Ruptured spinal dural arteriovenous fistula with subdural hematoma: A case report

Spinal dural arteriovenous fistulas (SDAVFs) are the most common spinal vascular malformations and can lead to significant neurological deficits if left untreated. Although typically associated with chronic myelopathy, rupture of SDAVFs is a rare yet severe complication that can result in acute spinal cord injury secondary to intradural hematoma expansion.

A 53-year-old male presented with fluctuating neck and back pain, unsteady gait, right leg numbness, and urinary retention, eventually attributed to a ruptured thoracic SDAVF resulting in a T3-T4 subdural hematoma. The original magnetic resonance imaging demonstrated a subdural collection with severe spinal cord compression, without any evidence of flow-voids indicative of a vascular malformation; the emergent spinal angiogram was negative for any vascular abnormalities. An emergent T2-3 laminectomy was performed for hematoma evacuation and fistula ligation (i.e., after identification of the fistula intraoperatively). Postoperatively, the patient gradually improved.

Early recognition and emergent surgical management of spinal subdural hematomas due to SDAVF ruptures are critical. Adequate preoperative preparation for open-vascular management of these lesions may be warranted despite negative preoperative vascular imaging.