Spinal epidural arteriovenous malformations: clinical, imaging, and angioarchitectural characteristics with...

To characterise clinical, imaging, and angioarchitectural features of spinal epidural arteriovenous malformations (SEAVMs) and report endovascular outcomes from a single-centre series.

We retrospectively reviewed spinal angiograms and clinical records from January 2010 to May 2025 and identified 24 patients with SEAVMs. Demographic, clinical, magnetic resonance imaging (MRI) and computed tomography (CT) findings, digital subtraction angiography characteristics, endovascular interventions, and Karnofsky Performance Status (KPS) before and after treatment were analysed.

Twenty-four patients with a mean age of 25.8 years were included. Presenting complaints were motor weakness in 23/24 (95.8 %) cases, sensory symptoms in 17/24 (70.8 %) cases, radicular pain in 15/24 (62.5 %) cases and bladder or bowel dysfunction in 10/24 (41.7 %) cases. MRI detected an epidural venous sac in 20/24 (83.3 %) cases and cord signal change in 20/24 (83.3 %) cases; CT (n=18) showed vertebral osseous changes in 15/18 (83.3 %) cases. Angiography localised lesions predominantly to lower thoracic levels; five cases were metameric (SAMS) and intradural venous reflux was uncommon. Nineteen patients underwent endovascular embolizisation; N-butyl cyanoacrylateNBCA was used in 18/19 cases and venous sac penetration was achieved in 17/19 cases. There were no major periprocedural neurological complications. Angiographic degrees of obliteration among treated patients were complete/near- complete in 4 patients , substantial in 4 patients, moderate in 9 patients, and partial in 2 patients. Mean follow-up was 49.2 months; and mean KPS improved from 51.1 to 80.0 (mean increase: 28.9 points, P<0.001).

SEAVMs occur in younger patients, frequently involve osseous structures, and are commonly associated with compressive epidural venous sacs. Targeted endovascular occlusion of the venous sac is safe and often yields substantial improvement with durable clinical benefit.