gms | German Medical Science

Objective: Intracranial and spinal dural arteriovenous fistulae (dAVF) are rare vascular malformations. The pathophysiology of dAVF is not fully understood yet. Generally, they are considered to be acquired lesions, often attributed to dural sinus thrombosis. We report on the detailed development of dAVF based on three cases which were precisely documented by way of routinely executed MRI imaging performed as a regular follow up for other pathologies.

Methods: Two patients who developed postoperative dAVFs underwent brain tumor surgery and one patient underwent surgery of a lumbar spinal stenosis. The development was documented during the postoperative follow-up examinations with MRI over a 1-,3- and 18-year time period. Afterwards DSA was performed to confirm the findings.

Results: A 53-year-old male patient underwent resection of a vestibular schwannoma (WHO I) in 2014. At the yearly follow-up examinations using cMRI, we documented the development of a complex dAVF (Cognard III) including transverse and sigmoid sinus on both sides and association with infratentorial veins with corticovenous reflux. A 57-year-old woman underwent resection of an right precentral astrocytoma (WHO III) in 1998. We documented the development of a left temporal dAVF graded as Cognard II b during the postoperative examinations with cMRI. Both patients first developed a venous sinus thrombosis and afterwards a dAVF. A 72-year-old man underwent surgery of a lumbar spinal stenosis in 2017. After one year he developed new neurological deficits. Lumbar MRI and DSA demonstrated the development of a spinal dAVF with feeders from the left radicular artery (L5), which was treated surgically.

Conclusion: DAVF are rare complications which most probably arises as a result of an asymptomatic sinus thrombosis. The clinical presentation and imaging findings of dAVF may be nonspecific and misleading, and are often mistaken for other entities.

Figure 1 [Fig. 1]