doi: 10.3174/ajnr.A1485
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American Journal of Neuroradiology 30:639-648, April 2009
© 2009 American Society of Neuroradiology
Review Article
Spinal Dural Arteriovenous Fistulas
a Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital and Hospital for Sick Children, Toronto, Ontario, Canada
b Clinic for Neuroradiology, University Hospital Aachen, Aachen, Germany
c Service de Neuroradiologie Diagnostique et Thérapeutique, CHU Le Kremlin Bicetre, Paris, France
d Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Please address correspondence to T. Krings, MD, PhD, University of Toronto, Toronto Western Hospital, UHN, Division of Neuroradiology, 399 Bathurst St, 3MCL-429, Toronto, ON, M5T 2S8, Canada; email: timo.krings{at}uhn.on.ca
SUMMARY: 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 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 decreased drainage of normal spinal veins, venous congestion, and the clinical findings of progressive myelopathy. On MR imaging, 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.