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|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 204-205
A Spinal Dural Arteriovenous Fistula Mimicking Spinal Arteriovenous Malformation
Xiaodong Niu, Xingwang Zhou, Chenghong Wang, Jin Li
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
|Date of Submission||24-Feb-2020|
|Date of Decision||27-Apr-2020|
|Date of Acceptance||01-Jul-2020|
|Date of Web Publication||24-Feb-2021|
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu - 610 041
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Niu X, Zhou X, Wang C, Li J. A Spinal Dural Arteriovenous Fistula Mimicking Spinal Arteriovenous Malformation. Neurol India 2021;69:204-5
Xiaodong Niu and Xingwang Zhou are considered as
Spinal dural arteriovenous fistulas (DAVFs) are the most common type of spinal vascular malformations and frequently result in progressive myelopathy. Spinal digital subtraction angiography (DSA) is still the gold standard for the diagnosis of these lesions. If a spinal DAVF is suspected according to clinical presentations and MRI findings, selective spinal angiography is performed to confirm the fistula, and meanwhile to differentiate from other lesions, such as spinal arteriovenous malformation (AVM). Here we report a rare case with a spinal DAVF mimicking spinal arteriovenous malformation in 2D DSA imaging. A 54-year-old man presented with a 1-year history of bilateral lower-extremity weakness. Spinal MRI [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d revealed T2-weighted hyperintensity in the spinal cord from T6 to T9. Conventional spinal angiography [Figure 1]e demonstrated a spinal AVM at the T8-9 level. However, 3D images uncovered a T9 spinal DAVF supplied by the left T9 intercostal artery, which also gave rise to the artery of Adamkiewicz [Figure 1]f. Intraoperative findings conformed the diagnosis of spinal DAVF. The fistula was coagulated and divided successfully and the artery of Adamkiewicz was preserved [Figure 1]g,[Figure 1]h. The postoperative course was uneventful. The symptoms of the patient gradually improved after surgery.
|Figure 1: A 54-year-old man with SDAVF. (a-c) Sagittal MRI shows T1 enlargement, T2 hyperintensity and swelling, and enhanced vessel (white arrows) of the spinal cord from T6 to T9. (d-e) MRA and 2-D angiography showed the suspected T8-9 AVM (red arrowheads). (f) 3-D angiography uncovered a left-T9 SDAVF (asterisk) drainage to peri-medullary venous plexus (white arrows), and the feeder also gave rise to the AA ( blue arrows). (g-h) Postoperative angiography showed no DAVF and the AA was preserved. (i-j) Intraoperative images showed a left-T9 SDAVF and the fistula was coagulated and divided successfully|
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Usually, spinal DAVF can be diagnosed according to the typical MRI/DSA images. Occasionally, spinal DAVFs have no typical MRI/2D DSA images and need to distinguish from other vascular lesions, such as AVMs with fistulous components as their treatments may be very different. Initially, this case was suspected as a spinal AVM according to spinal images without obvious flow voids and with nodular enhancement in MRI and the nidus in the 2D DSA, however 3D rotational DSA further revealed the diagnosis of spinal DAVF. The addition of 3D rotational DSA can further improve the imaging quality and angioarchitecture of spinal vascular lesions, which demonstrate that spinal 3D angiography is superior to conventional 2D angiography in the differential diagnosis of complicated spinal AVM and AVF. In addition, the radicular artery feeding the fistula in most of spinal DAVFs does not give rise to the anterior or posterior spinal artery (ASA/PSA), and thus the fistula can be easily treated successfully. Previous study by Adrianto revealed that nine patients (14%) had an occasional concomitant origin of the ASA/PSA with the feeder of spinal DAVF, and it is very critical for identifying and preserving the ASA/PSA, such as artery of Adamkiewicz (AA), accompanied by occasional concomitant origin with the feeder of spinal DAVF.
Financial support and sponsorship
Funded by the National Natural Science Foundation of China (81571131).
Conflicts of interest
There are no conflicts of interest.
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