[Clinical aspects and treatment of dural-spinal arteriovenous fistulas with perimedullary venous drainage. 10 cases].
OBJECTIVE
Spinal dural arteriovenous fistulas (SDAVF) are rare but represent the most frequent spinal arteriovenous malformation. Their clinical manifestations are well known, but their management can still be discussed between surgery and endovascular treatment. The purpose of this study is to emphasize the pre-eminence of surgical management for posterior and postero-lateral fistulas, which are the most common location of the malformation.


METHODS
We report a consecutive series of 10 patients with SDAVF treated between July, 1995 and July, 1997. Results are compared with other series of the literature.


RESULTS
Clinical manifestations were not specific and the diagnosis was established in most cases only one year after the onset of symptoms, as a progressive myelopathy. Low back pain was present in 4 patients, with pseudo-radicular pain in the lower limbs suggesting spinal degenerative disease in 3 cases. At the time of diagnosis, 8 patients had permanent motor weakness of the lower limbs, usually associated with hypesthesia and sphincterial dysfunction (7 cases). In all cases, the diagnosis was established using MRI. In most cases, the intradural draining spinal veins were also visible on MRI images. The location of the SDAVF was always precised by angiography, and was located between T5 and L1 in our series. Seven patients were successfully operated on, with surgical interruption of the intradural draining vein. Three patients underwent an endovascular treatment, but two of them were operated on later, as control angiography showed recurrence of the SDAVF. The clinical status of patients always improved after treatment, but recovery was incomplete in patients with severe and long lasting neurological deficit.


CONCLUSIONS
Surgical interruption of the intradural draining vein is a safe and effective method of treatment of SDAVF, especially for posterior and postero-lateral fistulas. Endovascular treatment is recommended for anterior locations of SDAVF.
Sleiman
M
M
Service de Neurochirurgie, CHRU, Lille.
Leclerc
X
X
Lejeune
J P
JP
Pruvo
J P
JP
Duquesnoy
B
B
Christiaens
J L
JL
D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001165:Arteriovenous Malformations / Q000150:complications; D004322:Drainage; D004388:Dura Mater / Q000002:abnormalities / Q000098:blood supply / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000002:abnormalities / Q000098:blood supply / Q000601:surgery*
Aspects cliniques et traitement des fistules artério-veineuses durales rachidiennes à drainage veineux périmédullaire. A propos de 10 observations.