Endovascular Management of Spinal Dural Arteriovenous Fistulas

Spinal vascular malformations, although rare, cause devastating disease. These malformations are commonly categorized as follows: spinal arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs), spinal hemangiomas, cavernous angiomas, and aneurysms. Spinal DAVFs (SDAVFs), or type 1 spinal AVMs, occur most frequently, representing ∼ 60 to 80% of vascular malformations of the spinal cord. While previously microsurgical treatment was considered the gold standard in the treatment of SDAVFs, recent advancements in technology-advancements of magnetic resonance imaging as a screening examination, contrast-enhanced magnetic resonance angiography, multidetector computed tomography as preangiographic evaluations, digital subtraction angiography, diagnostic catheters, and embolization materials-have made endovascular treatment a possible option. We review the treatment of SDAVFs, primarily discussing the endovascular management of these lesions.