Simultaneous Diagnosis and Treatment of Double Synchronous Spinal Cord Vascular Malformation

Although multiple concurrent spinal arteriovenous fistulas (DAVFs) are a well-known anatomical and clinical entity, the management of these lesions and timing of surgical intervention is still a matter of debate.A 74-year-old man with a 2-year history of progressive weakness of both lower limbs and lower back pain was diagnosed angiographically with a thoracic DAVF. During the surgical procedure, double independent spinal DAVFs were identified. With the aid of neurophysiologic monitoring, we proceeded to the closure of both fistulas in a one-step surgery.Neurophysiologic monitoring represents a valid, widely available, minimally invasive tool for the detection of immediate motor fiber damage due to disruption of the incorrect vessels during DAVF surgery and facilitates a safe treatment in a one-step procedure.