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<meta name="DC.Title" content="Osseous versus Nonosseous Spinal Epidural Arteriovenous Fistulas: Experiences of 13 Patients" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5904" />
<meta name="DC.Date" content="2019-01-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2019 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Spinal epidural arteriovenous fistulas are rare vascular malformations. We present 13 patients with spinal epidural arteriovenous fistulas, noting the various presenting symptom patterns, imaging findings related to bone involvement, and outcomes.

MATERIALS AND METHODS: Among 111 patients with spinal vascular malformations in the institutional data base from 1993 to 2017, thirteen patients (11.7%) had spinal epidural arteriovenous fistulas. We evaluated presenting symptoms and imaging findings, including bone involvement and mode of treatment. To assess the treatment outcome, we compared initial and follow-up clinical status using the modified Aminoff and Logue Scale of Disability and the modified Rankin Scale.

RESULTS: The presenting symptoms were lower back pain ( n = 2), radiculopathy ( n = 5), and myelopathy ( n = 7). There is overlap of symptoms in 1 patient (No. 11). Distribution of spinal epidural arteriovenous fistulas was cervical ( n = 3), thoracic ( n = 2), lumbar ( n = 6), and sacral ( n = 2). Intradural venous reflux was identified in 7 patients with congestive venous myelopathy. The fistulas were successfully treated in all patients who underwent treatment (endovascular embolization, n = 10; operation, n = 1) except 2 patients who refused treatment due to tolerable symptoms. Transarterial glue ( n = 7) was used in nonosseous types; and transvenous coils ( n = 3), in osseous type. After 19 months of median follow-up, the patients showed symptom improvement after treatment.

CONCLUSIONS: Although presenting symptoms were diverse, myelopathy caused by intradural venous reflux was the main target of treatment. Endovascular treatment was considered via an arterial approach in nonosseous types and via a venous approach in osseous types.

ALS
:   Aminoff and Logue Scale of Disability
SDAVF
:   spinal dural arteriovenous fistula
SEDAVF
:   spinal epidural arteriovenous fistula
TAE
:   transarterial embolization
TVE
:   transvenous embolization" />
<meta name="DC.Contributor" content="Y. Song" />
<meta name="DC.Contributor" content="S.H. Cho" />
<meta name="DC.Contributor" content="D.W. Lee" />
<meta name="DC.Contributor" content="J.J. Sheen" />
<meta name="DC.Contributor" content="J.H. Shin" />
<meta name="DC.Contributor" content="D.C. Suh" />
<meta name="article:published_time" content="2019-01-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Osseous versus Nonosseous Spinal Epidural Arteriovenous Fistulas: Experiences of 13 Patients" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Spinal epidural arteriovenous fistulas are rare vascular malformations. We present 13 patients with spinal epidural arteriovenous fistulas, noting the various presenting symptom patterns, imaging findings related to bone involvement, and outcomes.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Among 111 patients with spinal vascular malformations in the institutional data base from 1993 to 2017, thirteen patients (11.7%) had spinal epidural arteriovenous fistulas. We evaluated presenting symptoms and imaging findings, including bone involvement and mode of treatment. To assess the treatment outcome, we compared initial and follow-up clinical status using the modified Aminoff and Logue Scale of Disability and the modified Rankin Scale.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The presenting symptoms were lower back pain (&lt;i&gt;n&lt;/i&gt; = 2), radiculopathy (&lt;i&gt;n&lt;/i&gt; = 5), and myelopathy (&lt;i&gt;n&lt;/i&gt; = 7). There is overlap of symptoms in 1 patient (No. 11). Distribution of spinal epidural arteriovenous fistulas was cervical (&lt;i&gt;n&lt;/i&gt; = 3), thoracic (&lt;i&gt;n&lt;/i&gt; = 2), lumbar (&lt;i&gt;n&lt;/i&gt; = 6), and sacral (&lt;i&gt;n&lt;/i&gt; = 2). Intradural venous reflux was identified in 7 patients with congestive venous myelopathy. The fistulas were successfully treated in all patients who underwent treatment (endovascular embolization, &lt;i&gt;n&lt;/i&gt; = 10; operation, &lt;i&gt;n&lt;/i&gt; = 1) except 2 patients who refused treatment due to tolerable symptoms. Transarterial glue (&lt;i&gt;n&lt;/i&gt; = 7) was used in nonosseous types; and transvenous coils (&lt;i&gt;n&lt;/i&gt; = 3), in osseous type. After 19 months of median follow-up, the patients showed symptom improvement after treatment.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Although presenting symptoms were diverse, myelopathy caused by intradural venous reflux was the main target of treatment. Endovascular treatment was considered via an arterial approach in nonosseous types and via a venous approach in osseous types.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_mjid" content="ajnr;40/1/129" />
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<meta name="citation_author" content="Y. Song" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology and Research Institute of Radiology (Y.S., D.W.L., J.J.S., J.H.S., D.C.S.), University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea" />
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<meta name="citation_author" content="S.H. Cho" />
<meta name="citation_author_institution" content="bDepartment of Neurosurgery (S.H.C.), Ulsan University College of Medicine, Asan Hospital, Gang-reung, Republic of Korea." />
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<meta name="twitter:title" content="Osseous versus Nonosseous Spinal Epidural Arteriovenous Fistulas: Experiences of 13 Patients" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Spinal epidural arteriovenous fistulas are rare vascular malformations. We present 13 patients with spinal epidural arteriovenous fistulas, noting the various presenting symptom patterns, imaging findings related to bone involvement, and outcomes.

MATERIALS AND METHODS: Among 111 patients with spinal vascular malformations in the institutional data base from 1993 to 2017, thirteen patients (11.7%) had spinal epidural arteriovenous fistulas. We evaluated presenting symptoms and imaging findings, including bone involvement and mode of treatment. To assess the treatment outcome, we compared initial and follow-up clinical status using the modified Aminoff and Logue Scale of Disability and the modified Rankin Scale.

RESULTS: The presenting symptoms were lower back pain ( n = 2), radiculopathy ( n = 5), and myelopathy ( n = 7). There is overlap of symptoms in 1 patient (No. 11). Distribution of spinal epidural arteriovenous fistulas was cervical ( n = 3), thoracic ( n = 2), lumbar ( n = 6), and sacral ( n = 2). Intradural venous reflux was identified in 7 patients with congestive venous myelopathy. The fistulas were successfully treated in all patients who underwent treatment (endovascular embolization, n = 10; operation, n = 1) except 2 patients who refused treatment due to tolerable symptoms. Transarterial glue ( n = 7) was used in nonosseous types; and transvenous coils ( n = 3), in osseous type. After 19 months of median follow-up, the patients showed symptom improvement after treatment.

CONCLUSIONS: Although presenting symptoms were diverse, myelopathy caused by intradural venous reflux was the main target of treatment. Endovascular treatment was considered via an arterial approach in nonosseous types and via a venous approach in osseous types.

ALS
:   Aminoff and Logue Scale of Disability
SDAVF
:   spinal dural arteriovenous fistula
SEDAVF
:   spinal epidural arteriovenous fistula
TAE
:   transarterial embolization
TVE
:   transvenous embolization" />
<meta name="og-title" property="og:title" content="Osseous versus Nonosseous Spinal Epidural Arteriovenous Fistulas: Experiences of 13 Patients" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/40/1/129" />
<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 epidural arteriovenous fistulas are rare vascular malformations. We present 13 patients with spinal epidural arteriovenous fistulas, noting the various presenting symptom patterns, imaging findings related to bone involvement, and outcomes.

MATERIALS AND METHODS: Among 111 patients with spinal vascular malformations in the institutional data base from 1993 to 2017, thirteen patients (11.7%) had spinal epidural arteriovenous fistulas. We evaluated presenting symptoms and imaging findings, including bone involvement and mode of treatment. To assess the treatment outcome, we compared initial and follow-up clinical status using the modified Aminoff and Logue Scale of Disability and the modified Rankin Scale.

