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[Spinal dural arteriovenous fistulas]
1Abt. Neuroradiologie, Universitätsklinikum der RWTH, Pauwelsstr. 30, 52074 Aachen.
Abstract:
The spinal dural arteriovenous fistula (SDAVF) is an important cause of a slowly progressive sensorimotor transverse lesion in mostly elderly patients. The disease affects men in 80% of the cases. Per year and per 1 Million inhabitants only 5-10 new cases of the disease have to be expected. Although rare, the serious disease should not be missed. Diagnosis can be made by MRI and spinal angiography. The result of treatment depends on early diagnosis. The arteriovenous shunt is located within the dural layer of the spinal canal. It connects branches of a radiculomeningeal artery with the veins of the spinal cord. Spinal cord supplying vessels are not primarily involved. Arterialisation of the venous part of the spinal cord circulation results in a chronic congestive myelopathy, which can well be demonstrated by MR imaging. The role of selectice spinal angiography is to detect and exactly localize the site of the avshunt, which is rather difficult in some cases. Therapeutic alternatives are effective embolization of the fistula with liquid agents or surgical disconnection.
Insights
Spinal dural arteriovenous fistulas (SDAVF) cause progressive myelopathy, often missed in elderly men. Early diagnosis via MRI and angiography is crucial for effective treatment like embolization or surgery.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Context:
- Spinal dural arteriovenous fistula (SDAVF) is a rare condition causing progressive sensorimotor deficits, primarily affecting elderly males.
- It results from an abnormal connection between dural arteries and spinal veins, leading to venous congestion and myelopathy.
- The incidence is low, estimated at 5-10 new cases per million inhabitants annually, underscoring the need for awareness.
Purpose:
- To highlight the importance of recognizing and diagnosing spinal dural arteriovenous fistulas (SDAVF).
- To outline the diagnostic modalities, including MRI and spinal angiography.
- To discuss treatment options and emphasize the impact of early intervention.
Summary:
- SDAVF presents as a slowly progressive sensorimotor transverse lesion, predominantly in elderly men (80% of cases).
- Diagnosis relies on MRI to visualize congestive myelopathy and spinal angiography for precise localization of the arteriovenous shunt within the dura.
- Treatment involves either selective embolization of the fistula or surgical disconnection, with outcomes dependent on early diagnosis.
Impact:
- Early diagnosis and treatment of SDAVF can prevent irreversible neurological damage and improve patient outcomes.
- Increased awareness among clinicians can lead to timely diagnosis, reducing diagnostic delays for this rare condition.
- Effective management strategies, including embolization and surgery, offer viable therapeutic options for patients with SDAVF.