gms | German Medical Science

Objective: Spinal dural arteriovenous fistulae (SDAVF) are rare lesions in which an abnormal vascular shunt exists between a dural branch of a segmental spinal artery and a radicular vein that drains the perimedullary venous system. Optimal treatment of these lesions by surgery or embolization is still a matter of debate. We present the clinical characteristics of six consecutive patients and will discuss the treatment options in the light of the current literature.

Methods: We retrospectively reviewed the medical charts of 6 consecutive patients diagnosed with a spinal dural arteriovenous fistula between 2002 and 2007. Clinical history, time to diagnosis, neurologic examination and imaging results were retrospectively collected.

Results: There were 4 male and 2 female patients with a mean age of 55 years. The mean time to diagnosis was 9 months. Mean follow-up was 28 months. Progressive paraparesis, sensory deficits and gait ataxia were present in 5 of 6 patients. Urinary incontinence was present in 5 patients at diagnosis. The mean Aminoff-Logue score pre- and postoperatively were 5,5 and 4,3 respectively. All patients were treated by embolization and/or surgery. Two patients had embolization as the primary treatment option. Four patients were primarily operated. Complete obliteration was obtained in all treated patients. Two patients required a second procedure. All six patients were stable or better after endovascular or surgical treatment.

Conclusions: SDAVF will lead to significant morbidity if left untreated. If complete obliteration of the fistula cannot be achieved by embolization, direct surgery is recommended to avoid deterioration.