Treatment of 23 spinal perimedullary arteriovenous fistulas in a single center: A simple and practical treatment strategy.

Abstract

Background: The aim of the study is to present our strategy for stratifying patients with spinal perimedullary arteriovenous fistulas (PMAVFs) and apply the appropriate treatment.

Methods: This retrospective study included 23 patients with PMAVF. We divided the patients into three groups according to the location of the fistula and size of the predominant feeder: Group 1 (dorsal PMAVF, n = 4), Group 2 (nondorsal PMAVF having a predominant feeder through which the smallest coil-deploying microcatheter could pass, n = 6), and Group 3 (nondorsal PMAVF having no feeder through which the smallest available microcatheter could pass, n = 13). Group 1 underwent surgical treatment. All patients in Groups 2 and 3 underwent endovascular treatment with a liquid embolic agent, except one in Group 3, who opted for surgical treatment. Coil was used as a supplementary tool for treating lesions in Group 2. Patients' basic and clinical characteristics, treatment, and outcome data were recorded.

Results: Six patients were aged <15 years. Overall, patient fistulas were located in the thoracic region (n = 11), conus region (n = 7), and cervical spine (n = 5). Of the 18 PMAVFs who underwent endovascular treatment, 100% occlusion was observed in 14, 90% in 3, and 75% in 1. Nineteen patients had complete or partial recovery of neurological deficits. Six patients experienced temporary worsening immediately after treatment but recovered within 3 months. No bleeding or rebleeding was noted after either treatment.

Conclusion: Our simple strategy for stratifying PMAVF for treatment is easy to apply in clinical practice and results in favorable outcomes.