title: Lower vertebral-epidural spinal arteriovenous fistulas: a unique subtype of vertebrovertebral arteriovenous fistula, treatable with coil and Penumbra Occlusion Device embolization.
abstract: A vertebral-epidural spinal arteriovenous fistula (AVF) is an abnormal arteriovenous shunt connecting the vertebral artery to the spinal epidural venous plexus, and may occur spontaneously or secondary to a variety of causes. These unique lesions are uncommon in adults and rarer still in children. Previous reports have grouped together a heterogeneous collection of such arteriovenous lesions, including arterial contributions from the upper and lower vertebral artery, with venous drainage into a variety of spinal and paraspinal collectors. Here, through two cases, we delineate a distinct entity, the lower vertebral-to-epidural AVF. The salient clinical and anatomic features are summarized and contextualized within the broader constellation of vertebrovertebral AVF, the utility of a transarterial intravenous/retrograde intra-arterial endovascular approach is highlighted, and a new use of the Penumbra Occlusion Device (Penumbra Inc) for this purpose is reported.
authors.affiliation: Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ramsey
authors.identifier: http://orcid.org/0000-0002-3079-7052
authors.initials: R
authors.lastname: Ashour
authors.affiliation: Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Darren B
authors.initials: DB
authors.lastname: Orbach
mesh_terms: D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D004824:Epidural Space / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D013131:Spine / Q000098:blood supply; D014680:Veins / Q000002:abnormalities / Q000000981:diagnostic imaging; D014711:Vertebral Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging
keywords: Arteriovenous Malformation; Epidural; Pediatrics; Spine; Vascular Malformation