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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleNeurointervention

Spinal Dural Arteriovenous Fistulas: Clinical Experience with Endovascular Treatment as a Primary Therapy at 2 Academic Referral Centers

J.J. Gemmete, N. Chaudhary, A.E. Elias, A.K. Toma, A.S. Pandey, R.A. Parker, I. Davagnanam, C.O. Maher, S. Brew and F. Robertson
American Journal of Neuroradiology October 2013, 34 (10) 1974-1979; DOI: https://doi.org/10.3174/ajnr.A3522
J.J. Gemmete
aFrom the Departments of Radiology (J.J.G., N.C., A.E.E.)
bNeurosurgery (J.J.G., N.C., A.S.P., C.O.M.), University of Michigan Health Systems, Ann Arbor, Michigan
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N. Chaudhary
aFrom the Departments of Radiology (J.J.G., N.C., A.E.E.)
bNeurosurgery (J.J.G., N.C., A.S.P., C.O.M.), University of Michigan Health Systems, Ann Arbor, Michigan
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A.E. Elias
aFrom the Departments of Radiology (J.J.G., N.C., A.E.E.)
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A.K. Toma
dNeurosurgery (A.K.T.), National Hospital for Neurology & Neurosurgery, University College London Hospitals, London, United Kingdom
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A.S. Pandey
bNeurosurgery (J.J.G., N.C., A.S.P., C.O.M.), University of Michigan Health Systems, Ann Arbor, Michigan
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R.A. Parker
eDepartment of Biostatistics (R.A.P.), School of Public Health, University of Michigan, Ann Arbor, Michigan.
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I. Davagnanam
cDepartments of Neuroradiology (I.D., S.B., F.R.)
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C.O. Maher
bNeurosurgery (J.J.G., N.C., A.S.P., C.O.M.), University of Michigan Health Systems, Ann Arbor, Michigan
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S. Brew
cDepartments of Neuroradiology (I.D., S.B., F.R.)
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F. Robertson
cDepartments of Neuroradiology (I.D., S.B., F.R.)
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    Fig 1.

    Patient 15, a 66-year-old man with a history of bilateral lower extremity weakness. A, Sagittal T2-weighted MR image shows multiple serpiginous flow voids (arrow) within the sacrum and lower lumbar spine. B, Left anterior oblique right lateral sacral angiogram shows site of SDAVF (arrow). C, Frontal spot fluoroscopic image shows glue cast within the arterial feeder, site of the fistula, and outflow vein (arrow). D, Sagittal T2-weighted MR image 6 months after treatment shows some interval resolution of the multiple serpiginous flow voids (arrow) within the sacrum and lower lumbar spine.

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    Fig 2.

    Patient 1, a 59-year-old man with inability to stand and persistent retention. A, Sagittal T2-weighted MR image shows high signal within the conus medullaris, lower and midthoracic spinal cord (arrow). B, Right T12 angiogram shows filling of an SDAVF (small arrow) with initial filling of the epidural venous plexus (small arrow), which then fills the radicular veins (large arrow). C, Frontal spot fluoroscopic images showing Onyx cast. D, Sagittal T2-weighted MR image 3 months after treatment shows interval resolution of the high signal within the conus medullaris, lower and midthoracic spinal cord.

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    Fig 3.

    Site of fistulas. LS indicates lateral sacral; IL, Ileolumbar.

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    Table 1:

    ALS functional grades before and after intervention

    Before Treatment (Avg ± SD)Last Follow-Up (Avg ± SD)P Values
    Gait (n=33)3.09 ± 1.482.51 ± 1.46*.0021
    Micturition (n=25)2.24 ± 0.771.50 ± 1.09*.025
    • ↵* Values were statistically significant (P < .05; Wilcoxon signed rank test).

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    Table 2:

    MC and mRS scores before and after intervention

    Before Treatment (Avg ± SD)Last Follow-Up (Avg ± SD)P Values
    MC (n=30)2.96 ± 0.882.36 ± 1.06*.0003
    mRS (n=33)3.15 ± 1.482.60 ± 1.51*.0034
    • ↵* Values were statistically significant (P < .05; Wilcoxon signed rank test).

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American Journal of Neuroradiology: 34 (10)
American Journal of Neuroradiology
Vol. 34, Issue 10
1 Oct 2013
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Cite this article
J.J. Gemmete, N. Chaudhary, A.E. Elias, A.K. Toma, A.S. Pandey, R.A. Parker, I. Davagnanam, C.O. Maher, S. Brew, F. Robertson
Spinal Dural Arteriovenous Fistulas: Clinical Experience with Endovascular Treatment as a Primary Therapy at 2 Academic Referral Centers
American Journal of Neuroradiology Oct 2013, 34 (10) 1974-1979; DOI: 10.3174/ajnr.A3522

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Spinal Dural Arteriovenous Fistulas: Clinical Experience with Endovascular Treatment as a Primary Therapy at 2 Academic Referral Centers
J.J. Gemmete, N. Chaudhary, A.E. Elias, A.K. Toma, A.S. Pandey, R.A. Parker, I. Davagnanam, C.O. Maher, S. Brew, F. Robertson
American Journal of Neuroradiology Oct 2013, 34 (10) 1974-1979; DOI: 10.3174/ajnr.A3522
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Cited By...

  • Outcomes following surgical versus endovascular treatment of spinal dural arteriovenous fistula: a systematic review and meta-analysis
  • Angiographic and Clinical Characteristics of Thoracolumbar Spinal Epidural and Dural Arteriovenous Fistulas
  • Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF)
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