Venous manifestations of spinal arteriovenous fistulas

Impairment of the spinal cord venous outflow may create symptoms caused by venous hypertension and congestion. This has been referred to as venous congestive myelopathy. Spinal dural arteriovenous fistulas, as well as some of the epidural arteriovenous fistulas and perimedullary spinal cord arteriovenous malformations, commonly present with venous-related symptomatology. The typical MR imaging findings include peripheral T2 hypointensity outlining a T2 hyperintensity within a swollen spinal cord and dilated, tortuous perimedullary vessels. Contrast-enhanced MR angiography has been instrumental in the localization of spinal dural arteriovenous fistulas before conventional angiography. Selective catheter angiography is still the gold standard to characterize the angioarchitecture of these vascular malformations. Treatment planning is multidisciplinary and requires knowledge of the natural history of these complex lesions.