GIANT PERIMEDULLARY ARTERIOVENOUS-FISTULAS OF THE SPINE - CLINICAL AND RADIOLOGIC FEATURES AND ENDOVASCULAR TREATMENT

PURPOSE: To present the clinical and radiologic features of giant peri medullary arteriovenous fistulas (GAVFs) in 12 consecutive cases and t o evaluate the results of endovascular treatment. METHODS: We retrospe ctively reviewed the clinical and radiologic data as well as the resul ts of balloon endovascular treatment obtained from 1980 to 1989, RESUL TS: GAVFs, defined as large intradural perimedullary direct arterioven ous high-flow shunts, are revealed mainly in childhood either by subar achnoid hemorrhage or by progressive neurologic disorders. MR imaging and myelography show major vascular dilatations. The angioarchitecture of GAVFs can only be assessed by selective spinal angiography. Ten pa tients were treated by balloon occlusion resulting in eight anatomic c ures and six good clinical results. One balloon migrated to the venous side, leading to clinical deterioration. CONCLUSION: GAVF is a specia l subgroup of intradural perimedullary arteriovenous fistula. The endo vascular approach should be the first line of treatment, with surgery reserved for special circumstances. Nondetachable balloon occlusion is a safe and efficient method for treating GAVFs.