Article Figures & Data
Figures
- Fig 1.
A, Sagittal T2- weighted images (3T; T2-TSE; slice thickness, 3 mm) reveal extensive congestive myelopathy (white arrowhead). B–D, Spinal CE-MRA (3T; time-resolved imaging with strochastic trajectories (TWIST); sagittal MIP; coronal and axial MPR) shows arterialized pouch in the lumbar ventrolateral epidural space (white arrows) in association with arterialized perimedullary veins in the thoracic region (white arrowheads) suspicious for a SEAVF in the lumbar region. E, DSA in lateral projection shows a SEAVF (white arrow) supplied via branches of the left L2 segmental artery (black arrowhead) and drained via the respective intradural radicular vein (white arrowheads). Note the extraspinal venous outlet (asterisk).
- Fig 2.
A–B, Sagittal T2- and contrast-enhanced T1-weighted images (3T; T2-TSE; T1-TSE; slice thickness, 3 mm) show extensive congestive thoracic myelopathy. C, Spinal CE-MRA (sagittal MIP) reveals an abnormal arterialized epidural pouch in the lumbar region (white arrow) in addition to thoracic arterialized perimedullary veins (white arrowhead). D, DSA (posteroanterior projection) exams identify the fistula in the epidural space on the vertebral level of L4 (white arrow), supplied via the right L4 segmental artery and drained by the contralateral L4 intradural radicular vein (white arrowhead). E and F, Axial and coronal MPR of DynaCT, 2 mm, 8 seconds rotation: Note the multisegmental and bilateral extension of the arterialized epidural pouch and the left sided origin of the intradural radicular drainage vein crossing the dura at the contralateral neural foramen (white arrowhead).
- Fig 3.
A, Spinal CE-MRA (1.5 T, sagittal MIP) reveals an extensive pathological arterialization of a ventrolateral epidural venous pouch extending over four vertebral levels (white arrow). B–C, Further reconstructions of the source MRA images (coronal and axial MPR) demonstrate precisely the epidural pouch (white arrow) and show the filling of the intradural radicular drainage vein (white arrowhead). D–E, DSA exams (posteroanterior projections) identify the multisegmental ventrolateral epidural pouch of the SEAVF (white arrow) with multiple left-sided arterial feeders supplied by the thoracic segmental arteries T 10 and T 11. Note the distant origin of the intradural radicular drainage vein (asterisk).
Tables
Patient No. Age (yr)/Sex Duration of Symptoms (mo) Symptoms at Diagnosis Status at Discharge 1 78, M 6 Paraparesis, sphincter dysfunction Improved 2 63, M 1 Paraparesis, sphincter dysfunction hypesthesia below T10 Stable 3 77, M 1.5 Paraparesis, hypesthesia L4, ataxia, sphincter dysfunction Stable 4 60, F 1.5 Paraplegia, hypesthesia disturbances below T10 Improved 5 68, F 24 Neurogenic claudication <100 m Improved 6 77, M 1.5 Paraplegia, hypesthesia below L1, sphincter dysfunction Stable 7 64, F 1 Paraparesis, sphincter dysfunction Improved 8 83, M 60 Paraparesis, hypesthesia, sphincter dysfunction Stable 9 72, M 0 Paraparesis, hypesthesia, sphincter dysfunction Stable 10 80, M 12 Paraparesis, sphincter dysfunction Stable 11 77, M 2 Paresis of left foot, ataxia Stable 12 78, M 3 Paraparesis, hypesthesia Stable 13 59, M 5 Ataxia Stable Patient No. Arterial Feedera Origin of Intradural Radicular Drainage Veina Extension of Epidural Pouchb Extension of Arterialized Perimedullary Veinsb Location of Arterialized Perimedullary Veinsb No. of DSAs until Diagnosis 1 L3 R L3 L L3–L4 T8–T12 D = V 2 2 L3 bilateral, L4 L L3 L L2–L4 T3–T12 D = V 2 3 L1 R L1 R L1 ND D < V 1 4 L3 bilateral L3 R L3 T9–L1 D > V 1 5 Left iliolumbar artery S1 S1 T7–T12 D > V 3 6 T10 L and T11 L L2 L T 10–L3 T6–L1 D = V 3 7 L1 L L2 L L1–L2 T3–T12 D = V 1 8 T12 L T12 L T12 L T11 D > V 3 9 L3 L L3 L L3 L T6–T12 D < V 1 10 L4 R L4 R L2–L4 T3–T10 D = V 1 11 L3 L S1 bilateral L3–S1 T10–L1 D > V 1 12 L3 R L3 R L3 R T9–T12 D < V 1 13 L1 R L1 R L1 R T10–L1 D > V 1
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