Spinal Intradural Arteriovenous Shunt: Angiographic Characteristics and Treatment Outcomes

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Spinal intradural arteriovenous shunts (SIAVS) are uncommon vascular malformations.
• They are classified into spinal cord arteriovenous malformations (SCAVM), spinal cord arteriovenous fistulas (SCAVF), filum terminale arteriovenous fistulas (FTAVF), and radicular arteriovenous malformations (AVM).
• Clinical presentations often involve progressive myelopathy and hemorrhagic events.

Purpose of the Study:

• To elucidate the clinical presentations, angiographic characteristics, and treatment outcomes of SIAVS.
• To evaluate the efficacy of endovascular glue embolization and surgical interventions for SIAVS.

Main Methods:

• A retrospective study of 36 patients diagnosed with SIAVS between 2010 and 2023.
• Data collected included demographics, clinical presentations, radiological findings, treatments, outcomes, and complications.
• Functional outcomes were assessed using the Modified Aminoff and Logue Disability Scale.

Main Results:

• The study included 36 patients (mean age 30.7 years), with 17 SCAVM, 15 SCAVF, and 4 FTAVF.
• Progressive myelopathy was more common in fistulous types (SCAVF/FTAVF), while hematomyelia occurred more in nidus types (SCAVM).
• Endovascular glue embolization in 26 patients resulted in complete obliteration in 33.3% and partial in 55.5%, with significant functional improvements observed across all treatment groups.

Conclusions:

• Transarterial glue embolization is an effective treatment for SIAVS, yielding significant neurological benefits.
• Careful evaluation of anterior spinal artery occlusion risk is crucial during embolization.
• Surgical intervention remains a valuable alternative for managing SIAVS.