Surgical Management of Spinal Dural Arteriovenous Fistula: A Case Report

Spinal dural arteriovenous fistulas (SDAVFs) are the most commonly encountered vascular malformation of the spinal cord and a treatable cause of progressive myelopathy. They most commonly affect elderly men and are classically found in the thoracolumbar region. The arteriovenous shunt is located inside the dura mater 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 the decreased drainage of normal spinal veins, venous congestion, and the clinical findings of progressive myelopathy. We report the case of a 62-year-old patient who presented with spastic paraparesis 3/5 bilaterally, with thermalogic hypoesthesia, hyperreflexia, and genito-sphincter disorders. Spinal cord MRI and spinal cord arteriography confirmed the diagnosis of dorsal dural arteriovenous fistula regarding D11, which was excluded by surgical technique, with the disappearance of serpiginous venous dilatations in the perimedullary vein. A good postoperative clinical evolution has been noted, with a clear improvement in the deficit. We report the case of a patient with a dorsal medullary dural fistula; we will discuss the clinical and neuroimaging presentation of the dorsal spinal dural fistula and the surgical management.