title: Spinal cord arteriovenous shunts of the ventral (anterior) sulcus: anatomical, clinical, and therapeutic considerations.
abstract: BACKGROUND
  Ventral sulcus spinal cord arteriovenous shunts (SCAVS) are rare vascular lesions that are located outside the spinal cord, are exclusively vascularized by the anterior spinal axis, and drain exclusively through the anterior spinal vein. We report the anatomical, clinical, and neuro-radiological features of SCAVS managed by our team.
  
  
  METHODS
  We conducted a retrospective study of patients with SCAVSs evaluated by the senior author of this report (GR) between 1981 and 2014. Data were collected by reviewing clinical notes and by a systematic analysis of spinal angiograms and MRI.
  
  
  RESULTS
  Among 358 patients, we identified 8 patients (3 women) with ventral sulcus spinal cord arteriovenous shunts. Mean age was 30.5 years. Six patients presented with progressive neurological symptoms, and two with acute neurological symptoms related to hematomyelia. Three shunts were located in the cervical cord, four in the thoracic cord, and one at the conus medullaris; there were two nidus type A-V shunts (AVMs) and six fistula type A-V shunts (AVFs). Seven patients were treated by endovascular therapy with glue embolization. Embolization led to anatomical cure in 5 cases, and a significant reduction of shunt volume and flow of more than 75% in 2 cases. In none of the cases we observed permanent morbidity.
  
  
  CONCLUSIONS
  AVS of the ventral sulcus of the spinal cord are rare. Recognition of these lesions and precise localization of the anatomical space in which they are located, may allow a better understanding of their pathophysiology and clinical manifestations and guide proper therapeutic decisions.
authors.affiliation: Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France.|Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Roccatagliata
authors.affiliation: Department of Neurosurgery, Chiba-Hokuso Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Shushi
authors.initials: S
authors.lastname: Kominami
authors.affiliation: Department of Radiology, Faculty Hospital, Hradec Kralove, Czech Republic.
authors.forename: Antonin
authors.initials: A
authors.lastname: Krajina
authors.affiliation: Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Sellar
authors.affiliation: Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Soderman
authors.affiliation: Department of Radiology AMC, Amsterdam, The Netherlands.
authors.forename: René
authors.initials: R
authors.lastname: Van den Berg
authors.affiliation: Department of Neuroradiology, University of Nantes Medical Center, Nantes, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Desal
authors.affiliation: Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Condette-Auliac
authors.affiliation: Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France. g.rodesch@hopital-foch.org.
authors.forename: Georges
authors.initials: G
authors.lastname: Rodesch
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Anterior spinal artery; Embolization; Interventional neuroradiology; Spinal cord arteriovenous shunts; Ventral sulcus