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Multiple spinal arteriovenous fistulas: A case-based review
Josue M Avecillas-Chasín1, Juan R Brin2, Luis Lopez-Ibor2
1Department of Neurosurgery, Institute of Neurological Sciences, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
Abstract:
The occurrence of multiple spinal dural arteriovenous fistulas (AVFs) is rare. The majority of cases reported are synchronous and the lesions are mainly found at different spinal levels. Metachronous AVFs have been defined as lesions that manifest in a temporal sequence after treatment of a first AVF. In this report, we present two distinct cases of multiple spinal AVFs. Also, we review the main features of the cases previously reported, with emphasis on the proposed theories for the origin of multiple AVFs. In patients with failure to improve after treatment of a spinal DAVF, a whole-spine angiographic examination is mandatory, not only to ascertain the complete closure of the treated fistula, but also to look for a possible second lesion at a different spinal level.
Insights
Multiple spinal dural arteriovenous fistulas (AVFs) are rare, appearing synchronously or metachronously. Diagnosis requires whole-spine angiography if initial treatment fails, to detect additional lesions.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Multiple spinal dural arteriovenous fistulas (AVFs) are uncommon vascular malformations.
- Lesions are typically synchronous and at different spinal levels, but metachronous AVFs also occur.
Observation:
- This report details two unique cases of multiple spinal AVFs.
- A review of previously reported cases and theories on the origin of multiple AVFs is included.
Findings:
- Metachronous AVFs manifest temporally after the treatment of an initial spinal dural arteriovenous fistula.
- Failure to improve post-treatment necessitates comprehensive spinal angiography.
Implications:
- Mandatory whole-spine angiography is crucial for complete closure assessment and detection of secondary lesions.
- Early identification of multiple spinal AVFs can guide appropriate treatment strategies and improve patient outcomes.
