A New Type of Spinal Epidural Arteriovenous Fistulas Causes Spinal Epidural Hemorrhage: An Analysis of Five Cases and Natural History Consideration

• Published in: World neurosurgery 2017-07, Vol.103, p.371-379
• Main Authors: Yu, Jia-Xing, M.D, Hong, Tao, M.D, Ma, Yong-Jie, M.D, Ling, Feng, M.D., Ph.D, Zhang, Hong-Qi, M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Arteriovenous Fistula - complications; Edema - etiology; Epidural Space - blood supply; Female; Hematoma, Epidural, Spinal - complications; Humans; Magnetic Resonance Imaging; Male; Natural history; Neurosurgery; Spinal Canal - blood supply; Spinal Diseases - etiology; Spinal epidural arteriovenous fistula; Spontaneous spinal epidural hematoma; Vertebral Artery - abnormalities; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.04.036

Abstract Background Spinal epidural arteriovenous fistulas (SEDAVFs) are peculiar and poorly understood lesions with a poorly understood natural history. They are usually subclassified into two types according to their drainage components. This study aimed to describe a new type of SEDAVFs that is featured with a unique drainage pattern and present our natural history hypothesis of SEDAVFs. Methods Five SEDAVF cases of the new type were retrospectively reviewed from a high case-volume spinal vascular malformation database. The clinical manifestations, neuroradiologic findings, angioarchitecture, treatment strategies and clinical outcomes were assessed. Results All of the patients presented with spontaneous spinal epidural hematoma (SSEH) and 2 of them exhibited rebleeding. The median age at the initial episode was 20 years. Spinal digital subtraction angiography (DSA) revealed slow-flow epidural fistulas drained by spinal epidural venous plexus without intradural drainage or engorged venous pouches in all 5 patients. Three patients underwent microsurgical treatment. The outcomes of all of the patients were favorable. Conclusion Our study reported a special type of hemorrhagical SEDAVF without an intradural drainage component or epidural mass effect. The key diagnostic clue was early opacification of spinal epidural venous plexus on spinal angiogram. We believe SEDAVFs may form at an early age and gradually develop with time. Different types of SEDAVFs may represent different developing stages of one disease, and our type may represent the early stage of SEDAVFs.