Double spinal dural arteriovenous fistulas.

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Spinal dural arteriovenous fistulas (SDAVF) are typically solitary lesions.
• Synchronous or metachronous double SDAVF are exceptionally rare in medical literature.
• This study presents a single center's experience with three patients diagnosed with double SDAVF.

Purpose of the Study:

• To report on the rare occurrence of double spinal dural arteriovenous fistulas.
• To detail the diagnostic and treatment management strategies for patients with double SDAVF.
• To contribute to the understanding of the incidence and characteristics of double SDAVF.

Main Methods:

• Retrospective review of a single center's medical database from 1990 to 2017.
• Analysis of demographic, clinical, and radiological data for patients diagnosed with SDAVF.
• Focus on identifying and characterizing cases of double SDAVF.

Main Results:

• Double SDAVF were identified in 3 (1.4%) of 209 consecutive SDAVF patients.
• All three affected patients were male, with a mean age of 67.9 years.
• Myelopathic symptoms were present in all cases, with fistulas located in the thoracolumbar region (T7-L2).
• MRI/CE-MRA revealed medullary T2-hyperintensity, intramedullary enhancement, and perimedullary vein dilatation.

Conclusions:

• Double SDAVF represent a rare entity, accounting for 1.4% of cases in this series.
• The findings suggest that further segmental artery injections may be beneficial when an SDAVF is identified.
• A complete spinal digital subtraction angiography (DSA) is generally not indicated due to the extremely low incidence of double SDAVF.