Spinal Dural Arteriovenous Fistulas: A Review

Abstract

Spinal dural arteriovenous fistulas (SDAVF) are a rare pathologic entity with a diverse and often misleading clinical presentation. While digital subtraction spinal angiography remains the gold standard, recent advances in noninvasive vascular imaging have improved the diagnosis of SDAVF. As this condition can result in permanent spinal cord injury, all patients require treatment, which consists of surgical or endovascular occlusion of the fistula. Failure to recognize and treat SDAVF in a timely fashion can result in irreversible neurologic disability, including myelopathy, lower extremity weakness and bowel, bladder and sexual dysfunction. This article reviews the clinical features, pathogenesis, radiographic features and current treatment strategies for these complex lesions.

Spinal cord imaging in spastic paraparesis: are we cutting it thin enough?

“…This case highlights the importance of a high clinical suspicion since SDAVF are potentially reversible causes of mielopathy if identified early [1] and normal MRI does not exclude the diagnosis [4]. Thin-section volumetric post-contrast MRI and MR-angiography studies can reveal subtle details, not seen in routine protocols.…”

“…SDAVF are more common in men and typically present in the fifth and sixth decades of life [1]. The patients usually present with lower extremity spastic weakness, sensory symptoms, bowel/bladder disturbances and back pain [1,2].…”

Microscope-assisted endoscopic interlaminar ligation of spinal arteriovenous fistulas: technical note

“…5,22 The major reasons hindering the widespread use of spinal endoscopy for intradural spinal lesions are technical difficulties such as opening and closure of the dura mater, the potential for iatrogenic injury to the spinal cord and nerves, and difficulties involved with manipulating instruments through the single endoscopic canal. 12 Nevertheless, the relatively spacious lumbar spine makes it possible for endoscopic management of intradural lesions through the natural interlaminar space. The endoscopic approach is superior to traditional open microsurgery because it requires a smaller skin incision, leads to better preservation of bony structures of the spine, allows for better illumination of the surgical field and better visualization of anatomical details, and provides better observation angles of lesions.…”

“…5 For SDAVFs, both endovascular and microsurgical approaches have been shown to successfully occlude the proximal draining vein and the fistula itself. 1,9,12,13 With the help of preoperative spinal DSA, it is generally not difficult to identify the fistula site, the feeding artery, and the drainage pattern. However, the variability of epidural and spinal cord vascular anatomy may still pose diagnostic and therapeutic difficulties for endovascular treatment in some patients.…”

Our experience of spinal dural arteriovenous fistula: 4 case reports

“…Hastaların kısa dönem sonuçları, cerrahi hastalarıyla kıyaslandığında benzer bulunmuştur (13). Mikrocerrahi yöntem olarak fistülün boşaldığı spinal venin bipolar akım ile koterize edilmesi veya anevrizma klipsi ile kapatılması kullanılmaktadır (14). İntraoperatif anjiyografi kullanımı cerrahi tedavi başarısını arttırmaktadır.…”