Abstract
During ten operations for spinal dural arterio-venous fistulas (AVF), intraoperative measurement of flow velocity and intravascular pressure was performed. Flow velocities were recorded using a miniaturized Doppler probe. Intravascular pressure changes in the draining veins beofre and after AVF removal was measured with small needles. Varying the pCO2 between 20 mm Hg and 60 mm Hg, the flow velocities in arteries supplying the spinal cord were investigated so that the vasomotoric reactivity of the peripheral vessel wall in cord tissue was investigated before and after AVF occlusion. The flow velocities in dural AVF feeders were not as high as those known from cerebral angioma feeders. In addition, they often showed lowered end-diastolic flow velocity as a dign of increased vascular resistance, thus proving impaired venous outflow from the spinal canal. After excision of the local fistula, the vessels supplying and draining the spinal cord showed improved circulation. In the former recipient veins, no further flow could be recorded.
The venous pressure in dural AVF was about 70% of the systemic arterial pressure. Fistulas presenting a high shunt volume on angiography showed only moderately increased venous pressure and a more pronounced pressure drop after fistula occlusion as compared with low-volume fistulas. The CO2 reactivity of vessels supplying the spinal cord was normal before and after AFV removal.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aboulker J, D Bar, C Marsault, K Kouadja, A Recondo, L Garel, H Nahum: L'hypertension veineuse intrarachidienne par anomalies multiples du système cave: une cause majeure de souffrance médullaire. Chirurgie 103 (1977) 1003–1015
Aminoff MJ, RO Barnard, V Logue: The pathophysiology of spinal vascular malformations. J Neurol Sci 23 (1974) 255–263
Burguet JL; JL Dietemann, A Wackenheim, P Kehr, F Buchheit: Sacral meningeal arteriovenous fistula fed by branches of the hypogastric arteries and drained through medullary vein. Neuroradiology 27 (1985) 232–237
Cahan LD, RT Higashida, V van Halbach, GB Hieshima: Variants of radiculomeningeal vascular malformations of the spine. J Neurosurg 66 (1987) 333–337
Sjindjian R, M Hurth, R Hondart: L'angiographie de la moelle épinière. Masson, Paris 1970
Gilsbach JM: Intraoperative Doppler sonography in neurosurgery. Springer-Verlag, Vienna 1983
Gueguen B, JJ Merland, MC Riche, A Rey: Vascular malformations of the spinal cord: intrathecal perimedullary arteirovenous fistulas fed by medullary arteries. Neurology 37 (1987) 969–979
Hassler W: Hemodynamic aspects of cerebral angiomas. Acta Neurochirurgica, Supplementum 37, Springer-Verlag, Vienna 1986
Hassler W, H Steinmetz: Cerebral hemodynamics in angioma patients: an intraoperative study. J Neurosurg 67 (1987) 822–831
Heros RC, GM Debru, RG Ojeman, PL Lasjaunias, PJ Naessens: Direct spinal arteriovenous fistula: a new type of spinal AVM. J Neurosurg 64 (1986) 134–139
Kaufmann HH, AK Ommaya, G Di Chiro, JC Doppman: Compression vs. “steal”: The pathogenesis of symptoms in arteriovenous malformations of the spinal cord. Arch Neurol 23 (1970) 173–178
Kendall BE, V Logue: Spinal epicural angiomatous malformations draining into intrathecal veins. Neuroradiology 13 (1977) 181–189
Krayenbühl H, MG yasargil, McClintock: Treatment of excision. J Neurosurg 30 (1969) 427–435
Launay M, J Chiras, J Boeries: Angiographie médullaire: temps veineux. J Neuroradiology 6 (1979) 287–315
Merland JJ, Mc Riche, J Chiras: Les fistules arterioveneuses intracanalaires, extra-médullaires à drainage veineux médullaire. J Neuroradiol 7 (1980) 271–320
Newman MJD: Racemose angioma of the spinal cord. Q Jl Med 28 (1959) 97–108
Rosenblum B, EH Oldfield, JL Doppmann, G DiChiro: Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM's in 81 patients. J Neurosurg 67 (1987) 795–802
Shephard RH: Observations on intradural spinal angioma: treatment by excision. Neurochir (Stuttg) 6 (1963) 58–74
Symon L, H Kuyama, B Kendall: Dural arteriovenous malformations of the spine. Clinical features and surgical results in 55 cases. J Neurosurg 60 (1984) 238–247
Thron A: Vascular anatomy of the spinal cord. Neuroradiological investigations and clinical syndromes. Springer-Verlag, Vienna-New York 1988
Wyburn-Mason R: The vascular abnormalities and tumours of the spinal cord and its membranes. Kimpton, London 1943
Yasargil MG, L Symon, PJ Teddy: Arteriovenous malformations of the spinal cord. In: Symon L (ed): Advances and technical standards in neurosurgery 11. Springer-Verlag, Vienna 1984, 61–102
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hassler, W., Thron, A. Flow velocity and pressure measurements in spinal dural arteriovenous fistulas. Neurosurg. Rev. 17, 29–36 (1994). https://doi.org/10.1007/BF00309983
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00309983