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Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive para- or tetraplegia. They most commonly affect elderly men and are classically found in the thoracolumbar region. The AV shunt is located inside the dura matter close to the spinal nerve root where the arterial blood from a radiculomeningeal artery enters a radicular vein. The increase in spinal venous pressure leads to decreased drainage of normal spinal veins, venous congestion, and the clinical findings of progressive myelopathy. On MR imagining, the combination of cord edema, perimedullary dilated vessels, and cord enhancement is characteristic. Therapy has to be aimed at occluding the shunting zone, either by superselective embolization with a liquid embolic agent or by a neurosurgical approach. Following occlusion of the fistula, the progression of the disease can be stopped and improvement of symptoms is typically observed. |
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digital subtraction angiography
fistula,arterio-venous
fistula,arterio-venous,dural
fistula,arterio-venous,dural,spinal
MRI,abnormal
MRI,angiography
MRI,angiography,contrast enhanced
MRI,spinal cord
myelopathy
myelopathy,chronic progressive
paraplegia
prognosis
review article
spinal cord,vascular malformation of
treatment of neurologic disorder
venous engorgement
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