Type I Spinal Arteriovenous Fistula with Ventral Intradural Venous Drainage: A Proposal of a Modified Classification.

Asian J Neurosurg. 2018 Oct-Dec;13(4):1048-1052. doi: 10.4103/ajns.AJNS_100_17.

Adeeb N, Moore JM, Alturki AY, Bulsara KR, Griessenauer CJ, Patel AS, Gupta R, Tubbs RS, Ogilvy CS, Thomas AJ.

Abstract

OBJECTIVES:

Spinal arteriovenous fistula (AVF) is the most common spinal vascular lesion and constitutes an abnormal communication between a feeder artery and a draining vein. Arterialization of the venous plexus leads to venous hypertension; consequent edema and congestion of the spinal cord are associated with progressive neurological decline.

PATIENTS AND METHODS:

In this report, we describe two unique cases of type I cervical spinal AVF, in which a radiculomeningeal artery forms an intradural fistula that drains into the ventral venous plexus.

RESULTS:

Both patients underwent surgical obliteration of the fistula with complete occlusion confirmed on postoperative angiography.

CONCLUSION:

Both cases do not fit into the current classification scheme. A modified classification is proposed.

KEYWORDS:

Arteriovenous; Type I; arteriovenous fistulas; classification; fistula; spinal; venous plexus; ventral

(A) Computed tomography angiography showing a tortuous dilated vein (black arrowhead) on the ventral surface of the spinal cord. (B) Preoperative digital subtraction angiography showing; (a) radiculomeningeal branch (white arrow) arising from the ascending cervical artery (white arrowhead) forming a fistula that drains into a tortuous dilated vein (black arrowhead in a and b) on the ventral surface of the spinal cord. The vein drains caudally and cranially into the posterior cranial fossa (black arrow). (C) Intraoperative image showing the arteriovenous fistula with tortuous dilated vein on the ventral surface of the spinal cord. (a) C4 dorsal nerve root; (b) Gentle retraction of the spinal cord; (c) arteriovenous fistula; (d) draining vein. (D) Intraoperative image showing disconnected arteriovenous fistula. (a) C4 dorsal nerve root; (b) Gentle retraction of the spinal cord; (c) Disconnected arteriovenous fistula; (d) Stump of the draining vein. (E) Postoperative digital subtraction angiography (a) showing complete absence of the fistula, compared to preoperative digital subtraction angiography (b)

Figure 2

(A) Computed tomography angiography showing a tortuous dilated vein on the ventral surface of the spinal cord. (B) Sagittal T1- (a) and T2- (b) weighted magnetic resonance imaging scan demonstrating spinal cord compression by dilated ventral veins. (C) Digital subtraction angiography showing that the most prominent supply to the lesion arises from a radiculomeningeal branch of the right vertebral artery. (D) Postoperative computed tomography angiography showing no further filling of the fistula

Figure 3

New proposed Type I subclassification as type IA (a) and Type IB (b) (reprinted with permission from: Bulsara et al.)[3]

Guest UserAugust 5, 2020Arteriovenous; Type I; arteriovenous fistulas; classification; fistula; spinal; venous plexus; ventralComment