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Review of Dural AVF Types II, III, and IV

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The other types of Spetzler vascular

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malformations are much less common.

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They include the Type II malformation in which there is

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a true arteriovenous nidus within the spinal cord.

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So the AVM nidus is in the cord.

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It's intramedullary. However, they, too, may have enlarged

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draining veins in the intradural extramedullary location.

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This is the Type III or metameric type of vascular malformation.

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In this case,

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you may see arteriovenous malformation that is

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within the bone, within the intradural extramedullary space,

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as well as within the intradural intramedullary space.

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So you're seeing portions that are in the

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spinal cord outside the spinal cord,

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but within the intradural space,

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as well as outside the dura in the extradural space.

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This is the so-called Type III juvenile metameric

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Spetzler vascular malformation.

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This is the Type IV vascular malformation.

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In this case, it is truly an intradural extramedullary

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abnormality. That is a fistula that is occurring outside

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the spinal cord, within the dural space, showing both

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enlarged artery and vein in the abnormality in

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the intradural extramedullary location.

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This is incredibly uncommon but is part

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of that Spetzler classification.

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Here is an example of a patient who has a hemorrhage

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associated with a vascular malformation outside the

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spinal cord presumed to be a Type IV fistula.

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On this image, you see bright signal intensity from blood

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products, as well as dark signal intensity

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from high flow vascularity.

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Here is the bright stuff which is the blood.

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Here is the flow void, which is the

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fistula between an artery and a vein

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in the intradural extramedullary location.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Vascular Imaging

Vascular

Spine

Neuroradiology

Musculoskeletal (MSK)

MRI

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