Abstract

Introduction: Although Spinal Dural Arteriovenous Fistula (SDAVF) is the most common arterio-venous malformation of the spinal cord, it is an extremely rare pathology. It is usually an acquired condition that may cause congestive myelopathy through chronic venous hypertension. The clinical picture is non-specific but the diagnosis can be inferred from Magnetic Resonance Imaging (MRI) and confirmed through Digital Subtraction Angiography (DSA).
Case Presentation: We report four cases that presented in our clinic in the past twelve months and in which SDAVF was suspected based on spinal MRI. The mean age was 54. Three of them presented with severe motor deficits and two of them had sphincteric disturbances. Sensory deficits varied. Three of the patients had a subacute progression, while one of them evolved rather acutely. The diagnosis was confirmed through DSA with selective catheterization and endovascular occlusion of the feeding artery by injection of liquid embolic material was performed with no periprocedural incidents. There was no further progression of deficits and three of the patients presented partial improvement by the time of discharge.
Discussion: One of the main challenges posed by these patients is correctly identifying the feeding artery of the SDAVF, which may be achieved by spinal Magnetic Resonance Angiography (MRA) and elaborate DSA. Another aspect relates to the recovery of neurologic deficits which includes motor rehabilitation programmes, as well as management of associated symptoms and pathologies.
Conclusion: It is our experience that shunt obliteration should be always attempted as SDAVF is a rare but recuperable cause of severe neurologic deficits.

Keywords:Spinal dural arteriovenous fistula; Paraparesis; Paraplegia; MRI; DSA; Embolization; Neuroradiology; Rehabilitation

Abbreviations:DSA=Digital Subtraction Angiography; MRA=Magnetic Resonance Angiography; MRI=Magnetic Resonance Imaging; MRC=Medical Research Council; SDAVF=Spinal Dural Arteriovenous Fistula