Clinical and Radiographic Features of Dural Arteriovenous Fistula, a Treatable Cause of Myelopathy

Venous congestive myelopathy: a mimic of neoplasia

“…1,2 Large series of patients with this condition have been reported in recent decades. 11,12,23 and their clinicoradiologic characteristics and therapeutic approaches have been well studied. Generally, the condition is suspected by the characteristic clinical syndrome and radiologic findings.…”

“…The fistula is corrected surgically or by embolization, 20,32 and spinal cord biopsy is usually not necessary. MRI total 100 29 0 71 43 29 71 57 characteristically shows spinal cord enlargement and T2 hyperintensity with variable contrast enhancement, 10,11,15,17,19 often in the early course of the disease, features that are also present in spinal cord tumors. More specific signs, leading to a diagnosis of spinal dural arteriovenous fistula, include demonstration of serpentine vessels predominantly on the dorsal surface of the spinal cord, 19 and probably the recently described peripheral spinal cord hypointensity by T2 sign.…”

“…[8][9][10] The spinal dural arteriovenous fistula usually localizes to the lower thoracic and/or lumbosacral levels; cervical cord involvement is rare. [11][12][13] In the typical spinal dural arteriovenous fistula, engorged tortuous vascular channels are identified in the subarachnoid space predominantly on the dorsal aspect of the cord, a consequence of the impaired spinal venous drainage. 2,11,12 Venous congestive myelopathy can also be caused by arteriovenous fistulas occurring intradurally and involving the perimedullary space, or rarely extradurally.…”

“…[11][12][13] In the typical spinal dural arteriovenous fistula, engorged tortuous vascular channels are identified in the subarachnoid space predominantly on the dorsal aspect of the cord, a consequence of the impaired spinal venous drainage. 2,11,12 Venous congestive myelopathy can also be caused by arteriovenous fistulas occurring intradurally and involving the perimedullary space, or rarely extradurally. 2 Similar pathologic changes have also been rarely reported in the absence of a demonstrable fistula or of abnormal spinal surface vessels.…”

“…19 The surgical pathologist may encounter spinal cord biopsies from these patients; thus it is necessary to be familiar with the histologic features of venous congestive myelopathy to avoid a misdiagnosis of neoplasm and to identify a surgically treatable condition. 11,12,[20][21][22][23] Herein, we report the clinical/histopathologic findings and follow-up in a group of seven patients who underwent spinal cord biopsy with a preoperative clinical and radiographic diagnosis of neoplasia. All were found to have histologic findings characteristic of venous congestive myelopathy and suggestive of an associated spinal dural arteriovenous fistula.…”