Paravertebral Arteriovenous Malformations with Epidural Drainage: Clinical Spectrum, Imaging Features, and Results of Treatment
Mayank Goyala,
Robert Willinsky
,a,
Walter Montaneraa and
Karel terBruggea
a From the Department of Medical Imaging, the Toronto Hospital, Western Division, and the University of Toronto Brain Vascular Malformation Study Group, University of Toronto.
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FIG 1. Case 4.
A, Sagittal T2-weighted image obtained through the lower thoracic spine shows hyperintensity within the cord and the presence of multiple flow voids on the surface of the cord (arrows).
B, Axial T1-weighted image obtained through the lower thoracic spine shows the presence of multiple flow voids (arrows) in the epidural space and extending into the paravertebral space.
C, Angiogram with injection into the left T9 intercostal artery shows the PVAVM draining into the epidural vein. Reflux into the perimedullary veins is clearly seen (arrow).
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FIG 2. Case 8.
A, Midsagittal T2-weighted image obtained through the lumbar spine shows the presence of an intramedullary mass in a low-lying cord. Additionally, a round hypointense lesion is seen opposite the L5 vertebral body (arrow).
B, Flush aortogram shows the feeding artery (arrow) to an epidural AVF and the venous pouch draining the AVF.
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FIG 3. Case 5. The patient has a large PVAVM and had undergone multiple arterial embolizations with NBCA.
A, Coronal T1-weighted image shows multiple flow voids in the paravertebral space with large epidural veins compressing the thecal sac (arrows) and pushing it to the contralateral side.
B, Angiogram (injection into right T9 intercostal artery) shows a complex AVM partially treated with liquid adhesives from the arterial route.
C, Postembolization follow-up angiogram obtained through the left T9 intercostal artery shows residual AVM with reduced flow and the unaffected anterior spinal artery (arrow).
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FIG 4. Case 7.
A, Angiogram obtained with the catheter in the left supreme intercostal artery shows an epidural fistula (small arrows) draining into the epidural veins. The epidural venous plexus drainage is bidirectional (large, double-headed arrow).
B, Embolization was performed with coils (arrows) using the arterial route. Postembolization angiogram, oblique view, shows complete obliteration of the fistula.
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