Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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September 21, 2015
Direct Vertebral-Epidural Arteriovenous Fistula
- Relevant Clinical Information:
- Spinal epidural fistulas are uncommon. They are usually asymptomatic. When symptomatic they manifest with a spontaneous epidural hematoma.
- Rarely, they may present with slowly progressive myelopathy or radiculopathy, due to venous reflux through radicular veins into perimedullary veins causing venous congestion.
- Nerve root compression may occur due to the dilated radicular veins within the neural foramina.
- Key Diagnostic Features:
- Epidural AVFs rarely affect intramedullary venous drainage.
- The gold standard diagnostic procedure is angiography were there is a single-hole connection between artery and vein.
- An intervening vascular network is notoriously absent, as its presence would imply a dural spinal AVF.
- DDx:
- Lateral and dorsal spinal dural arteriovenous fistula
- Traumatic vertebro-venous fistula
- Other vascular malformations
- Treatment: Conservative treatment is usually warranted in asymptomatic patients. There is no consensus about treatment strategies in symptomatic patients. When needed, transarterial embolization is the treatment modality of choice.
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