Giant perimedullary arteriovenous fistulas of the spine: clinical and radiologic features and endovascular treatment.
OBJECTIVE
To present the clinical and radiologic features of giant perimedullary arteriovenous fistulas (GAVFs) in 12 consecutive cases and to evaluate the results of endovascular treatment.


METHODS
We retrospectively reviewed the clinical and radiologic data as well as the results of balloon endovascular treatment obtained from 1980 to 1989.


RESULTS
GAVFs, defined as large intradural perimedullary direct arteriovenous high-flow shunts, are revealed mainly in childhood either by subarachnoid hemorrhage or by progressive neurologic disorders. MR imaging and myelography show major vascular dilatations. The angioarchitecture of GAVFs can only be assessed by selective spinal angiography. Ten patients were treated by balloon occlusion resulting in eight anatomic cures and six good clinical results. One balloon migrated to the venous side, leading to clinical deterioration.


CONCLUSIONS
GAVF is a special subgroup of intradural perimedullary arteriovenous fistula. The endovascular approach should be the first line of treatment, with surgery reserved for special circumstances. Nondetachable balloon occlusion is a safe and efficient method for treating GAVFs.
Ricolfi
F
F
Service de Neuroradiologie, Hôpital Henri Mondor, Cretéil, France.
Gobin
P Y
PY
Aymard
A
A
Brunelle
F
F
Gaston
A
A
Merland
J J
JJ
D000328:Adult; D000792:Angiography; D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009192:Myelography; D010243:Paralysis / Q000209:etiology; D010291:Paresis / Q000209:etiology; D012189:Retrospective Studies; D012449:Safety; D013116:Spinal Cord / Q000098:blood supply*; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome