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<meta name="DC.Title" content="Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5497" />
<meta name="DC.Date" content="2018-02-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Spinal dural arteriovenous fistulas located in the deep lumbosacral region are rare and the most difficult to diagnose among spinal dural arteriovenous fistulas located elsewhere in the spinal dura. Specific clinical and radiologic features of these fistulas are still inadequately reported and are the subject of this study.

MATERIALS AND METHODS: We retrospectively evaluated all data of patients with spinal dural arteriovenous fistulas treated and/or diagnosed in our institution between 1990 and 2017. Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this study.

RESULTS: The most common neurologic findings at the time of admission were paraparesis (85%), sphincter dysfunction (70%), and sensory disturbances (20%). Medullary T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 19/20 (95%) patients. Time-resolved contrast-enhanced dynamic MRA indicated a spinal dural arteriovenous fistula at or below the L5 vertebral level in 7/8 (88%) patients who received time-resolved contrast-enhanced dynamic MRA before DSA. A bilateral arterial supply of the fistula was detected via DSA in 5 (25%) patients.

CONCLUSIONS: Clinical symptoms caused by deep lumbosacral spinal dural arteriovenous fistulas are comparable with those of spinal dural arteriovenous fistulas at other locations. Medullary congestion in association with an enlargement of the filum vein or other lumbar radicular veins is a characteristic finding in these patients. Spinal time-resolved contrast-enhanced dynamic MRA facilitates the detection of the drainage vein and helps to localize deep lumbosacral-located fistulas with a high sensitivity before DSA. Definite detection of these fistulas remains challenging and requires sufficient visualization of the fistula-supplying arteries and draining veins by conventional spinal angiography.

AV
:   arteriovenous
CE-MRA
:   time-resolved contrast-enhanced dynamic MRA
FV
:   filum terminale vein
lsSDAVF
:   deep lumbosacral spinal dural arteriovenous fistula
SDAVF
:   spinal dural arteriovenous fistula" />
<meta name="DC.Contributor" content="F. Jablawi" />
<meta name="DC.Contributor" content="O. Nikoubashman" />
<meta name="DC.Contributor" content="G.A. Schubert" />
<meta name="DC.Contributor" content="M. Dafotakis" />
<meta name="DC.Contributor" content="F.-J. Hans" />
<meta name="DC.Contributor" content="M. Mull" />
<meta name="article:published_time" content="2018-02-01" />
<meta name="article:section" content="Spine" />
<meta name="citation_title" content="Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Spinal dural arteriovenous fistulas located in the deep lumbosacral region are rare and the most difficult to diagnose among spinal dural arteriovenous fistulas located elsewhere in the spinal dura. Specific clinical and radiologic features of these fistulas are still inadequately reported and are the subject of this study.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively evaluated all data of patients with spinal dural arteriovenous fistulas treated and/or diagnosed in our institution between 1990 and 2017. Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this study.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The most common neurologic findings at the time of admission were paraparesis (85%), sphincter dysfunction (70%), and sensory disturbances (20%). Medullary T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 19/20 (95%) patients. Time-resolved contrast-enhanced dynamic MRA indicated a spinal dural arteriovenous fistula at or below the L5 vertebral level in 7/8 (88%) patients who received time-resolved contrast-enhanced dynamic MRA before DSA. A bilateral arterial supply of the fistula was detected via DSA in 5 (25%) patients.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Clinical symptoms caused by deep lumbosacral spinal dural arteriovenous fistulas are comparable with those of spinal dural arteriovenous fistulas at other locations. Medullary congestion in association with an enlargement of the filum vein or other lumbar radicular veins is a characteristic finding in these patients. Spinal time-resolved contrast-enhanced dynamic MRA facilitates the detection of the drainage vein and helps to localize deep lumbosacral-located fistulas with a high sensitivity before DSA. Definite detection of these fistulas remains challenging and requires sufficient visualization of the fistula-supplying arteries and draining veins by conventional spinal angiography.&lt;/p&gt;" />
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<meta name="twitter:title" content="Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas" />
<meta name="twitter:card" content="summary_large_image" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Spinal dural arteriovenous fistulas located in the deep lumbosacral region are rare and the most difficult to diagnose among spinal dural arteriovenous fistulas located elsewhere in the spinal dura. Specific clinical and radiologic features of these fistulas are still inadequately reported and are the subject of this study.

MATERIALS AND METHODS: We retrospectively evaluated all data of patients with spinal dural arteriovenous fistulas treated and/or diagnosed in our institution between 1990 and 2017. Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this study.

RESULTS: The most common neurologic findings at the time of admission were paraparesis (85%), sphincter dysfunction (70%), and sensory disturbances (20%). Medullary T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 19/20 (95%) patients. Time-resolved contrast-enhanced dynamic MRA indicated a spinal dural arteriovenous fistula at or below the L5 vertebral level in 7/8 (88%) patients who received time-resolved contrast-enhanced dynamic MRA before DSA. A bilateral arterial supply of the fistula was detected via DSA in 5 (25%) patients.

