Spinal dural arteriovenous fistulae - A diagnostic challenge

Background: Spinal dural arteriovenous fistulae comprise the majority of sp inal vascular malformations. The most common clinical presentation is that of progressive myeloradiculopathy, probably related to venous hypertension, which may lead to permanent disability and even death. Objective: To report our clinical experience with spinal dural arteriovenou s fistulae. Methods: Nine patients with spinal dural AVF were managed at our center dur ing a one year period (1998-1999). The patients, eight men and one woman ra nging in age from 46 to 75 years, presented with initially fluctuating and eventually permanent and progressive paraparesis, sensory disturbances and sphincter dysfunction. The neurological signs generally began symmetrically and progressed from the distal to proximal limb regions. The duration of s ymptoms before diagnosis ranged from 6 to 36 months during which the patent s underwent an extensive but fruitless work-up and even unnecessary operati ons due to misdiagnosis. All patients finally underwent magnetic resonance imaging and spinal angiography, which demonstrated the pathological vascula r fistula. Interruption of the AVF was achieved by embolization or by surgi cal resection. Results: Following treatment, six patients experienced improvement of gait and sphincter control, and the severe neurological deficits stabilized in t he other three patents with long duration of illness. There was no further deterioration in any of the treated patients. Conclusions: The history, neurological findings and radiological changes on MRI scan should alert clinicians to the possibility of spinal dural AVF, l eading to diagnostic spinal angiography. Early diagnosis and treatment may significantly improve outcome and prevent permanent disability and even mor tality.