Experience in the treatment of patients with rare arteriovenous spinal fistulas

Abstract

Objective – to study the prevalence, clinical manifestations, features of diagnostics and effectiveness of treatment of rare arteriovenous spinal fistulas.
Materials and methods. From 2004 to 2019 in SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» were examined and treated 43 patients with spinal dural arteriovenous fistulas (DAVF) – type I arteriovenous malformations according to the Anson and Spetzler classification (1992). Only 2 (4.6 %) patients had an afferent effusion from the internal iliac artery with fistula at L5-S1 level. Magnetic resonance imaging and spinal selective subtraction angiography were used to diagnose arteriovenous fistulas. Liquid cyanoacrylate embolizant and transfemoral access were used for endovascular intervention, and posterior median access and single-level hemilaminectomy for microsurgical intervention.
Results. Total DAVF exclusion from blood flow was achieved in both patients. One patient underwent microsurgical separation of DAVF, the other one was operated by a combination of endovascular and microsurgical techniques. Neurological improvement in the postoperative period was noted in both patients.
Conclusions. Arteriovenous fistulas are diverse in clinical manifestations and radiographs. Verification of venous hypertensive myelopathy with the presence of pronounced perimedullary vessels on data of magnetic resonance imaging is the most specific feature of DAVF. If standard spinal angiography does not allow DAVF afferents to be verified it should be supplemented by selective catheterization of the internal iliac arteries, from where the arterial fistula can originate. The study of angioarchitectonics of arteriovenous fistula, according to angiography, makes it possible to choose surgical treatment to ensure effective and radical separation of arteriovenous fistula.