Neurointervention.  2012 Feb;7(1):10-16. 10.5469/neuroint.2012.7.1.10.

Angioarchitecture of Spinal Dural Arteriovenous Fistula - Evaluation with 3D Rotational Angiography

• Suh DC
• Kim HS
• Baek HJ
• Park JW
• Kim KK
• Rhim SC

• KMID: 1783993
• DOI: http://doi.org/10.5469/neuroint.2012.7.1.10

Abstract

PURPOSE
The complex angioarchitecture of spinal dural arteriovenous fistulas (SDAVFs) sometimes preclude angiographic analyses or superselective procedures. Therefore, the effectiveness of 3 dimensional rotational angiography (3DRA) as a detailed imaging technique for SDAVFs was evaluated.
MATERIALS AND METHODS
Of 57 patients with spinal vascular malformations, recent 13 SDAVF patients underwent 3DRA. The advantage of 3DRA compared to digital subtraction angiography (DSA) in imaging SDAVF was assessed. Angioarchitecture of SDAVF was focused on location, number, and course of feeders and draining vein. Appropriate angled views were also selected to reveal the segmental artery and feeders.
RESULTS
3DRA technique provided additional information for imaging evaluation of SDAVFs compared to DSA; the presence of multiple feeders, including their transdural portions, as well as their courses. The contralaterally angled anterior-oblique-caudal (spider) view showed the radicular feeder by separating the intercostal artery and the dorsal muscular branch. The bottom-to-up (tunnel) view was useful for revealing the location (ventral vs. dorsal) including sharp medial turn of the dural feeder. The dual mode, which displays both vessels and bones, revealed the course of the feeders and the fistula related to the spinal bony column.
CONCLUSION
Because spinal vasculature overlaps in DSA, 3DRA revealed additional information for evaluations of the number and transdural course of fistular feeders in SDAVFs, and it offers working angles to obtain appropriate views.

Keyword

Arteriovenous fistula; Spine; Imaging, Three-dimensional

MeSH Terms

Angiography
Angiography, Digital Subtraction
Arteries
Arteriovenous Fistula
Central Nervous System Vascular Malformations
Fistula
Humans
Imaging, Three-Dimensional
Imidazoles
Nitro Compounds
Spine
Vascular Malformations
Veins
Imidazoles
Nitro Compounds

Figure

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  Fig. 1 A 47-year-old male presented with progressive numbness and weakness in both legs.A. The spider view of the right T6 segmental arteriogram shows a radiculodural artery (arrow) running off of the segmental artery.B. The tunnel view shows how acutely the feeder makes a medial turn to enter the intervertebral foramen (a long arrow).C. The selective angiogram shows two parallel channels of the feeder that turn downward toward the fistula (arrows). These two channels can be regarded as the transdural course of the fistula. Note two separate veins ascending and descending directly from the focally dilated fistular end (arrowhead).D. The dual mode (showing vessels and bone) shows how far the fistula is relative to the right pedicle (asterisk) of the T7 vertebra.E. The glue cast penetrated the transdural channels (short arrows) as well as the focally dilated fistular pouch.

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  Fig. 2 A 64-year-old female presented with voiding difficulty and weakness in both legs for two months.A. The left L3 lumbar arteriogram shows a SDAVF (arrow) draining into the ascending radicular vein (short arrow).B. The 3D angiogram reveals two separate feeders (arrows) converging onto a fistula.C. The lower feeder (a short arrow) was selected because the upper one (a long arrow) was difficult to select due to the acute angle of its origin.D. A small amount of glue cast penetrated the proximal radicular vein (arrow), occluding the view of the other feeder.

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