Spinal dural arteriovenous fistula.
OBJECTIVE
To summarize clinical key points, diagnostic features, and results of imaging and therapy of spinal dural arteriovenous fistula (SDAVF).


RESULTS
SDAVF accounts for 70% of spinal arteriovenous malformation with an annual incidence of 5-10 cases per million. At least 80% of patients are male, and more than 66% of patients are in the sixth and seventh decade of life indicating preponderance of gender and age. Thrombophilia is not a predisposing factor of disease. Clinical course is predominated by symptoms of congestive myelopathy, but subarachnoid hemorrhage may occur. Double SDAVF is a rare problem in the management of disease. Magnetic resonance imaging has replaced myelography as screening procedure. Contrast-enhanced magnetic resonance angiography and multislice computerized tomographic angiography may facilitate diagnostic procedure, however, spinal angiography is still required to confirm diagnosis. Treatment by permanent occlusion of fistula results in clinical improvement in 70% of cases. Microsurgical shunt interruption has proven secure and reliable. Endovascular shunt embolization has been established as a standardized procedure, but occlusion rates are still lower than in surgical treatment.


CONCLUSIONS
Advances have been made in diagnosis and treatment of SDAVF, but the disease is still not completely understood.
Koch
Christoph
C
Department of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. koch@neuroradiologie.uni-luebeck.de
D017677:Age Distribution; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D003952:Diagnostic Imaging / Q000592:standards; D004388:Dura Mater / Q000098:blood supply* / Q000473:pathology* / Q000503:physiopathology; D004621:Embolization, Therapeutic / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D017678:Sex Distribution; D013116:Spinal Cord / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D020760:Spinal Cord Ischemia / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery