Abstract 081: Clinical Presentation and Treatment of 26 Spinal Epidural Arteriovenous Fistulas: A Single Center Experience

Abstract

Introduction Spinal epidural arteriovenous fistulas (SEAVFs) are rarely diagnosed vascular malformations that can cause spinal cord compression and congestive myelopathy. Methods This is a single center, retrospective case series of patients with SEAVF who underwent observation or treatment at UCLA medical center from 1993 to 2023. Results A total of 26 patients were found to have a SEAVF at UCLA from 1993 to 2023. The median age at treatment was 59 years (range 4 months to 91 years). 16 of 26 patients (55.2%) were male. 12 were located in the cervical spine, 2 in the thoracic spine, 11 in the lumbar spine, and 1 in the sacral spine. Sacral, lumbar, and thoracic SEAVFs demonstrated a strong male predominance (12 of 14, 85.7%), while cervical SEAVFs were more common in women (8 of 12, 66.7%). The median duration of symptoms prior to treatment was 6.5 months (range 1 day to 8 years). Possible triggers included prior spinal surgery (n=3), turning neck (n=1), trauma to the neck (n=1), lifting a heavy box (n=1), prolonged period of bending over (n=1). The remaining patients did not have any particular trigger. All patients with lumbar and thoracic SEAVFs (except the 3‐month‐old) demonstrated flow voids and cord edema. Patients with cervical SEAVF did not demonstrate cord edema and only 5 of 12 explicitly mentioned flow voids. 22 patients were treated strictly endovascularly, 1 patient endovascularly and then surgically, 1 patient surgically, and 2 patients refused treatment. No patients treated endovascularly experienced complications. 19 of 23 patients (82.6%) treated endovascularly received complete cure after the first treatment. 1 patient had a successful subsequent embolization 2 days later. Of the 3 other incomplete treatments, one patient received subsequent successful surgery, one patient was a 3‐month‐old patient with Parkes‐Weber syndrome who subsequently died of other medical issues, and one was lost to follow‐up. One patient underwent surgical treatment alone due to the feeding arteries being too small to catheterize and unfortunately experienced a failed surgery on the first attempt and developed a surgical site infection after the second successful attempt at treatment. Onyx was used in 10 cases (9 of 10 successful). 2 cases treated with NBCA were unsuccessful. Cervical and Sacral SEAVFs were treated successfully (mostly prior to 2006) with coils and/or detachable balloons. Conclusion SEAVF is a rare disease that can be treated effectively and safely with endovascular embolization in most cases. Pre‐operative MRI demonstrated abnormalities in all cases. We found a strong male predominance in our cohort.