Osseous versus Nonosseous Spinal Epidural Arteriovenous Fistulas: Experiences of 13 Patients

Spinal epidural arteriovenous fistula (perimedullary venous drainage) in a 63-year-old woman (case 4). A, Sagittal T2-weighted MR imaging reveals diffuse spinal cord edema up to the T5 level and multiple signal voids in the posterior aspect of the cord. B, Right lumbar arteriogram shows an arteriovenous fistula at the L2 level with multiple fine feeding arteries and early venous drainage to the epidural and paravertebral venous plexuses and to intradural veins (arrows). A small venous sac is visible around the fistula (arrowhead). C, 3D rotational angiogram shows the anatomy in detail where the intradural reflux originated (arrow). Note the focal narrowing of the vein where it penetrates the dura (arrowhead). D, Volume-rendering image demonstrates the epidural location of the fistula and the venous pouch (arrowhead). An intradural course of the radicular vein is also visible (arrow). E, Postembolization 3D angiogram confirms the presence of radiopaque glue in the fistula and along the intradural vein (white areas). F, Follow-up MR imaging 2 months later shows that the diffuse cord edema and the perimedullary vessels have disappeared.

Osseous spinal epidural arteriovenous fistula in a 57-year-old man (case 9). A, T2-weighted axial MR image reveals a well-defined lesion with dark signal intensity in the right epidural space at the C6 level. B, CT scan at the corresponding level shows adjacent bone destruction of the right lamina and spinous process of the C6 vertebra that resulted from the well-enhanced epidural lesion. C (right) and D (left), Deep cervical arteriograms. A large arteriovenous fistula with multiple arterial feeders is visible at the C6 level. E, 3D fusion image demonstrates that the feeders from both sides converge on a focal region—the epidural venous plexus and internal jugular veins—from which venous flow drains exclusively via extradural veins. F, After 2 sessions of transvenous coil embolization, the fistula flow has almost completely disappeared (G and H).