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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(02): 178-179
DOI: 10.1590/0004-282X20150171
IMAGES IN NEUROLOGY

Intracranial dural arteriovenous fistula with perimedullary drainage treated by endovascular embolization

Fístula arteriovenosa dural intracraniana com drenagem perimedular tratada por embolização via endovascular
Lucas Giansante Abud
1   Documenta, Hospital São Francisco, Departamento de Neurorradiologia, Ribeirao Preto SP, Brazil;
2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Diagnóstica, Ribeirao Preto SP, Brazil;
,
Thiago Giansante Abud
1   Documenta, Hospital São Francisco, Departamento de Neurorradiologia, Ribeirao Preto SP, Brazil;
3   Hospital Albert Einstein, Neurorradiologia Intervencionista, Sao Paulo SP, Brazil;
,
Guilherme Seizem Nakiri
1   Documenta, Hospital São Francisco, Departamento de Neurorradiologia, Ribeirao Preto SP, Brazil;
4   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirao Preto SP, Brazil.
,
Rodolfo Mendes Queiroz
1   Documenta, Hospital São Francisco, Departamento de Neurorradiologia, Ribeirao Preto SP, Brazil;
,
Daniel Giansante Abud
4   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirao Preto SP, Brazil.
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A 66-year-old woman presenting progressive tetraparesis during the past month. Magnetic resonance (MR) showed nonspecific abnormalities in the cervical spinal cord ([Figure 1]), which could be related to demyelination, neoplasia or inflammation[1]. However, these findings, in concomitance with extensive dilated perimedullary vessels, suggested myelopathy secondary to dural arteriovenous fistula (DAVF).

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Figure 1 (A) Sagittal T2-weighted MRI of the cervical spine showing enlargement and signal change of spinal cord and bulb, characterizing myelopathy due to venous congestion. We can also see images of flow artifacts corresponding to enlarged perimedullary veins. (B) Coronal T1-weighted MRI after contrast injection showing venous ectasia around the bulb and spinal (white arrows).

Digital angiography identified a Cognard type V intracranial DAVF ([Figure 2]). After prompt endovascular treatment ([Figure 3]), complete remission of symptoms was obtained.

Zoom Image
Figure 2 Digital angiography showing right sigmoid sinus DAVF (Cognard classification type V) being fed by transosseous branches of the right occipital artery (A) (white arrows), with cortical venous drainage through ectatic and tortuous perimedullary veins (B) (white arrows).
Zoom Image
Figure 3 (A) and (B) Digital angiography after endovascular embolization with Onyx (Medtronic) showing resolution of the fistula. (C) Sagittal T2-weighted MRI of the cervical spine, at 3 months after treatment, demonstrating no evidence of cervical myelopathy or dilated vascular structures, with complete regression of the intramedullary edema.

Despite its intracranial location, type V DAVF presents, by definition, perimedullary venous drainage, which leads to venous congestion, and, consequently, intramedullary edema, progressive myelopathy and chronic hypoxia[1] , [2] , [3].


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Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 Ernst RJ, Gaskill-Shipley M, Tomsick TA, Hall LC, Tew JM Jr, Yeh HS. Cervical myelopathy associated with intracranial dural arteriovenous fistula: MR findings before and after treatment. AJNR Am J Neuroradiol. 1997;18(7):1330-4.
  • 2 Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995;194(3):671-80. doi:10.1148/radiology.194.3.7862961
  • 3 Abud TG, Nguyen A, Saint-Maurice JP, Abud DG, Bresson D, Chiumarulo L, Enesi E, Houdart E. The use of Onyx in different types of intracranial dural arteriovenous fistula. AJNR Am J Neuroradiol. 2011;32(11):2185-91. doi:10.3174/ajnr.A2702

Address for correspondence

Lucas Giansante Abud
Rua Olavo Bilac, 839; 14020-020 Ribeirão Preto SP
Brasil   

Publication History

Received: 27 June 2015

Accepted: 11 September 2015

Article published online:
06 September 2023

© 2015. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ernst RJ, Gaskill-Shipley M, Tomsick TA, Hall LC, Tew JM Jr, Yeh HS. Cervical myelopathy associated with intracranial dural arteriovenous fistula: MR findings before and after treatment. AJNR Am J Neuroradiol. 1997;18(7):1330-4.
  • 2 Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995;194(3):671-80. doi:10.1148/radiology.194.3.7862961
  • 3 Abud TG, Nguyen A, Saint-Maurice JP, Abud DG, Bresson D, Chiumarulo L, Enesi E, Houdart E. The use of Onyx in different types of intracranial dural arteriovenous fistula. AJNR Am J Neuroradiol. 2011;32(11):2185-91. doi:10.3174/ajnr.A2702

   Permissions and Reprints
Zoom Image
Figure 1 (A) Sagittal T2-weighted MRI of the cervical spine showing enlargement and signal change of spinal cord and bulb, characterizing myelopathy due to venous congestion. We can also see images of flow artifacts corresponding to enlarged perimedullary veins. (B) Coronal T1-weighted MRI after contrast injection showing venous ectasia around the bulb and spinal (white arrows).
Zoom Image
Figure 2 Digital angiography showing right sigmoid sinus DAVF (Cognard classification type V) being fed by transosseous branches of the right occipital artery (A) (white arrows), with cortical venous drainage through ectatic and tortuous perimedullary veins (B) (white arrows).
Zoom Image
Figure 3 (A) and (B) Digital angiography after endovascular embolization with Onyx (Medtronic) showing resolution of the fistula. (C) Sagittal T2-weighted MRI of the cervical spine, at 3 months after treatment, demonstrating no evidence of cervical myelopathy or dilated vascular structures, with complete regression of the intramedullary edema.