Detection of the common origin of the radiculomedullary artery with the feeder of spinal dural arteriovenous fistula using slab maximum intensity projection image



Endovascular therapy to the spinal dural arteriovenous fistula (SDAVF) with a common origin of the radiculomedullary artery and the feeder of the shunt has the risk of spinal cord infarction. This study aimed to retrospectively assess the detection rate of normal spinal arteries from the feeder of SDAVF.


We retrospectively collected the angiographic and clinical data of SDAVFs. This study included 19 patients with 20 SDAVF lesions admitted to our department between January 2007 and December 2018. We assessed the detection rate of normal radiculomedullary artery branched from the feeder of SDAVF between the period using the image intensifier (II) and flat panel detector (FPD) and evaluated the treatment results.


The detection rates of the radiculomedullary artery branched from the feeder of SDAVF were 10% (1/10 lesions) during the II period and 30% (3/10 lesions) during the FPD period. During the FPD period, all normal radiculomedullary arteries branched from the feeder were only detected on slab maximum intensity projection (MIP) images of rotational angiography, and we could not detect them in 2D or 3D digital subtraction angiography. All lesions that had a common origin of a normal radiculomedullary artery and the feeder were completely obliterated without complications. There was no recurrence during the follow-up period.


The flat panel detector and slab MIP images seem to show the common origin of the normal radiculomedullary arteries from the feeder more accurately. With detailed analyses, SDAVF can be safety treated.

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Adamkiewicz’s artery


anterior radiculomedullary artery


anterior spinal artery


endovascular therapy


flat panel detector


image intensifier


posterior radiculomedullary artery




posterolateral spinal artery


spinal dural arteriovenous fistula


two-dimensional DSA


three-dimensional DSA


  1. 1.

    Thron A (2001) Spinal durale arteriovenose fisteln. Radiologe 41:955–960

    CAS  Article  Google Scholar 

  2. 2.

    Spetzler RF, Detwiler PW, Riina HA, Porter RW (2002) Modified classification of spinal cord vascular lesions. J Neurosurg 96:145–156

    PubMed  Google Scholar 

  3. 3.

    Koch MJ, Stapleton CJ, Agarwalla PK, Torok C, Shin JH, Coumans JV, Borges LF, Ogilvy CS, Rabinov JD, Patel AB (2017) Open and endovascular treatment of spinal dural arteriovenous fistulas: a 10-year experience. J Neurosurg Spine 26:519–523

    Article  Google Scholar 

  4. 4.

    Saladino A, Atkinson JLD, Rabinstein AA, Piepgras DG, Marsh WR, Krauss WE, Kaufmann TJ, Lanzino G (2010) Surgical treatment of spinal dural arteriovenous fistulae: a consecutive series of 154 patients. Neurosurgery 67:1350–1357

    Article  Google Scholar 

  5. 5.

    Sasamori T, Hida K, Yano S, Asano T, Seki T, Houkin K (2016) Long-term outcomes after surgical and endovascular treatment of spinal dural arteriovenous fistulae. Eur Spine J 25:748–754

    Article  Google Scholar 

  6. 6.

    Gokhale S, Khan SA, McDonagh DL, Britz G (2014) Comparison of surgical and endovascular approach in management of spinal dural arteriovenous fistulas: a single center experience of 27 patients. Surg Neurol Int 5:7

    Article  Google Scholar 

  7. 7.

    Kiyosue H, Matsumaru Y, Niimi Y, Takai K, Ishiguro T, Hiramatsu M, Tatebayashi K, Takagi T, Yoshimura S, JSNET Spinal AV Shunts Study Group (2017) Angiographic and clinical characteristics of thoracolumbar spinal epidural and dural arteriovenous fistulas. Stroke 48:3215–3222

    Article  Google Scholar 

  8. 8.

    Thron AK (2016) Vascular anatomy of the spinal cord, radioanatomy as the key to diagnosis and treatment, Second Edition. Springer, Switzerland, p 15

    Google Scholar 

  9. 9.

    Lasjaunias P, Berenstein A, terBrugge KG (2001) Spinal artery. Surgical neuroangiography 1, clinical vascular anatomy and variations, Second edition. Springer-Verlag, Berlin, p 123

    Google Scholar 

  10. 10.

    Takase K, Akasaka J, Sawamura Y, Ota H, Sato A, Yamada T, Higano S, Igarashi K, Chiba Y, Takahashi S (2006) Preoperative MDCT evaluation of the artery of Adamkiewicz and its origin. J Comput Assist Tomogr 30:716–722

    Article  Google Scholar 

  11. 11.

