title: Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF).
abstract: OBJECTIVE
  The concomitant origin of the anterior spinal artery (ASA) or the posterior spinal artery (PSA) from the feeder of a spinal dural arteriovenous fistula (SDAVF) is rare and the exact incidence is not known. We present our experience with the management of SDAVFs in such cases.
  
  
  METHODS
  In 63 patients with SDAVF between 1993 and 2015, the feeder origin of the SDAVF was evaluated to determine whether it was concomitant with the origin of the ASA or PSA. Embolization was attempted when the patient did not want open surgery and an endovascular approach was regarded as safe and possible. The outcome of the procedure was evaluated as complete, partial, or no obliteration. The clinical outcome was evaluated by Aminoff-Logue (ALS) gait and micturition scale scores.
  
  
  RESULTS
  Nine patients (14%) had a concomitant origin of the ASA or PSA with the feeder. There were two cervical, five thoracic, and two lumbar level SDAVFs. A concomitant origin of the feeder was identified with the ASA (n=7) and PSA (n=2). Embolization was performed in four patients and open surgery was performed in five. Embolization resulted in complete obliteration in three patients and partial obliteration in one. Using the ALS gait and micturition scale, the final outcome improved in six while three cases remained in an unchanged condition over 2-148 months.
  
  
  CONCLUSIONS
  The concomitant origin of the ASA or PSA with the feeder occurs occasionally. Complete obliteration of the fistula can be achieved either by embolization or open surgery. Embolization can be carefully performed in selected patients who are in a poor condition and do not want to undergo open surgery.
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.|Departement of Neurology, Soetomo General Hospital/Airlangga University Hospital, Airlangga University Medical Faculty, Surabaya, Indonesia.
authors.forename: Yudhi
authors.identifier: http://orcid.org/0000-0001-9068-8248
authors.initials: Y
authors.lastname: Adrianto
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ku Hyun
authors.identifier: http://orcid.org/0000-0003-0019-6122
authors.initials: KH
authors.lastname: Yang
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hae-Won
authors.identifier: http://orcid.org/0000-0001-7014-3005
authors.initials: HW
authors.lastname: Koo
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Wonhyoung
authors.initials: W
authors.lastname: Park
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sung Chul
authors.initials: SC
authors.lastname: Jung
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jie Eun
authors.identifier: http://orcid.org/0000-0002-4419-4682
authors.initials: JE
authors.lastname: Park
authors.affiliation: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Kwang-Kuk
authors.initials: KK
authors.lastname: Kim
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang Ryong
authors.initials: SR
authors.lastname: Jeon
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Dae Chul
authors.identifier: http://orcid.org/0000-0003-1561-5596
authors.initials: DC
authors.lastname: Suh
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D000368:Aged; D000792:Angiography; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D004210:Dissection; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging
keywords: Arteriovenous Malformation; Fistula; Intervention; Spine