Dural fistula

In most patients the dural fistula is supplied by a thoracic or lumbar artery. Deep located fistulas of the lumbosacral region are rare and beset with particular diagnostic problems mainly due to the unusual anatomic and hemodynamic conditions. In these cases MRI should be focused on the lumbosacral region. The arterialized dilated vein of the filum can be detected in 3-mm slices after paramagnetic contrast administration even if the flow is very slow. 

Bousson V, Brunereau L, Vahedi K et al (1999) Intracranial dural fistula as a cause of diffuse MR enhancement of the cervical spinal cord. J Neurol Neurosurg Psychiatry 67 227-230... 

Miller NR, Monsein LH, Debrun GM et al (1995) Treatment of carotid-cavernous sinus fistulas using a superior ophthalmic vein approach. J Neurosurg 83 838-842 Mironov A (1998) Selective transvenous embolization of dural fistulas without occlusion of the dural sinus. AJNR Am J Neuroradiol 19 389-391... 

Subacute/chronic vascular myelopathy Dural AV fistula... 

Thus, acute, subacute, or chronic impairment of spinal blood supply can result from a deficient arterial supply and from venous circulatory problems (Mull and Thron 2004). Spinal vascular malformations like spinal dural arteriovenous (AV) fistulas and AV malformations (AVM) of the perimedullary fistula type are the typical disorders associated with venous congestion of the spinal cord. On the other hand, AVM of the glomerular type are seldom combined with a venous outflow disorder. 

Spinal dural arteriovenous fistulas (SDAVF) are the most frequent (acquired) AVM of the spinal canal and its meninges. In 1977 Kendall and Logue were the first to recognize that this disease, which had formerly been described as so-called retromedullary angiomas, in fact is an AV fistula situated within the dura mater. This was confirmed by Merland et al. in 1980 who pointed out the angiographic characteristics of the disease in detail (Fig. 17.6). 

Perimedullary fistulas type 1 may present with multisegmental hyperintensive cord lesions on T2-weighted images due to congestive myelopathy similar to spinal cord affection in spinal dural AVF. 

Bammer R, Fazekas F, Augustin M, Simbrunner J, Strasser-Fuchs S, Seifert T, Stollberger R, and Hartung HP (2000) Diffusion-weighted MR imaging of the spinal cord. AJNR Am J Neuroradiol 21 (3) 587-591 Behrens S, Thron A (1999) Long-term follow-up and outcome in patients treated for spinal dural arteriovenous fistula. J Neurol 246 181-185... 

Haddad MC, Aabed al-Thagafi MY, Djurberg H (1996) MRI of spinal cord and vertebral body infarction in the anterior spinal artery syndrome. Neuroradiology 38 161-162 HasslerW, Thron A, Grote EH (1989) Hemodynamics of spinal dural arteriovenous fistulas. An intraoperative study. JNeu-rosurg 70 360-370... 

Huffmann BC, Gilsbach JM, Thron A (1995) Spinal dural arteriovenous fistulas a plea for neurosurgical treatment. Acta Neurochir (Wien) 135 44-51... 

Larsen DW, Halbach VV, Teitelbaum GP, McDougaU CG, Higashida RT, Dowd CF, Hieshima GB (1995) Spinal dural arteriovenous fistulas supplied by branches of the internal iliac arteries. Surg Neurol 43 35-40 discussion 40-1 Lasjaun ias P, Berenstein A, ter Brugge KG (2001) Surgical Neu-... 

Rosenblum B, Oldfield EH, Doppman JL, Di Chiro G (1987) Spinal arteriovenous malformations a comparison of dural arteriovenous fistulas and intradural AVM s in 81 patients. J Neurosurg 67 795-802 Rosenkranz M, Grzyska U, Niesen W, Fuchs K, Schummer W, Weiller C, Rother J (2004) Anterior spinal artery syndrome following periradicular cervical nerve root therapy. J Neurol 251 229-231... 

Song JK, Vinuela F, Gobin YP, Duckwiler GR, Murayama Y, Kureshi I, Frazee JG, Martin NA (2001) Surgical and endovascular treatment of spinal dural arteriovenous fistulas long-term disability assessment and prognostic factors. J Neurosurg 94 199-204... 

Intraorbital tumor Caroticocavernous fistula Retinal migraine Intracranial dural malformation Paraneoplastic retinopathy Reversible diabetic cataract Uveitis-glaucoma-hyphema syndrome... 

Atypical antipsychotic drugs Chronic subdural hematoma (Ch. 7) Vertebral/carotid artery dissection (Ch. 6) Fat embolism (Ch. 6) nternal carotid artery stenosis (distal) Dural arteriovenous fistula (Ch. 7)... 

Results of combined stereotactic, radiosurgery and transarterial embolization for dural arteriovenous fistulas of the transverse and sigmoid sinuses. Journal of Neurosurgery 94 886-891... 

Local sepsis (sinuses, ears, mastoids, scalp, nasopharynx) Subdural empyema Bacterial meningitis Dural arteriovenous fistula... 

The presence of a stenosis on the venous drainage of a brain AVM is associated with an increased risk of bleeding (Miyasaka et al. 1992 Nataf et al. 1997), probably due to proximal venous hypertension. This factor was also identified in the large series of patients analyzed by Mansmann et al. (2000), but venous stenosis was not statistically associated with intracranial hemorrhage for cortical AVMs. Venous dilatation was correlated to an increased risk of hemorrhagic presentation in dural arteriovenous fistulas (CoGNARD et al. 1995). 

Onyx as non-adhesive liquid embolic has now become a widely used material to treat AV-malfor-mations and also pial and dural AV-fistulas. With knowledge of the morphologic characteristics of AVMs that are suitable for a treatment with Onyx, high occlusion rates and low complication rates in treating a small number of feeders are feasible. Su-perselective intranidal or perinidal catheter positions and slow, controlled injections that protect the draining veins make the therapy safe even in complex AVMs and critical locations. Complete oblit-... 

---