2. • Introduction :
• Vascular lesions of the spine are rare, accounting for only 1–2% of vascular
neurological pathologies. They are divided into arteriovenous fistulae and
arteriovenous malformations. They are further classified based on
pathophysiology, neuroimaging and neuroanatomy.Spinal intradural
arteriovenous fistulae (sdAVF) are consistently the most common
representing up to 80% of lesions identified.
• sdAVF tend to be located dorsally in the low thoracic and lumbar area with
80% occurring between T6 and L2.They represent an abnormal connection
between a spinal radicular artery and vein, typically at the dural sleeve of
the dorsal nerve root. Arterialization of the medullary vein leads to venous
congestion in the coronal venous plexus of the spinal cord. As venous
pressure increases there is decreased tissue perfusion along with vascular
steal, ischemia and in some cases hemorrhage.
3. • Meterial and methods:
• We report a 30-year-old man with no particular medical history, the
first telltale symptoms were gait disturbance, sensory disorders and
paresthesia. The time between the first symptoms and diagnosis did
not depend on the nature of the initial symptoms. Initially, these only
appeared after a certain distance (gait lameness), but as the disease
progressed, walking immediately became difficult.
4. • Preoperative images of T12 cord lesion.(a, b) T2-weighted MR
showing enhancement at T12 involving the conus with subtle
perimedullary flow voids. (c) T1 weighted MR showing enhancement
at T12 likely representing necrosis.
5.
6. • Discussion and results : Spinal dural arteriovenous fistulas (AVFs) have been categorized
on the basis of the Anson and Spetzler classification into 4 types. Type I is the most
common type and describes an abnormal connection between a radicular artery at the
nerve root sleeve and an intradural draining vein. This communication results in
progressive dilatation and mass effect from the draining vein experiencing arterial
pressures without intervening arterioles. In this patient, preoperative angiography
showed a type I dural AVF. A laminoplasty was performed to provide dural exposure, and
a midline durotomy was performed. Indocyanine green (ICG) angiography was used to
visualize flow within the fistula. This dorsal dural AVF demonstrated the characteristic
slow venous flow. Pressure recordings were obtained and confirmed the elevated venous
pressure observed in these lesions. Bipolar coagulation of the fistulous point was
performed, and the vessel was removed at the site of the root entry zone to permit
pathologic confirmation of the arteriovenous interface. Intraoperative ICG angiography
findings confirmed disconnection. The patient gave informed consent for surgery and
video recording
• In post-operative the patient was able to resume walking without pain
7.
8.
9. • Conclusion : All physicians who are involved in the management and
diagnosis of patients with spinal disorders must have an excellent
understanding of sdAVF. Misdiagnosis and delay in diagnosis is
common. A timely diagnosis and treatment likely leads to improved
neurological outcomes in select patients.
