[Spinal dural arteriovenous fistula with peri-medullary venous drainage: analysis of a series from a single centre and review of the literature].
BACKGROUND
The optimal diagnosis and therapeutic managements of spinal dural arteriovenous fistulae, a rare disease, is discussed.


METHODS
We report a series of 10 patients seen in a 7-year period, treated by embolization.


RESULTS
There were 6 males and 4 females, with an average age of 58.4 years (range: 31 to 74 years). Diagnosis was made 2 days to 5 years (mean 15.3 months) after symptom onset with a high rate of incomplete or atypical clinical patterns (prolonged isolated sensory disorder, lumbo-sciatalgia, claudication, monoplegia), or sudden-onset deficit. In all cases, spinal MRI showed an intramedullary high-intensity signal on T2-weighted images but enlarged intradural vessels in only 70p.cent of cases. Angiography showed in all cases an arteriovenous fistula at the upper dorsal level (T1 to T7, 5 cases), lower dorsal (T8-T12, in 3 cases) and lumbar levels (2 cases). The fistula was successfully obliterated after initial embolization in 3 cases, but two (2 cases) or 3 procedures (2 cases) were sometimes required. The endovascular therapy failed in 3 cases.


CONCLUSIONS
In this series, the fistula was successfully obliterated in 70p.cent of patients. In the literature, fistula of 96.8p.cent to 97.9p.cent of patients were obliterated by surgery, which is a more invasive treatment. Embolization could be used as the first-line therapy, but incomplete obliteration requires rapid surgery. While the success of embolization is demonstrated, MRI and angiography must still be performed 6 months later.
Bléhaut
V
V
Service de Neurologie, Hôpital d'Instruction des Armées Desgenettes, Lyon.
Drouet
A
A
Tahon
F
F
Salkine
F
F
Belmar
A
A
Déruty
R
R
Turjman
F
F
D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000473:pathology*; D002533:Cerebral Angiography; D004388:Dura Mater / Q000473:pathology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology*; D008875:Middle Aged; D011379:Prognosis; D013122:Spinal Diseases / Q000175:diagnosis / Q000473:pathology*