Purely transvenous treatment of cervical paraspinal arteriovenous fistulas

The spinal arteriovenous malformations are rare and comprise a heterogeneous spectrum of disease. Paraspinal arteriovenous fistulas (PSAVF) are defined as pathologic connections between arteries and veins in the paraspinal space. Microsurgical, transarterial or combined transarterial and transvenous embolization has been published as the treatment of choice of such lesions. In this report, we elaborate on the principles of the pathoanatomy of the PSAVF with its implications on the concept of purely transvenous treatment. We present two patients with paraspinal arteriovenous fistula treated with purely transvenous approach and describe the procedure. The rationale of purely transvenous embolization relies on the possibility of direct access of the primary venous structure affected by the PSAVF. The multiple existing connections between the internal and external periverterbal venous plexus, the condylar system and the vertebral veins allows for very precise and restricted occlusion of the pathology, reducing the risk of arterial ischemia of the spinal cord.