Treatment of 23 spinal perimedullary arteriovenous fistulas in a single center: A simple and practical treatment strategy.

BACKGROUND

The aim of the study is to present our strategy for stratifying patients with spinal perimedullary arteriovenous fistulas (PMAVFs) and apply the appropriate treatment.

METHODS

This retrospective study included 23 patients with PMAVF. We divided the patients into three groups according to the location of the fistula and size of the predominant feeder: Group 1 (dorsal PMAVF, = 4), Group 2 (nondorsal PMAVF having a predominant feeder through which the smallest coil-deploying microcatheter could pass, = 6), and Group 3 (nondorsal PMAVF having no feeder through which the smallest available microcatheter could pass, = 13). Group 1 underwent surgical treatment. All patients in Groups 2 and 3 underwent endovascular treatment with a liquid embolic agent, except one in Group 3, who opted for surgical treatment. Coil was used as a supplementary tool for treating lesions in Group 2. Patients' basic and clinical characteristics, treatment, and outcome data were recorded.

RESULTS

Six patients were aged <15 years. Overall, patient fistulas were located in the thoracic region ( = 11), conus region ( = 7), and cervical spine ( = 5). Of the 18 PMAVFs who underwent endovascular treatment, 100% occlusion was observed in 14, 90% in 3, and 75% in 1. Nineteen patients had complete or partial recovery of neurological deficits. Six patients experienced temporary worsening immediately after treatment but recovered within 3 months. No bleeding or rebleeding was noted after either treatment.

CONCLUSION

Our simple strategy for stratifying PMAVF for treatment is easy to apply in clinical practice and results in favorable outcomes.