Transvenous Approaches to the Vertebral‐Venous Plexus for Endovascular Treatment of Cervical Epidural Arteriovenous Fistulas: Anatomy and Technique

Background Spinal epidural arteriovenous fistulas (seAVF) are a rare subset of vascular lesions that most commonly found in the cervical levels. Unlike spinal dural AVF, seAVF typically supplied by multiple arteries, including direct branches from vertebral artery, which increases risk nontarget embolization using transarterial endovascular approach. In these cases, transvenous may be preferable option, but accessing venous space, also termed internal plexus, can challenging and requires advanced foreknowledge channels. Methods The authors review salient neurovascular anatomy present 2 techniques for access space to treat seAVF. Results physiology structure plexus is briefly reviewed. Next, describe complementary methods via jugular vein (cranial‐caudal) (caudal‐cranial). first approach involves retrograde microcatheterization bulb condylar veins. second antegrade vein, arising brachiocephalic vein. Both approaches enable stable catheter positioning coil at remote levels wide spectrum Conclusions Accessing technically demanding effective planning knowledge relevant anatomy. These important tools safe treatment