RESULTS: The presenting symptoms were lower back pain ( n = 2), radiculopathy ( n = 5), and myelopathy ( n = 7). There is overlap of symptoms in 1 patient (No. 11). Distribution of spinal epidural arteriovenous fistulas was cervical ( n = 3), thoracic ( n = 2), lumbar ( n = 6), and sacral ( n = 2). Intradural venous reflux was identified in 7 patients with congestive venous myelopathy. The fistulas were successfully treated in all patients who underwent treatment (endovascular embolization, n = 10; operation, n = 1) except 2 patients who refused treatment due to tolerable symptoms. Transarterial glue ( n = 7) was used in nonosseous types; and transvenous coils ( n = 3), in osseous type. After 19 months of median follow-up, the patients showed symptom improvement after treatment.

CONCLUSIONS: Although presenting symptoms were diverse, myelopathy caused by intradural venous reflux was the main target of treatment. Endovascular treatment was considered via an arterial approach in nonosseous types and via a venous approach in osseous types.

ALS
:   Aminoff and Logue Scale of Disability
SDAVF
:   spinal dural arteriovenous fistula
SEDAVF
:   spinal epidural arteriovenous fistula
TAE
:   transarterial embolization
TVE
:   transvenous embolization" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Interventional</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Osseous versus Nonosseous Spinal Epidural Arteriovenous Fistulas: Experiences of 13 Patients</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Y. Song</span>, <span class="highwire-citation-author" data-delta="1">S.H. Cho</span>, <span class="highwire-citation-author" data-delta="2">D.W. Lee</span>, <span class="highwire-citation-author" data-delta="3">J.J. Sheen</span>, <span class="highwire-citation-author" data-delta="4">J.H. Shin</span> and <span class="highwire-citation-author" data-delta="5">D.C. Suh</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">January 2019,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">129-134; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5904 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-65172--6327025714" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Y. Song </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 Radiology and Research Institute of Radiology (Y.S., D.W.L., J.J.S., J.H.S., D.C.S.), University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea</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=Y.%2BSong%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=Song%20Y&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%3AY.%2BSong%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="https://orcid.org/0000-0003-4738-0533" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Song</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S.H. Cho </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Neurosurgery (S.H.C.), Ulsan University College of Medicine, Asan Hospital, Gang-reung, Republic of Korea.</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=S.H.%2BCho%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=Cho%20S&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%3AS.H.%2BCho%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="https://orcid.org/0000-0002-8906-6422" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.H. Cho</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">D.W. Lee </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 Radiology and Research Institute of Radiology (Y.S., D.W.L., J.J.S., J.H.S., D.C.S.), University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea</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=D.W.%2BLee%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=Lee%20D&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%3AD.W.%2BLee%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="https://orcid.org/0000-0002-7795-6110" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.W. Lee</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">J.J. Sheen </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 Radiology and Research Institute of Radiology (Y.S., D.W.L., J.J.S., J.H.S., D.C.S.), University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea</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=J.J.%2BSheen%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=Sheen%20J&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%3AJ.J.%2BSheen%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="https://orcid.org/0000-0002-0474-5830" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.J. 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Shin </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 Radiology and Research Institute of Radiology (Y.S., D.W.L., J.J.S., J.H.S., D.C.S.), University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea</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=J.H.%2BShin%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=Shin%20J&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%3AJ.H.%2BShin%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="https://orcid.org/0000-0001-5922-5720" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.H. 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Suh </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 Radiology and Research Institute of Radiology (Y.S., D.W.L., J.J.S., J.H.S., D.C.S.), University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea</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=D.C.%2BSuh%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=Suh%20D&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%3AD.C.%2BSuh%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="https://orcid.org/0000-0003-1561-5596" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.C. 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