 years. The indications for treatment included progressive myelopathy in five patients, spinal subarachnoid hemorrhage in four, and acute paraplegia in one. Associated conditions included Rendu-Osler-Weber syndrome in two patients, and Cobb's syndrome in two patients. In one patient, the cause of the fistula may have been related to epidural anesthesia traumatizing a low tethered cord. Angiographically, the fistulas were subclassified in three groups: a single-hole fistula supplied by a single feeding medullary artery (three patients); a single-hole fistula supplied by multiple medullary arteries (three patients); and multiple separate fistulas supplied by multiple medullary arteries (four patients). Eight patients were classified as perimedullary Type III and two as perimedullary Type II. Embolic agents were delivered from transarterial routes in 14 procedures and transvenous routes in 2 procedures. A total of 16 embolizations and 8 operations were performed in 10 patients. Seven patients were cured of their fistula (as demonstrated by angiography), two patients had 5% residual filling and are scheduled for future therapy. One refused a follow-up angiographic examination. Complications related to embolization included rupture of the anterior spinal artery by a detachable balloon, resulting in transient worsening of paraplegia with recovery to baseline. Transient worsening of symptoms after surgery was common, but all patients returned to baseline or better. Dramatic improvement was observed in four patients. The follow-up period ranged from 3 to 112 months, with a mean of 44.8 months. Giant (perimedullary) intradural arteriovenous fistulas can be effectively managed with endovascular and/or surgical techniques.

Original languageEnglish (US)
Pages (from-to)972-980
Number of pages9
JournalNeurosurgery
Volume33
Issue number6
StatePublished - 1993

Fingerprint

Arteriovenous Fistula
Fistula
Therapeutics
Arteries
Paraplegia
Hereditary Hemorrhagic Telangiectasia
Epidural Anesthesia
Spinal Cord Diseases
Subarachnoid Hemorrhage
Rupture

Keywords

  • Embolization
  • Intradural arteriovenous fistula
  • Perimedullary fistula
  • Spinal arteriovenous malformation
  • Transarterial
  • Transvenous

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Halbach, V. V., Higashida, R. T., Dowd, C. F., Fraser, K. W., Edwards, M. S., & Barnwell, S. L. (1993). Treatment of giant intradural (perimedullary) arteriovenous fistulas. Neurosurgery, 33(6), 972-980.

Treatment of giant intradural (perimedullary) arteriovenous fistulas. / Halbach, Van V.; Higashida, Randall T.; Dowd, Christopher F.; Fraser, Kenneth W.; Edwards, Michael S.; Barnwell, Stanley L.

In: Neurosurgery, Vol. 33, No. 6, 1993, p. 972-980.

Research output: Contribution to journalArticle

Halbach, VV, Higashida, RT, Dowd, CF, Fraser, KW, Edwards, MS & Barnwell, SL 1993, 'Treatment of giant intradural (perimedullary) arteriovenous fistulas', Neurosurgery, vol. 33, no. 6, pp. 972-980.
Halbach VV, Higashida RT, Dowd CF, Fraser KW, Edwards MS, Barnwell SL. Treatment of giant intradural (perimedullary) arteriovenous fistulas. Neurosurgery. 1993;33(6):972-980.
Halbach, Van V. ; Higashida, Randall T. ; Dowd, Christopher F. ; Fraser, Kenneth W. ; Edwards, Michael S. ; Barnwell, Stanley L. / Treatment of giant intradural (perimedullary) arteriovenous fistulas. In: Neurosurgery. 1993 ; Vol. 33, No. 6. pp. 972-980.
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