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Table of Contents    
LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 204-205

A Spinal Dural Arteriovenous Fistula Mimicking Spinal Arteriovenous Malformation


Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China

Date of Submission24-Feb-2020
Date of Decision27-Apr-2020
Date of Acceptance01-Jul-2020
Date of Web Publication24-Feb-2021

Correspondence Address:
Jin Li
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu - 610 041
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.310079

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How to cite this article:
Niu X, Zhou X, Wang C, Li J. A Spinal Dural Arteriovenous Fistula Mimicking Spinal Arteriovenous Malformation. Neurol India 2021;69:204-5

How to cite this URL:
Niu X, Zhou X, Wang C, Li J. A Spinal Dural Arteriovenous Fistula Mimicking Spinal Arteriovenous Malformation. Neurol India [serial online] 2021 [cited 2021 Apr 23];69:204-5. Available from: https://www.neurologyindia.com/text.asp?2021/69/1/204/310079

Xiaodong Niu and Xingwang Zhou are considered as co.first authors




Sir,

Spinal dural arteriovenous fistulas (DAVFs) are the most common type of spinal vascular malformations and frequently result in progressive myelopathy. Spinal digital subtraction angiography (DSA) is still the gold standard for the diagnosis of these lesions. If a spinal DAVF is suspected according to clinical presentations and MRI findings, selective spinal angiography is performed to confirm the fistula, and meanwhile to differentiate from other lesions, such as spinal arteriovenous malformation (AVM).[1] Here we report a rare case with a spinal DAVF mimicking spinal arteriovenous malformation in 2D DSA imaging. A 54-year-old man presented with a 1-year history of bilateral lower-extremity weakness. Spinal MRI [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d revealed T2-weighted hyperintensity in the spinal cord from T6 to T9. Conventional spinal angiography [Figure 1]e demonstrated a spinal AVM at the T8-9 level. However, 3D images uncovered a T9 spinal DAVF supplied by the left T9 intercostal artery, which also gave rise to the artery of Adamkiewicz [Figure 1]f. Intraoperative findings conformed the diagnosis of spinal DAVF. The fistula was coagulated and divided successfully and the artery of Adamkiewicz was preserved [Figure 1]g,[Figure 1]h. The postoperative course was uneventful. The symptoms of the patient gradually improved after surgery.
Figure 1: A 54-year-old man with SDAVF. (a-c) Sagittal MRI shows T1 enlargement, T2 hyperintensity and swelling, and enhanced vessel (white arrows) of the spinal cord from T6 to T9. (d-e) MRA and 2-D angiography showed the suspected T8-9 AVM (red arrowheads). (f) 3-D angiography uncovered a left-T9 SDAVF (asterisk) drainage to peri-medullary venous plexus (white arrows), and the feeder also gave rise to the AA ( blue arrows). (g-h) Postoperative angiography showed no DAVF and the AA was preserved. (i-j) Intraoperative images showed a left-T9 SDAVF and the fistula was coagulated and divided successfully

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Usually, spinal DAVF can be diagnosed according to the typical MRI/DSA images. Occasionally, spinal DAVFs have no typical MRI/2D DSA images and need to distinguish from other vascular lesions, such as AVMs with fistulous components as their treatments may be very different. Initially, this case was suspected as a spinal AVM according to spinal images without obvious flow voids and with nodular enhancement in MRI and the nidus in the 2D DSA, however 3D rotational DSA further revealed the diagnosis of spinal DAVF. The addition of 3D rotational DSA can further improve the imaging quality and angioarchitecture of spinal vascular lesions,[2] which demonstrate that spinal 3D angiography is superior to conventional 2D angiography in the differential diagnosis of complicated spinal AVM and AVF.[3] In addition, the radicular artery feeding the fistula in most of spinal DAVFs does not give rise to the anterior or posterior spinal artery (ASA/PSA), and thus the fistula can be easily treated successfully. Previous study by Adrianto[4] revealed that nine patients (14%) had an occasional concomitant origin of the ASA/PSA with the feeder of spinal DAVF, and it is very critical for identifying and preserving the ASA/PSA, such as artery of Adamkiewicz (AA), accompanied by occasional concomitant origin with the feeder of spinal DAVF.

Financial support and sponsorship

Funded by the National Natural Science Foundation of China (81571131).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jeng Y, Chen DY-T, Hsu H-L, Huang Y-L, Chen C-J, Tseng Y-C. Spinal dural arteriovenous fistula: Imaging features and its mimics. Korean J Radiol 2015;16:1119-31.  Back to cited text no. 1
    
2.
Takai K, Kin T, Oyama H, Shojima M, Saito N. Three-dimensional angioarchitecture of spinal dural arteriovenous fistulas, with special reference to the intradural retrograde venous drainage system: Clinical article. J Neurosurg Spine 2013;18:398-408.  Back to cited text no. 2
    
3.
Takai K, Kin T, Oyama H, Shojima M, Saito N. Three-dimensional angioarchitecture of spinal dural arteriovenous fistulas, with special reference to the intradural retrograde venous drainage system. J Neurosurg Spine 2013;18:398-408.  Back to cited text no. 3
    
4.
Adrianto Y, Yang KH, Koo H-W, Park W, Jung SC, Park JE, et al. Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF). J NeuroInterv Surg 2017;9:405-10.  Back to cited text no. 4
    


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