    Yoshioka K, Niinuma H, Ehara S, Nakajima T, Nakamura M, Kawazoe K (2006) MR angiography and CT angiography of the artery of Adamkiewicz: state of the art. RadioGraphics 26:S63–S73

    Article  Google Scholar 

  12. 12.

    Uotani K, Yamada N, Kono AK, Taniguchi T, Sugimoto K, Fujii M, Kitagawa A, Okita Y, Naito H, Sugimura K (2008) Preoperative visualization of the artery of adamkiewicz by intra-arterial CT angiography. AJNR Am J Neuroradiol 29:314–318

    CAS  Article  Google Scholar 

  13. 13.

    Gemmete JJ, Chaudhary N, Elias AE, Toma AK, Pandey AS, Parker RA, Davagnanam I, Maher CO, Brew S, Robertson F (2013) Spinal dural arteriovenous fistulas: clinical experience with endovascular treatment as a primary therapy at 2 academic referral centers. AJNR Am J Neuroradiol 34:1974–1979

    CAS  Article  Google Scholar 

  14. 14.

    Aggarwal S, Willinsky R, Montanera W, Terbrugge K, Wallace MC (1992) Superselective angiography of a spinal dural arteriovenous fistula having a common segmental origin with the artery of Adamkiewicz. Neuroradiology 34:352–354

    CAS  Article  Google Scholar 

  15. 15.

    Cawley CM, Howard BM, Barrow DL (2019) Microsurgical management of a spinal dural arteriovenous fistula with shared blood supply to the artery of Adamkiewicz: 3-dimensional operative video. Oper Neurosurg (Hagerstown) 16:E174–E175

    Article  Google Scholar 

  16. 16.

    Eneling J, Karlsson PM, Rossitti S (2014) A treatment-refractory spinal dural arteriovenous fistula sharing arterial origin with the artery of Adamkiewicz: repeated endovascular treatment after failed microsurgery. Surg Neurol Int 5:S165–S169

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Hadzipasic M, Grant R, Johnson M, Cheng J, Bulsara KR (2017) Spinal dural arteriovenous fistulas with segmental arterial supply also giving rise to a radiculomedullary artery: a case report and review of the literature. World Neurosurg 97:E21–E26

    Article  Google Scholar 

  18. 18.

    Shapiro M, Kister I, Raz E, Loh J, Young M, Goldman-Yassen A, Chancellor B, Nelson PK (2019) Spinal dural fistula and anterior spinal artery supply from the same segmental artery: case report of volumetric T2 MRI diagnosis and rational endovascular treatment. Interv Neruroradiol 25:579–584

    Article  Google Scholar 

  19. 19.

    Shedid D, Podichetty VK (2009) Common origin of the artery of adamkiewicz and a posterior spinal artery with a spinal dural arteriovenous fistula: a case report. Br J Neurosurg 23:630–633

    Article  Google Scholar 

  20. 20.

    Kirsch M, Berg-Dammer E, Musahl C, Bäzner H, Kühne D, Henkes H (2013) Endovascular management of spinal dural arteriovenous fistulas in 78 patients. Neuroradiology 55:337–343

    CAS  Article  Google Scholar 

  21. 21.

    Adrianto Y, Yang KH, Koo HW, Park W, Jung SC, Park JE, Kim KK, Jeon SR, Suh DC (2017) Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF). J Neurointerv Surg 9:405–410

    Article  Google Scholar 

  22. 22.

    Aadland TD, Thielen KR, Kaufmann TJ, Morris JM, Lanzino G, Kallmes DF, Schueler BA, Cloft H (2010) 3D c-arm conebeam CT angiography as an adjunct in the precise anatomic characterization of spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 31:476–480

    CAS  Article  Google Scholar 

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We thank Mr. Niida N (Siemens Healthcare) for his technical support with the reconstruction method of three-dimensional rotational angiography.


The authors have not received any research grant nor funding.

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Correspondence to Masafumi Hiramatsu.

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Hiramatsu, M., Sugiu, K., Yasuhara, T. et al. Detection of the common origin of the radiculomedullary artery with the feeder of spinal dural arteriovenous fistula using slab maximum intensity projection image. Neuroradiology (2020).

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  • Slab MIP image
  • Spinal dural arteriovenous fistula
  • Radiculomedullary artery
  • Spinal artery