CONCLUSIONS: Clinical symptoms caused by deep lumbosacral spinal dural arteriovenous fistulas are comparable with those of spinal dural arteriovenous fistulas at other locations. Medullary congestion in association with an enlargement of the filum vein or other lumbar radicular veins is a characteristic finding in these patients. Spinal time-resolved contrast-enhanced dynamic MRA facilitates the detection of the drainage vein and helps to localize deep lumbosacral-located fistulas with a high sensitivity before DSA. Definite detection of these fistulas remains challenging and requires sufficient visualization of the fistula-supplying arteries and draining veins by conventional spinal angiography.

AV
:   arteriovenous
CE-MRA
:   time-resolved contrast-enhanced dynamic MRA
FV
:   filum terminale vein
lsSDAVF
:   deep lumbosacral spinal dural arteriovenous fistula
SDAVF
:   spinal dural arteriovenous fistula" />
<meta name="og-title" property="og:title" content="Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/39/2/392" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Spinal dural arteriovenous fistulas located in the deep lumbosacral region are rare and the most difficult to diagnose among spinal dural arteriovenous fistulas located elsewhere in the spinal dura. Specific clinical and radiologic features of these fistulas are still inadequately reported and are the subject of this study.

MATERIALS AND METHODS: We retrospectively evaluated all data of patients with spinal dural arteriovenous fistulas treated and/or diagnosed in our institution between 1990 and 2017. Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this study.

RESULTS: The most common neurologic findings at the time of admission were paraparesis (85%), sphincter dysfunction (70%), and sensory disturbances (20%). Medullary T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 19/20 (95%) patients. Time-resolved contrast-enhanced dynamic MRA indicated a spinal dural arteriovenous fistula at or below the L5 vertebral level in 7/8 (88%) patients who received time-resolved contrast-enhanced dynamic MRA before DSA. A bilateral arterial supply of the fistula was detected via DSA in 5 (25%) patients.

CONCLUSIONS: Clinical symptoms caused by deep lumbosacral spinal dural arteriovenous fistulas are comparable with those of spinal dural arteriovenous fistulas at other locations. Medullary congestion in association with an enlargement of the filum vein or other lumbar radicular veins is a characteristic finding in these patients. Spinal time-resolved contrast-enhanced dynamic MRA facilitates the detection of the drainage vein and helps to localize deep lumbosacral-located fistulas with a high sensitivity before DSA. Definite detection of these fistulas remains challenging and requires sufficient visualization of the fistula-supplying arteries and draining veins by conventional spinal angiography.

AV
:   arteriovenous
CE-MRA
:   time-resolved contrast-enhanced dynamic MRA
FV
:   filum terminale vein
lsSDAVF
:   deep lumbosacral spinal dural arteriovenous fistula
SDAVF
:   spinal dural arteriovenous fistula" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node58365--5" data-node-nid="58365" id="top-node-58365--61314689798" data-pisa="ajnr;39/2/392" data-pisa-master="ajnr;ajnr.A5497" data-apath="/ajnr/39/2/392.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">F. Jablawi</span>, <span class="highwire-citation-author" data-delta="1">O. Nikoubashman</span>, <span class="highwire-citation-author" data-delta="2">G.A. Schubert</span>, <span class="highwire-citation-author" data-delta="3">M. Dafotakis</span>, <span class="highwire-citation-author" data-delta="4">F.-J. Hans</span> and <span class="highwire-citation-author" data-delta="5">M. Mull</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">February 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">392-398; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5497 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-58365--61314689798" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">F. Jablawi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Diagnostic and Interventional Neuroradiology (F.J., O.N., M.M.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BJablawi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jablawi%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.%2BJablawi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5620-0384" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. Jablawi</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">O. Nikoubashman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Diagnostic and Interventional Neuroradiology (F.J., O.N., M.M.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Diagnostic and Interventional Radiology (O.N.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=O.%2BNikoubashman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nikoubashman%20O&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AO.%2BNikoubashman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-2055-4217" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for O. Nikoubashman</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">G.A. Schubert </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery (G.A.S.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.A.%2BSchubert%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Schubert%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.A.%2BSchubert%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-9135-6042" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G.A. Schubert</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M. Dafotakis </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Neurology (M.D.), RWTH Aachen University Hospital, Aachen, Germany</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BDafotakis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Dafotakis%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BDafotakis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9680-7436" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Dafotakis</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">F.-J. Hans </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neurosurgery (F-.J.H.), Paracelsus Kliniken, Osnabrück, Germany.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.-J.%2BHans%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hans%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.-J.%2BHans%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-8211-6223" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F.-J. Hans</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">M. Mull </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Diagnostic and Interventional Neuroradiology (F.J., O.N., M.M.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BMull%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mull%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BMull%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-7789-2957" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. 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      <div class="highwire-cite-title">Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Jablawi</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">O.</span> <span class="nlm-surname">Nikoubashman</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.A.</span> <span class="nlm-surname">Schubert</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Dafotakis</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">F.-J.</span> <span class="nlm-surname">Hans</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Mull</span></span></span></div>
  
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      <div class="highwire-cite-title">Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Jablawi</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">O.</span> <span class="nlm-surname">Nikoubashman</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.A.</span> <span class="nlm-surname">Schubert</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Dafotakis</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">F.-J.</span> <span class="nlm-surname">Hans</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Mull</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Feb 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">392-398; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5497 </span></div>
  
  
  
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