title: Management of spinal epidural arteriovenous fistulas: interventional techniques and results.
abstract: BACKGROUND
  Spinal epidural arteriovenous fistulas (SEDAVF) are rare and poorly understood clinical entities.
  
  
  METHODS
  We report a series of five (three men, two women) consecutive cases treated at our center to analyze their characteristic and treatment strategies in their management. We report a successful technique of percutaneous embolization of fistulas in a patient with failed previous attempts.
  
  
  RESULTS
  All five patients were symptomatic; three patients presented with a history of back pain, which progressed to myelopathic symptoms, one patient had symptoms of persistent back pain, and one patient had intermittent numbness of the left arm and thigh. Of the three patients who had myelopathic symptoms, two were successfully treated with transarterial embolizations with Onyx copolymer. The third patient who had a prominent epidural venous pouch with numerous arterial feeders was embolized percutaneously with a flat detector CT guided navigation (XperCT) and real time fluoroscopic monitoring of the injected n-butyl cyanoacrylate glue, after previous unsuccessful attempts with surgery and arterial embolizations. All three myelopathic treated patients had complete angiographic remission of the fistulas and symptoms on follow-up (mean 7.2 months).
  
  
  CONCLUSIONS
  The diagnosis and treatment of SEDAVF can be challenging due to their rarity and intricate pathomechanics. Patients with severe pain or progression of symptoms or myelopathic symptoms need to be treated at the earliest opportunity, while asymptomatic patients can be closely monitored. Percutaneous embolization is an effective strategy to embolize SEDAVF associated venous pouch.
authors.affiliation: Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Ramanathan
authors.forename: Michael R
authors.initials: MR
authors.lastname: Levitt
authors.forename: Laligam N
authors.initials: LN
authors.lastname: Sekhar
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Kim
authors.forename: Danial K
authors.initials: DK
authors.lastname: Hallam
authors.forename: Basavaraj V
authors.initials: BV
authors.lastname: Ghodke
mesh_terms: D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D019468:Disease Management; D061345:Early Medical Intervention / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography
keywords: Angiography; Arteriovenous Malformation; Fistula; Liquid Embolic Material; Spinal cord