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J Neurointerv Surg. 2016 Jun;8(6):643-7. doi: 10.1136/neurintsurg-2015-011677. Epub 2015 May 11.

Lower vertebral-epidural spinal arteriovenous fistulas: a unique subtype of vertebrovertebral arteriovenous fistula, treatable with coil and Penumbra Occlusion Device embolization.

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Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.


A vertebral-epidural spinal arteriovenous fistula (AVF) is an abnormal arteriovenous shunt connecting the vertebral artery to the spinal epidural venous plexus, and may occur spontaneously or secondary to a variety of causes. These unique lesions are uncommon in adults and rarer still in children. Previous reports have grouped together a heterogeneous collection of such arteriovenous lesions, including arterial contributions from the upper and lower vertebral artery, with venous drainage into a variety of spinal and paraspinal collectors. Here, through two cases, we delineate a distinct entity, the lower vertebral-to-epidural AVF. The salient clinical and anatomic features are summarized and contextualized within the broader constellation of vertebrovertebral AVF, the utility of a transarterial intravenous/retrograde intra-arterial endovascular approach is highlighted, and a new use of the Penumbra Occlusion Device (Penumbra Inc) for this purpose is reported.


Arteriovenous Malformation; Epidural; Pediatrics; Spine; Vascular Malformation

[Indexed for MEDLINE]

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