title: Comparison of 3 Different Types of Spinal Arteriovenous Shunts below the Conus in Clinical Presentation, Radiologic Findings, and Outcomes.
abstract: Spinal arteriovenous shunts below the conus constitute 3 types of lesions, which have previously been mainly described in case reports, given their rarity, and are sometimes misdiagnosed. The purpose of this study was to describe the features of each type and compare these types as to epidemiologic features, clinical and radiologic presentations, treatment, and outcomes in a consecutive series of 48 cases.
  
  
  
  The prospectively collected data bases of 2 referral centers for spinal vascular lesions were retrospectively reviewed. Spinal arteriovenous shunts below the conus were defined as all dural and intradural shunts below the conus medullaris. Clinical features, radiologic findings, treatment results, and clinical outcomes were assessed.
  
  
  
  There were filum terminale arteriovenous fistulas in 11 patients (22.9%), radicular arteriovenous shunts in 7 patients (14.6%), and spinal dural arteriovenous fistulas in 30 patients (62.5%). Radicular arteriovenous shunts presented at a younger age (P= .017) and with a higher incidence of back pain symptoms (P= .037). A tethered spinal cord was found in 54.5% of patients with filum terminale arteriovenous fistulas and 23.3% of patients with spinal dural arteriovenous fistulas. After treatment, the angiographic complete obliteration rate was 89.4% and spinal function was improved significantly (P< .001).
  
  
  
  Three groups of spinal arteriovenous shunts below the conus can be differentiated according to clinical and radiologic features. Filum terminale arteriovenous fistulas are frequently associated with dysraphic malformations, which may suggest a particular embryologic origin.
authors.affiliation: From the Department of Neurosurgery (T.H., F.L., H.Q.Z.), Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: T
authors.identifier: 0000-0003-3273-0529
authors.initials: T
authors.lastname: Hong
authors.affiliation: Department of Radiology and Research Institute of Radiology (J.E.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: J E
authors.identifier: 0000-0002-4419-4682
authors.initials: JE
authors.lastname: Park
authors.affiliation: From the Department of Neurosurgery (T.H., F.L., H.Q.Z.), Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: F
authors.identifier: 0000-0002-9860-5758
authors.initials: F
authors.lastname: Ling
authors.affiliation: Department of Medical Imaging (K.G.T., T.K.).
authors.forename: K G
authors.identifier: 0000-0001-5316-7873
authors.initials: KG
authors.lastname: terBrugge
authors.affiliation: Division of Neurosurgery (M.T.), Toronto Western Hospital, University of Toronto, Ontario, Canada.
authors.forename: M
authors.identifier: 0000-0002-3019-784X
authors.initials: M
authors.lastname: Tymianski
authors.affiliation: From the Department of Neurosurgery (T.H., F.L., H.Q.Z.), Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: H Q
authors.identifier: 0000-0001-9429-6655
authors.initials: HQ
authors.lastname: Zhang
authors.affiliation: Department of Medical Imaging (K.G.T., T.K.) Timo.Krings@uhn.ca.
authors.forename: T
authors.identifier: 0000-0001-6321-5787
authors.initials: T
authors.lastname: Krings
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001416:Back Pain / Q000000981:diagnostic imaging / Q000601:surgery; D002420:Cauda Equina / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D052078:Conus Snail; D003937:Diagnosis, Differential; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009436:Neural Tube Defects / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult