Abstract
Spinal dural arteriovenous fistulas (SDAVFs) are vascular lesions caused by the interactions between the arterial and venous vascular systems of the spinal cord, leading to venous congestion of the spinal cord. They are the most frequent vascular malformation of the spine. These acquired lesions occur most commonly in the thoracic and lumbar spine of middle-aged men. Although the natural history of SDAVFs is not clearly defined, their clinical course is characterised by progressive neurologic decline leading to functional disability.
Here we report a case of a 60-year-old male patient admitted with complaints of back pain that irradiated to the lower legs, intermittent claudication, who then developed progressive paraparesis, gait disorder, and sphincter disturbances. The symptoms were typically progressive for four months with increasing severity. On MRI, on sagittal T2-weighted images, the cord oedema is depicted as a centromedullary hyperintensity, extended in dorso-lumbar (Th4-L1), and numerous serpiginous vessels dorsal to the spinal cord. Based on physical examination and magnetic resonance imaging findings, a preliminary diagnosis of SDAVF was made. The diagnosis was confirmed by spinal angiography, with a selective injection of the left Th9 segmental vessels, which demonstrates a dorsal intradural AVF. The aim of treatment in SDAVF is to occlude the shunting zone, the most distal part of the artery, together with the most proximal part of the draining vein, either by superselective embolisation with a liquid embolic agent or by neurosurgical approach. Our patient was treated by Microsurgery.
Spinal dural AVFs diagnosis should not be overlooked, and it should be kept in mind that early diagnosis and treatment prevent severe morbidities. The gold standard for the diagnosis is selective spinal angiography. Angiography is used for localization of the vascular lesion and treatment. Microsurgery and endovascular embolisation are effective methods for the treatment of SDAVF. Following occlusion of the fistula, the progression of the disease can be stopped, and improvement of symptoms is typically observed.
In this article, we report a case of SDAVF Intradural dorsal AVFs presenting with progressive paraparesis, gait and sphincter disturbances, bladder in the light of literature data.
