title: Curable cause of paraplegia: spinal dural arteriovenous fistulae.
abstract: OBJECTIVE
  The rarity of spinal dural arteriovenous fistulae makes physicians often overlook this potential diagnosis in patients with progressive gait disturbance and paraparesis. Consequently, patients with spinal dural arteriovenous fistulae can gradually become completely paraplegic if the final diagnosis is delayed considerably. The objective of the current study is to demonstrate that, particularly in patients with paraplegia, surgical treatment of fistula is necessary and often has a favorable outcome.
  
  
  METHODS
  Of 42 patients with spinal dural arteriovenous fistulae treated in our institution (surgery or endovascular treatment), 6 were paraplegic preoperatively (Grade IV on the McCormick scale and Grade V on the Aminoff scale, Grade 5 of modified Rankin Scale with motor ASIA between 0 and 10 for both lower limbs). Their clinical history revealed that paraplegia appeared progressively within a period of <3 months. All patients were clinically evaluated at 6 weeks, 6 months, and then annually during an average follow-up of 3 years. Patients received at least one spinal angiography and MRI test during the follow-up period.
  
  
  RESULTS
  Total exclusion of the fistula was performed surgically in all cases and was confirmed by spinal angiography. No surgical complications were recorded. All patients improved postoperatively. Three patients showed almost normal walking (Grade I on the McCormick scale, I on the Aminoff scale, Grade 1 of modified Rankin Scale) and 3 were able to walk with a cane (Grade II on McCormick, Grade III on Aminoff scale, Grade 2 of modified Rankin Scale). MRI tests were normal in all patients.
  
  
  CONCLUSIONS
  Our results indicate that treatment of fistula is a necessary intervention, even in patients with complete paraplegia.
authors.affiliation: Department of Neurosurgery, Bicêtre University Hospital, Le Kremlin-Bicetre, France. Nozar.aghakhani@bct.aphp.fr
authors.forename: Nozar
authors.initials: N
authors.lastname: Aghakhani
authors.forename: Fabrice
authors.initials: F
authors.lastname: Parker
authors.forename: Philippe
authors.initials: P
authors.lastname: David
authors.forename: Pierre
authors.initials: P
authors.lastname: Lasjaunias
authors.forename: Marc
authors.initials: M
authors.lastname: Tadie
mesh_terms: D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010264:Paraplegia / Q000209:etiology* / Q000601:surgery*; D020127:Recovery of Function; D013116:Spinal Cord / Q000098:blood supply / Q000601:surgery*