[Spinal dural arteriovenous malformations]

Vascular malformations of the spinal cord are a rare and complex clinical entity and can lead to severe morbidity with progressive spinal cord symptoms if not treated properly. In early stages the disease is characterized by slowly progressive, nonspecific symptoms, such as gait disturbance, paresthesia, diffuse sensory symptoms and radicular pain. In the late stages, bowel and bladder incontinence, erectile dysfunction, and urinary retention may develop. In recent decades the understanding and treatment of spinal vascular malformations have improved with the evolution of diagnostic tools and treatment modalities; however, it is still difficult to treat these cases because of the complexity of the pathology. All spinal dural arteriovenous fistulas (sdAVF) are most likely acquired; however, the exact etiology remains unknown. They typically present as a progressive myelopathy and have a poor prognosis if left untreated. Delayed diagnosis and intervention are associated with an increased risk of neurological deficits and a reduced likelihood of recovery. The general aim of treatment is disconnection of the arteriovenous shunt, which can be achieved by either open surgery or endovascular techniques. The surgical treatment of sdAVFs should be regarded as a combination of techniques with the shared goal of disconnecting the fistula.