Spinal Intradural Arteriovenous Shunt: Angiographic Characteristics and Treatment Outcomes

Abstract Spinal intradural arteriovenous shunt (SIAVS) is a rare entity of vascular diseases, classified into spinal cord arteriovenous malformation (SCAVM), spinal cord arteriovenous fistula (SCAVF), filum terminale arteriovenous fistula (FTAVF), and radicular arteriovenous malformation (AVM). Clinical presentations commonly include progressive myelopathy due to spinal venous congestion and hemorrhagic events. This study aimed to describe the clinical presentations, angiographic characteristics, and treatment outcomes. This retrospective study was conducted between 2010 and 2023. The collected data included demographic characteristics, clinical presentations, radiological findings, treatment modalities, treatment outcomes, and complications. Functional outcomes were assessed pre- or posttreatment using the Modified Aminoff and Logue Disability Scale. A total of 36 patients (22 males) were included, with a mean age at diagnosis of 30.7 years. Seventeen patients were diagnosed with SCAVM, 15 with SCAVF, and 4 with FTAVF. Progressive myelopathy was significantly found in patients with the fistulous type (SCAVF and FTAVF; p = 0.008), whereas hematomyelia was common in the nidus-type group (SCAVM; p = 0.006). Eight patients had spinal arteriovenous metameric syndrome (SAMS), and radicular AVM was observed in five cases of SCAVM and SCAVF. Multiple intradural shunts were identified in seven patients. Endovascular treatment using glue embolization was performed in 26 patients. Four patients were treated with surgery alone, and four received conservative management. Two patients underwent combined surgery and glue embolization. Angiographic outcomes showed complete obliteration in 12 (33.3%) patients and partial obliteration in 20 (55.5%) patients. Significant functional outcome improvements were found in all groups of disease and overall patients. One SCAVM patient had progressive enlargement of the venous pouch, which required repeated embolization. No recurrent hemorrhages were observed throughout the follow-up period. Transarterial glue embolization is an effective treatment for SIAVS, providing significant neurological improvement, even in cases of partial embolization. The potential risk of anterior spinal artery occlusion must be carefully evaluated. Surgical intervention remains a viable alternative.