J Korean Neurosurg Soc.  2016 Jul;59(4):420-424. 10.3340/jkns.2016.59.4.420.

Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula

• Sung KS
• Song YJ
• Kim KU

• KMID: 2315983
• DOI: http://doi.org/10.3340/jkns.2016.59.4.420

Abstract

The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system.

Keyword

Spinal vascular disease; Dural arteriovenous fistula; Stereotactic radiosurgery

MeSH Terms

Angiography
Central Nervous System Vascular Malformations*
Hemodynamics
Humans
Radiosurgery*
Spinal Cord Diseases
Spinal Cord Ischemia

Figure

• 

  Fig. 1 Magnetic resonance imaging (MRI) of the thoracolumbar spine reveals abnormal lesions with signal void and enhancement, indicating a vascular anomaly at the T12, L1, and L2 levels (A). Axial images at the L1 level show a left-sided mass lesion in the spinal canal (B). Three-dimensional volumetric contrast-enhanced sagittal TRICKS abdominal magnetic resonance angiography (MRA) using 1.5T MRI system was performed. The study was post-processed into maximum-intensity projection images. These images show a feeding artery at the L1 level (C). Magnetic resonance myelography (anterior-posterior view) reveals a left-sided vascular anomaly (D).

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  Fig. 2 View of the treatment plan. The target, involving the dura margin, was constructed to include the fistula during structural segmentation under spinal computed tomography imaging (A). Ten conformal beams were used, and a multileaf collimator shaped the target margin. The yellow isodose line represents the 90% isodose line and total prescribed dose of 18 Gy. The blue line represents the 30% isodose line (6 Gy). This treatment plan showed a low dose of radiation exposure to spinal cord (B).

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  Fig. 3 Follow-up MRI and MRA images after 7 months. The size of the feeding artery and abnormal vascular lesion is decreased (A). The previous lesion with signal void and enhancement is also reduced (B).

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  Fig. 4 Follow-up MRI and MRA images after 3 years show disappearance of the feeding artery of the spinal dural arteriovenous fistula (A) and sequelae of the previous lesion (B).

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