Surgical treatment of spinal extradural arteriovenous fistula with parenchymal drainage: report on 5 cases.
BACKGROUND
Spinal extradural arteriovenous fistula (SEDAVF) with parenchymal drainage (type A) is a rare clinical entity that causes venous congestive myelopathy. Treatment includes endovascular and open microsurgical interventions. We reviewed the clinical records of patients treated for a type A SEDAVF to evaluate the feasibility of our treatment strategy.


METHODS
Between 2004 and 2010, 5 patients with a type A SEDAVF were treated at our institutes (4 men and 1 woman; mean age, 60 years). We performed endovascular transvenous embolization (TVE) when lesions were accessible transvenously; otherwise, microsurgical perimedullary drainer occlusion was performed. Follow-up ranged from 23 to 94 months (mean, 45.8 months). One patient was treated with TVE, and the remaining 4 were treated with microsurgical drainer occlusion. After a simple intradural drainer occlusion, an epidural venous lake was completely thrombosed in 2 patients. In 1 patient, postoperative angiography revealed that a part of the epidural component had persisted; however, the patient has been asymptomatic. In the remaining case with multiple intradural draining veins, sole drainer occlusion was not sufficient. A second surgery was required to meticulously coagulate the venous lake. As a consequence, parenchymal drainers disappeared. Overall, all patients stabilized or improved neurologically and experienced no recurrence.


CONCLUSIONS
To treat a type A SEDAVF, either TVE or microsurgical intradural drainer occlusion can be used for satisfactory long-term results with minimal surgical risks. For a case with multiple intradural draining veins, detachment of the venous lake should be considered.
*Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan; ‡Department of Neuroendovascular Therapy, Tohoku University Graduate School of Medicine, Sendai, Japan; §Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan.
Kuniyasu
K
Niizuma
Toshiki
T
Endo
Kenichi
K
Sato
Shihomi
S
Takada
Takayuki
T
Sugawara
Shigeki
S
Mikawa
Teiji
T
Tominaga
D000368:Aged; D000792:Angiography; D001164:Arteriovenous Fistula / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D004824:Epidural Space / Q000098:blood supply*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed