Double Spinal Dural Arteriovenous Fistula

Background: Spinal dural AVFs are vascular malformation comprising of AV shunts within the spinal dura. They present with gradually progressive myelopathy. Double spinal dural AVFs at different levels identified and treated endovascularly in the same time are rare.

Case: A 62-year-old man presented with gradual onset progressive weakness of both lower limbs associated with paresthesia for last 1 year. He had recent onset bowel bladder disturbance presenting with constipation and overflow incontinence. MRI showed cord edema with flow voids along posterior aspect of spinal cord from C5 to L2 vertebral level. Spinal angiography showed dural AVF at T12 level with descending perimedullary veins. As MR imaging showed flow voids at the cervical and upper thoracic level also and no ascending perimedullary veins were identified found, angiography was continued. A second SdAVF was found at the level of T2 level. Both fistulas were embolized in the same session with NBCA.

Discussion: Multiple spinal dAVFs are rare. MRI is unable to determine whether there is single or multiple fistulas as in MRI only abnormal veins are seen; fistula itself is not seen. Discrepancy in the venous drainage in MRI and spinal angiography can prompt us to look for second fistula.

Publication History

Article published online:
09 February 2023