General spine vascular malformation classification
Type 1: Dural AVF (dAVF)
Most common = type 1 (up to 80%)
Type 2: Intramedullary glomus-type AVM (similar to brain AVM)
Type 3: Juvenile-type AVM (intramedullary, extramedullary)
2nd most common = intramedullary types 2 and 3 (15-20%)
Type 4: Intradural extra-/perimedullary AVF (types A, B, C)
Type 4: Direct intradural extramedullary arterial/venous communication from anterior spinal artery (ASA) or posterior spinal artery (PSA) to draining vein without capillary bed
Heterogenous group of lesions ranging from slow-flow fistula (IVa) to large high flow (IVc)
IMAGING
General Features
CT Findings
MR Findings
Angiographic Findings
Nonvascular Interventions
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
Takai K: Spinal arteriovenous shunts: angioarchitecture and historical changes in classification. Neurol Med Chir (Tokyo). 57(7):356-65, 2017
Gross BA et al: Spinal pial (type IV) arteriovenous fistulae: a systematic pooled analysis of demographics, hemorrhage risk, and treatment results. Neurosurgery. 73(1):141-51; discussion 151, 2013
Krings T et al: Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol. 30(4):639-48, 2009
Pattany PM et al: MR angiography of the spine and spinal cord. Top Magn Reson Imaging. 14(6):444-60, 2003
Hida K et al: Corpectomy: a direct approach to perimedullary arteriovenous fistulas of the anterior cervical spinal cord. J Neurosurg. 96(2 Suppl): 157-61, 2002
Rodesch G et al: Classification of spinal cord arteriovenous shunts: proposal for a reappraisal--the Bicetre experience with 155 consecutive patients treated between 1981 and 1999. Neurosurgery. 51(2): 374-9; discussion 379-80, 2002
Spetzler RF et al: Modified classification of spinal cord vascular lesions. J Neurosurg. 96(2 Suppl): 145-56, 2002
Mascalchi M et al: Spinal vascular malformations: MR angiography after treatment. Radiology. 219(2): 346-53, 2001
Sugiu K et al: Successful embolization of a spinal perimedullary arteriovenous fistula with cellulose acetate polymer solution: technical case report. Neurosurgery. 49(5): 1257-60; discussion 1260-1, 2001
Vates GE et al: Conus perimedullary arteriovenous fistula with intracranial drainage: case report. Neurosurgery. 49(2): 457-61; discussion 461-2, 2001
Sure U et al: Spinal type IV arteriovenous malformations (perimedullary fistulas) in children. Childs Nerv Syst. 16(8): 508-15, 2000
Grote EH et al: Clinical syndromes, natural history, and pathophysiology of vascular lesions of the spinal cord. Neurosurg Clin N Am. 10(1): 17-45, 1999
Hida K et al: Results of the surgical treatment of perimedullary arteriovenous fistulas with special reference to embolization. J Neurosurg. 90(4 Suppl): 198-205, 1999
Mascalchi M et al: Contrast-enhanced time-resolved MR angiography of spinal vascular malformations. J Comput Assist Tomogr. 23(3): 341-5, 1999
Bao YH et al: Classification and therapeutic modalities of spinal vascular malformations in 80 patients. Neurosurgery. 40(1):75-81, 1997
Ricolfi F et al: Giant perimedullary arteriovenous fistulas of the spine: clinical and radiologic features and endovascular treatment. AJNR Am J Neuroradiol. 18(4): 677-87, 1997
General spine vascular malformation classification
Type 1: Dural AVF (dAVF)
Most common = type 1 (up to 80%)
Type 2: Intramedullary glomus-type AVM (similar to brain AVM)
Type 3: Juvenile-type AVM (intramedullary, extramedullary)
2nd most common = intramedullary types 2 and 3 (15-20%)
Type 4: Intradural extra-/perimedullary AVF (types A, B, C)
Type 4: Direct intradural extramedullary arterial/venous communication from anterior spinal artery (ASA) or posterior spinal artery (PSA) to draining vein without capillary bed
Heterogenous group of lesions ranging from slow-flow fistula (IVa) to large high flow (IVc)
IMAGING
General Features
CT Findings
MR Findings
Angiographic Findings
Nonvascular Interventions
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
Takai K: Spinal arteriovenous shunts: angioarchitecture and historical changes in classification. Neurol Med Chir (Tokyo). 57(7):356-65, 2017
Gross BA et al: Spinal pial (type IV) arteriovenous fistulae: a systematic pooled analysis of demographics, hemorrhage risk, and treatment results. Neurosurgery. 73(1):141-51; discussion 151, 2013
Krings T et al: Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol. 30(4):639-48, 2009
Pattany PM et al: MR angiography of the spine and spinal cord. Top Magn Reson Imaging. 14(6):444-60, 2003
Hida K et al: Corpectomy: a direct approach to perimedullary arteriovenous fistulas of the anterior cervical spinal cord. J Neurosurg. 96(2 Suppl): 157-61, 2002
Rodesch G et al: Classification of spinal cord arteriovenous shunts: proposal for a reappraisal--the Bicetre experience with 155 consecutive patients treated between 1981 and 1999. Neurosurgery. 51(2): 374-9; discussion 379-80, 2002
Spetzler RF et al: Modified classification of spinal cord vascular lesions. J Neurosurg. 96(2 Suppl): 145-56, 2002
Mascalchi M et al: Spinal vascular malformations: MR angiography after treatment. Radiology. 219(2): 346-53, 2001
Sugiu K et al: Successful embolization of a spinal perimedullary arteriovenous fistula with cellulose acetate polymer solution: technical case report. Neurosurgery. 49(5): 1257-60; discussion 1260-1, 2001
Vates GE et al: Conus perimedullary arteriovenous fistula with intracranial drainage: case report. Neurosurgery. 49(2): 457-61; discussion 461-2, 2001
Sure U et al: Spinal type IV arteriovenous malformations (perimedullary fistulas) in children. Childs Nerv Syst. 16(8): 508-15, 2000
Grote EH et al: Clinical syndromes, natural history, and pathophysiology of vascular lesions of the spinal cord. Neurosurg Clin N Am. 10(1): 17-45, 1999
Hida K et al: Results of the surgical treatment of perimedullary arteriovenous fistulas with special reference to embolization. J Neurosurg. 90(4 Suppl): 198-205, 1999
Mascalchi M et al: Contrast-enhanced time-resolved MR angiography of spinal vascular malformations. J Comput Assist Tomogr. 23(3): 341-5, 1999
Bao YH et al: Classification and therapeutic modalities of spinal vascular malformations in 80 patients. Neurosurgery. 40(1):75-81, 1997
Ricolfi F et al: Giant perimedullary arteriovenous fistulas of the spine: clinical and radiologic features and endovascular treatment. AJNR Am J Neuroradiol. 18(4): 677-87, 1997
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