Spinal dural arteriovenous fistula with an associated feeding artery aneurysm: Case report

OBJECTIVE AND IMPORTANCE: A case of a spinal dural arteriovenous fistula (D AVF) with two associated feeding artery aneurysms is reported. Intradural s pinal arteriovenous malformations have been associated with aneurysms that present with subarachnoid hemorrhage and with venous varices that produce m ass effect, but spinal DAVFs have not previously been described in associat ion with feeding artery aneurysms. CLINICAL PRESENTATION: A 71-year-old man presented with progressive spastic paraparesis, constipation, and overflow incontinence. Magnetic resonance i maging demonstrated a spinal vascular lesion and venous ischemia in the low er spinal cord. Diagnostic spinal angiography revealed a DAVF originating f rom the left T11 radicular artery and having the unusual feature of two pro ximal feeding artery aneurysms. INTERVENTION: The patient deteriorated neurologically after undergoing angi ography, prompting emergent surgery. The DAVF was resected through a T11 tr anspedicular approach. One aneurysm was dolichoectatic and therefore unclip pable, requiring proximal occlusion of the parent artery after establishing tolerance of test occlusion using somatosensory evoked potentials; the sec ond aneurysm was adjacent to the fistula and was resected with the DAVF. CONCLUSION: Feeding artery aneurysms in association with spinal DAVFs have not been previously reported. They present additional risk to patients and, with simple modifications of the standard operative approaches, can easily be treated as part of the surgery for the DAVF.