INTERVENTIONAL NEURORADIOLOGY Spinal cord arteriovenous shunts of the ventral (anterior) sulcus: anatomical, clinical, and therapeutic considerations Luca Roccatagliata 1,2 & Shushi Kominami 3 & Antonin Krajina 4 & Robin Sellar 5 & Michael Soderman 6 & René Van den Berg 7 & Hubert Desal 8 & Stephanie Condette-Auliac 1 & Georges Rodesch 1 Received: 26 September 2016 /Accepted: 18 January 2017 # Springer-Verlag Berlin Heidelberg 2017 Abstract Introduction Ventral sulcus spinal cord arteriovenous shunts (SCAVS) are rare vascular lesions that are located outside the spinal cord, are exclusively vascularized by the anterior spinal axis, and drain exclusively through the anterior spinal vein. We report the anatomical, clinical, and neuro-radiological fea- tures of SCAVS managed by our team. Methods We conducted a retrospective study of patients with SCAVSs evaluated by the senior author of this report (GR) between 1981 and 2014. Data were collected by reviewing clinical notes and by a systematic analysis of spinal angio- grams and MRI. Results Among 358 patients, we identified 8 patients (3 wom- en) with ventral sulcus spinal cord arteriovenous shunts. Mean age was 30.5 years. Six patients presented with progressive neurological symptoms, and two with acute neurological symptoms related to hematomyelia. Three shunts were located in the cervical cord, four in the thoracic cord, and one at the conus medullaris; there were two nidus type A-V shunts (AVMs) and six fistula type A-V shunts (AVFs). Seven pa- tients were treated by endovascular therapy with glue embo- lization. Embolization led to anatomical cure in 5 cases, and a significant reduction of shunt volume and flow of more than 75% in 2 cases. In none of the cases we observed permanent morbidity. Conclusions AVS of the ventral sulcus of the spinal cord are rare. Recognition of these lesions and precise localization of the anatomical space in which they are located, may allow a better understanding of their pathophysiology and clinical manifestations and guide proper therapeutic decisions. Keywords Spinal cord arteriovenous shunts . Interventional neuroradiology . Anterior spinal artery . Ventral sulcus . Embolization Introduction Spinal cord arteriovenous shunts (SCAVS) are rare lesions; despite the scarcity of large studies on natural history, they are considered to be devastating vascular malformations be- cause of their aggressiveness with poor neurological outcome if left untreated [1–4]. SCAVS have been submitted to several, often conflict- ing, different classifications. We identified artero-venous shunts of the ventral sulcus as lesions located in the ven- tral sulcus of the cord and vascularized exclusively by the anterior spinal artery (ASA) through one or more sulco- commisural arteries. Endovascular or surgical treatment of SCAVSs is challenging, especially when they are * Georges Rodesch g.rodesch@hopital-foch.org 1 Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France 2 Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy 3 Department of Neurosurgery, Chiba-Hokuso Hospital, Nippon Medical School, Chiba, Japan 4 Department of Radiology, Faculty Hospital, Hradec Kralove, Czech Republic 5 Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK 6 Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden 7 Department of Radiology AMC, Amsterdam, The Netherlands 8 Department of Neuroradiology, University of Nantes Medical Center, Nantes, France Neuroradiology DOI 10.1007/s00234-017-1789-z