Successful embolization of an upper cervical spinal dural fistula despite anterior spinal artery anastomosis

Anthony Nguyen, Ken Maynard, William Coggins, Karthikram Raghuram

Research output: Contribution to journalArticle

Abstract

A female in her 40s presented with classic symptoms of subarachnoid hemorrhage and limited mobility of the bilateral upper extremities. Imaging demonstrated a minor amount of subarachnoid blood, and a follow-up computed tomography angiogram revealed a spinal dural arteriovenous fistula (SDAVF) located at C2–3. The C2–3 radicular artery proximal to the fistula feeder anastomosed with the anterior spinal artery, challenging the safety of embolization. However, surgical treatment of the SDAVF would require a suboccipital craniotomy due to its proximity to the foramen magnum, so possible embolization based on lidocaine provocative test results was decided upon. Neurologic examination of the patient following lidocaine provocative testing suggested that embolization could be performed safely. Glue embolization was successfully performed, and the patient awoke without complications. Subsequent imaging revealed no filling of the medullary vein that previously drained the fistula.

Original languageEnglish (US)
JournalBritish Journal of Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Central Nervous System Vascular Malformations
Lidocaine
Fistula
Arteries
Foramen Magnum
Craniotomy
Neurologic Examination
Subarachnoid Hemorrhage
Upper Extremity
Adhesives
Veins
Angiography
Tomography
Safety
Therapeutics

Keywords

  • Embolization
  • endovascular
  • lidocaine provocative testing
  • neurointerventional radiology
  • neurosurgery
  • spinal dural arteriovenous fistula

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Successful embolization of an upper cervical spinal dural fistula despite anterior spinal artery anastomosis. / Nguyen, Anthony; Maynard, Ken; Coggins, William; Raghuram, Karthikram.

In: British Journal of Neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

@article{02cb3916a6fb497aa9c03dfac7bc4b2b,
title = "Successful embolization of an upper cervical spinal dural fistula despite anterior spinal artery anastomosis",
abstract = "A female in her 40s presented with classic symptoms of subarachnoid hemorrhage and limited mobility of the bilateral upper extremities. Imaging demonstrated a minor amount of subarachnoid blood, and a follow-up computed tomography angiogram revealed a spinal dural arteriovenous fistula (SDAVF) located at C2–3. The C2–3 radicular artery proximal to the fistula feeder anastomosed with the anterior spinal artery, challenging the safety of embolization. However, surgical treatment of the SDAVF would require a suboccipital craniotomy due to its proximity to the foramen magnum, so possible embolization based on lidocaine provocative test results was decided upon. Neurologic examination of the patient following lidocaine provocative testing suggested that embolization could be performed safely. Glue embolization was successfully performed, and the patient awoke without complications. Subsequent imaging revealed no filling of the medullary vein that previously drained the fistula.",
keywords = "Embolization, endovascular, lidocaine provocative testing, neurointerventional radiology, neurosurgery, spinal dural arteriovenous fistula",
author = "Anthony Nguyen and Ken Maynard and William Coggins and Karthikram Raghuram",
year = "2019",
month = "1",
day = "1",
doi = "10.1080/02688697.2019.1694136",
language = "English (US)",
journal = "British Journal of Neurosurgery",
issn = "0268-8697",
publisher = "Informa Healthcare",

}

TY - JOUR

T1 - Successful embolization of an upper cervical spinal dural fistula despite anterior spinal artery anastomosis

AU - Nguyen, Anthony

AU - Maynard, Ken

AU - Coggins, William

AU - Raghuram, Karthikram

PY - 2019/1/1

Y1 - 2019/1/1

N2 - A female in her 40s presented with classic symptoms of subarachnoid hemorrhage and limited mobility of the bilateral upper extremities. Imaging demonstrated a minor amount of subarachnoid blood, and a follow-up computed tomography angiogram revealed a spinal dural arteriovenous fistula (SDAVF) located at C2–3. The C2–3 radicular artery proximal to the fistula feeder anastomosed with the anterior spinal artery, challenging the safety of embolization. However, surgical treatment of the SDAVF would require a suboccipital craniotomy due to its proximity to the foramen magnum, so possible embolization based on lidocaine provocative test results was decided upon. Neurologic examination of the patient following lidocaine provocative testing suggested that embolization could be performed safely. Glue embolization was successfully performed, and the patient awoke without complications. Subsequent imaging revealed no filling of the medullary vein that previously drained the fistula.

AB - A female in her 40s presented with classic symptoms of subarachnoid hemorrhage and limited mobility of the bilateral upper extremities. Imaging demonstrated a minor amount of subarachnoid blood, and a follow-up computed tomography angiogram revealed a spinal dural arteriovenous fistula (SDAVF) located at C2–3. The C2–3 radicular artery proximal to the fistula feeder anastomosed with the anterior spinal artery, challenging the safety of embolization. However, surgical treatment of the SDAVF would require a suboccipital craniotomy due to its proximity to the foramen magnum, so possible embolization based on lidocaine provocative test results was decided upon. Neurologic examination of the patient following lidocaine provocative testing suggested that embolization could be performed safely. Glue embolization was successfully performed, and the patient awoke without complications. Subsequent imaging revealed no filling of the medullary vein that previously drained the fistula.

KW - Embolization

KW - endovascular

KW - lidocaine provocative testing

KW - neurointerventional radiology

KW - neurosurgery

KW - spinal dural arteriovenous fistula

UR - http://www.scopus.com/inward/record.url?scp=85075447813&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075447813&partnerID=8YFLogxK

U2 - 10.1080/02688697.2019.1694136

DO - 10.1080/02688697.2019.1694136

M3 - Article

AN - SCOPUS:85075447813

JO - British Journal of Neurosurgery

JF - British Journal of Neurosurgery

SN - 0268-8697

ER -