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Case Reports
. 2023 May 2;15(5):e38448.
doi: 10.7759/cureus.38448. eCollection 2023 May.

Spinal Dural Arteriovenous Fistula: Insights Into Operative Management

Ali Msheik  1 , Zeinab Al Mokdad  2 , Teddy Gerges  3 , Ahmad Aoude  4
Affiliations
Case Reports

Spinal Dural Arteriovenous Fistula: Insights Into Operative Management

Ali Msheik et al. Cureus. .

Abstract

Spinal Dural Arteriovenous Fistula (SDAVF) is a rare and complex vascular condition with significant neurological consequences if left untreated. We present a case of SDAVF in a 46-year-old male who presented with progressive myelopathy. The patient presented with a three-month history of progressive lower extremity weakness, numbness, urinary retention, constipation, and gait disturbance. The spine's magnetic resonance imaging (MRI) showed diffuse T2 hyperintensity and contrast enhancement from T11 to L1, raising the suspicion of an intradural spinal cord lesion. Further evaluation with spinal angiography revealed an SDAVF at the level of T11-T12. The patient underwent surgical resection of the fistula, His lower extremity weakness and numbness improved significantly after surgery, and he was discharged with a plan for close follow-up. Early diagnosis and appropriate treatment prevent neurological deficits and improve patient outcomes. Surgical resection of the fistula can significantly improve neurological symptoms and should be considered a treatment option for SDAVF.

Keywords: erectile dysfunction; sdavf; spinal venous congestion; urinary retention; weakness.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Sagittal cut of the lumbar spine of the patient.
A: T1 sequence; B: T2 sequence; C: STIR sequence
Figure 2
Figure 2. The analogy between the Digital Subtraction Angiography (DSA) (right side) and the surgical findings (left side)
Cd: caudal side of the patient, L: left side of the patient, black star: venous part of the SDAVF, yellow star: Dural perforating artery. SDAVF: Spinal Dural Arteriovenous Fistula
Figure 3
Figure 3. Surgical findings with annotation.
Arrows by color. Yellow: Perforating dural artery, black: venous part of SDAVF, Purple: congested spinal vein, Orange: SDAVF ends after resection. Blue star: Vascular clip, Green star: decongested spinal vein after SDAVF resection. SDAVF: Spinal Dural Arteriovenous Fistula
Figure 4
Figure 4. Recordings of neural electric conduction before the resection of the SDAVF.
Red star: low voltage; Yellow star: Low current conduction. SDAVF: Spinal Dural Arteriovenous Fistula
Figure 5
Figure 5. Recordings of neural electric conduction after the resection of the SDAVF.
Green star: 4x-7x increase in the voltage and current recordings after the resection. SDAVF: Spinal Dural Arteriovenous Fistula
See this image and copyright information in PMC

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