title: Cervical perimedullary arteriovenous shunts: a study of 22 consecutive cases with a focus on angioarchitecture and surgical approaches.
abstract: BACKGROUND
  Reports of cervical perimedullary arteriovenous shunt (PMAVS) are limited, and treatment strategies have not been established.
  
  
  OBJECTIVE
  To describe angioarchitecture and optimal treatment strategies for cervical PMAVS.
  
  
  METHODS
  We treated 22 patients with cervical PMAVS between 2000 and 2012 (8 women and 14 men; age, 9-80 years). According to the classification, our patients included type IVa (4 patients), type IVb (16 patients), and type IVc (2 patients). Seventeen patients presented with subarachnoid hemorrhage.
  
  
  RESULTS
  A total of 41 shunting points were localized in 22 patients, of which 34 points were located ventral or ventrolateral to the spinal cord. The anterior spinal artery (ASA) contributed to the shunts in 16 patients. Aneurysm formation was identified in 8 patients. Endovascular treatment was attempted in 3 patients, resulting in complete obliteration in 1 patient (type IVc). Overall, 21 patients underwent open surgery. An anterior approach with corpectomy was elected for 2 patients; the other 19 patients underwent the posterior approaches using indocyanine green videoangiography, intraoperative angiography, endoscopy (8 patients), and neuromonitoring. Twenty patients were rated as having a good recovery at 6 months after surgery. No recurrence was observed in any patients during the follow-up (mean, 59.7 months).
  
  
  CONCLUSIONS
  Shunting points of the cervical PMAVS were predominantly located ventral or ventrolateral to the spinal cord and were often fed by the ASA. Even for ventral lesions, posterior exposure assisted with neuromonitoring and endoscopy, and intraoperative angiography provided a view sufficient to understand the relationships between the shunts and the ASA and contributed to good surgical outcomes.
authors.affiliation: Departments of *Neurosurgery and ‡Neuroendovascular Therapy, Tohoku University, Graduate School of Medicine; §Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Endo
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sato
authors.forename: Kuniyasu
authors.initials: K
authors.lastname: Niizuma
authors.forename: Ryushi
authors.initials: R
authors.lastname: Kondo
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Akira
authors.initials: A
authors.lastname: Takahashi
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000002:abnormalities / Q000098:blood supply* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult