J Korean Soc Spine Surg.  2006 Jun;13(2):126-131. 10.4184/jkss.2006.13.2.126.

Myelopathy due to Spinal Dural Arteriovenous Fistula: A Case Report

• Kang CH
• Pyun YS
• Shin HK
• Sohn CH

• KMID: 2097829
• DOI: http://doi.org/10.4184/jkss.2006.13.2.126

Abstract

Spinal dural arteriovenous fistulas are rare abnormal connections of arteries and veins on the surface of the dura. A male presenting with myelopathy, which had a slowly progressive course for about 28 months, was diagnosed by magnetic resonance imaging and selective angiography. After surgical coagulation and excision, his symptoms were mildly improved. We report here on a man who underwent a surgical procedure for his myelopathy that was due to spinal arteriovenous fistula. Although it is unusual, spinal arteriovenous fistula should be considered when making a differential diagnosis of myelopathy.

Keyword

Spinal dural arteriovenous fistula; Myelopathy

MeSH Terms

Angiography
Arteries
Arteriovenous Fistula
Central Nervous System Vascular Malformations*
Diagnosis, Differential
Humans
Magnetic Resonance Imaging
Male
Spinal Cord Diseases*
Veins

Figure

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  Fig. 1A-D. (A) Coronal and sagittal T2-weighted MRI of the thoracic spine shows marked tortuosity of the perimedullary vessel in upper and midthoracic spine level. (arrow) (B) (Right) Sagittal T2-weighted MRI of the thoracic spine shows fine dotted signal intensities in subdural space and intramedullary hyperintensity within spinal cord. (Left) Sagittal T2-weighted MRI of the thoracolumbar spine shows serpentine signal intensities within spinal cord in lumbar spine area.

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  Fig. 2. (A, B) Axial T2-weighted MRI (Right) In midthoracic level, fine dotted signal intensities in subdural space. (Left) In lumbar 3-4th disc level, abnormal dilated intradural medullary vein. (arrow)

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  Fig. 3. (A, B) Spinal angiography (A) feeding artery -Adamkiewicz artery comes from left thoracic 11 level. (arrow) (B) Shunt were found at lumbar 3-4th disc level. (arrow)

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  Fig. 4. Intraoperative photograph showing an arterialized vein within dural sac in umbar 3-4th disc level. The fistula was treated with coagulation. (arrow)

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  Fig. 5. Artist's rendering of an intradural ventral arteriovenous fistula.

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  Fig. 6. (A) Sagittal T2-weighted MRI of the thoracolumbar spine shows no fine dotted signal intensities and no hyperintensity within spinal cord. (B) Axial T2-weighted MRI shows no abnormally enlarged intradural medullary vein.

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