ARTERIOVENOUS-FISTULAS OF THE BRAIN AND THE SPINAL-CORD

Arteriovenous (AV) fistulas of cerebral and spinal arteries are charac terized angiographically by an immediate AV transition without a capil lary bed or ''nidus'' as occurs in AV malformations (AVM's). The clini cal presentation, morphology, radiology, and treatment of 12 patients with cerebral AV fistulas and of 12 patients with spinal AV fistulas a re reviewed. In the patients with cerebral lesions, headache and seizu re disorders were the most common presentations followed by subarachno id hemorrhage, cardiac failure, progressive neurological dysfunction, and incidental detection on prenatal ultrasound study. In patients wit h spinal AV fistulas, weakness and sensory disturbance in the lower ex tremities were the most frequent clinical presentations followed by ba ck pain, disturbances of micturition, and grand mal seizure. The etiol ogy of the symptom complex produced by AV fistulas in each of these lo cations differed, with venous hypertension being important in spinal c ord lesions. Of the patients with cerebral lesions, nine had a single AV fistula, one had two fistulas, and two had multiple fistulas. An AV M was observed in five patients with fistulas (two large, three small) . Nine patients exhibited extramedullary AV fistulas of the spine, of whom eight had a single fistula and one had three fistulas; three pati ents had intramedullary spinal AV fistulas. An arterial aneurysm was f ound in association with two fistulas, one cerebral and one spinal. Ve nous ectasias or varices, frequently exhibiting mural calcification, w ere observed to be prominent in all AV fistulas involving cerebral art eries and in two involving spinal arteries. The location and size of t he venous complexes reflected the diameter of the fistula. In addition to conventional imaging techniques (cerebral angiography, computerize d tomography, and magnetic resonance (MR) imaging), MR angiography was a helpful adjunct in the evaluation of fistulas. Treatment strategies employed for AV fistulas in both locations included open surgical and endovascular procedures, frequently used in combination. A satisfacto ry outcome was observed in all patients.