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Transarterial Embolization Safe and Effective in Giant Perimedullary Arteriovenous Fistulas

A transvenous approach and direct puncture of the venous pouch are also good options

According to a study published recently in Neurosurgery, cervical giant perimedullary arteriovenous fistulas can be treated effectively with transarterial embolization. Treatment should take place in highly experienced centers, however.

Spinal vascular malformations are a rare pathology, and perimedullary arteriovenous malformations account for 17 to 39 percent of them. Little data existed on their presentation and treatment, so the authors of the current study wanted to investigate further. They reviewed a series of 369 spinal malformations treated between January 1990 and December 2009 at a group of European hospitals. Six patients had giant perimedullary arteriovenous fistulas (GPMAVFs) of the cervical region, which are unique in their high flow and local drainage to the epidural space.

Clinical presentations included progressive motor deficits, hematomyelia, meningeal syndrome, and respiratory arrest and gait apraxia. Three GPMAVF patients were treated with transarterial embolization, two patients were treated with a transvenous approach, and one patient was treated with direct puncture of the ecstatic venous pouch due to complex anatomy. All were observed post-procedure and treated with intravenous heparin to prevent progressive venous thrombosis. Complete occlusion was the result in every embolization and there was no recanalization during a mean 21 months of follow-up. Three patients were asymptomatic. “Transarterial embolization of cervical GPMAVFs with coils and [n-butyl-2-cyanoacrylate] is safe when it is realized in highly experienced centers. Surgery of this type of fistula can be used to address incomplete embolizations or postembolization complications. Cervical GPMAVFs with complex angioarchitecture can be treated with transvenous embolization or direct puncture of the venous pouch with very good clinical results,” the authors conclude.

Source: Casasco A, Guimaraens L, Senturk C, et al. 2012. Endovascular treatment of cervical giant perimedullary arteriovenous fistulas. Neurosurgery 70:141-149.