Kiyosue Hiro, Matsumaru Yuji, Niimi Yasunari, Takai Keisuke, Ishiguro Tomoya, Hiramatsu Masafumi, Tatebayashi Kotaro, Takagi Toshinori, Yoshimura Shinichi
From the Department of Radiology, Oita University Hospital, Yufu, Japan (H.K.); Department of Neurosurgery, Tsukuba University, Japan (Y.M.); Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan (Y.N.); Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Japan (K.T.); Department of Neurosurgery, Osaka City General Hospital, Japan (T.I.); Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan (M.H.); and Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan (K.T., T.T., S.Y.).
Stroke. 2017 Dec;48(12):3215-3222. doi: 10.1161/STROKEAHA.117.019131. Epub 2017 Nov 7.
The purpose of this study is to compare the angiographic and clinical characteristics of spinal epidural arteriovenous fistulas (SEAVFs) and spinal dural arteriovenous fistulas (SDAVFs) of the thoracolumbar spine.
A total of 168 cases diagnosed as spinal dural or extradural arteriovenous fistulas of the thoracolumbar spine were collected from 31 centers. Angiography and clinical findings, including symptoms, sex, and history of spinal surgery/trauma, were retrospectively reviewed. Angiographic images were evaluated, with a special interest in spinal levels, feeders, shunt points, a shunted epidural pouch and its location, and drainage pattern, by 6 readers to reach a consensus.
The consensus diagnoses by the 6 readers were SDAVFs in 108 cases, SEAVFs in 59 cases, and paravertebral arteriovenous fistulas in 1 case. Twenty-nine of 59 cases (49%) of SEAVFs were incorrectly diagnosed as SDAVFs at the individual centers. The thoracic spine was involved in SDAVFs (87%) more often than SEAVFs (17%). Both types of arteriovenous fistulas were predominant in men (82% and 73%) and frequently showed progressive myelopathy (97% and 92%). A history of spinal injury/surgery was more frequently found in SEAVFs (36%) than in SDAVFs (12%; =0.001). The shunt points of SDAVFs were medial to the medial interpedicle line in 77%, suggesting that SDAVFs commonly shunt to the bridging vein. All SEAVFs formed an epidural shunted pouch, which was frequently located in the ventral epidural space (88%) and drained into the perimedullary vein (75%), the paravertebral veins (10%), or both (15%).
SDAVFs and SEAVFs showed similar symptoms and male predominance. SDAVFs frequently involve the thoracic spine and shunt into the bridging vein. SEAVFs frequently involve the lumbar spine and form a shunted pouch in the ventral epidural space draining into the perimedullary vein.
本研究旨在比较胸腰椎节段脊髓硬膜外动静脉瘘（SEAVF）和脊髓硬脊膜动静脉瘘（SDAVF）的血管造影特征及临床特点。
从31个中心收集了168例诊断为胸腰椎节段脊髓硬膜或硬膜外动静脉瘘的病例。对血管造影及临床资料进行回顾性分析，包括症状、性别、脊柱手术/外伤史等。由6名阅片者对血管造影图像进行评估，重点关注脊髓节段、供血动脉、分流点、硬膜外分流囊及其位置、引流方式，以达成共识。
6名阅片者的共识诊断为SDAVF 108例，SEAVF 59例，椎旁动静脉瘘1例。59例SEAVF中有29例（49%）在各中心被误诊为SDAVF。SDAVF累及胸椎（87%）较SEAVF（17%）更为常见。两种类型的动静脉瘘均以男性为主（分别为82%和73%），且常表现为进行性脊髓病（分别为97%和92%）。SEAVF（36%）较SDAVF（12%；P=0.001）更常出现脊柱损伤/手术史。77%的SDAVF分流点位于椎弓根内侧连线内侧，提示SDAVF通常向桥静脉分流。所有SEAVF均形成硬膜外分流囊，常位于硬膜前间隙（88%），并引流至脊髓周静脉（75%）、椎旁静脉（10%）或两者（15%）。
SDAVF和SEAVF具有相似的症状且以男性为主。SDAVF常累及胸椎并向桥静脉分流。SEAVF常累及腰椎并在硬膜前间隙形成分流囊，引流至脊髓周静脉。
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