Embolization of spinal dural arteriovenous fistula via the retrocorporeal artery: case report.
BACKGROUND
The goal of spinal dural arteriovenous fistula (DAVF) treatment is to permanently occlude the proximal draining vein and the fistula itself, which can be achieved by open surgery or endovascular treatment. The endovascular approach is currently the primary treatment, but it requires the presence of an access as close to the site of the fistula as possible. This case illustrates that the retrocorporeal artery may be an alternative option in case of previous embolization failure with proximal occlusion of the radicular arteries.


METHODS
A 54-year-old man presented with an 18-month history of progressive paraparesis secondary to right L2 spinal DAVF. The first endovascular treatment failed to achieve occlusion of the fistula via the ipsilateral L2 and L3 radicular arteries. Given the proximal occlusion of these feeders during the first embolization, the dilated retrocorporeal arteries were approached via the contralateral L2 and L3 radicular arteries. Complete occlusion of the fistula was achieved with Onyx in a single session with progressive improvement of preoperative neurological deficit.


CONCLUSIONS
The retrocorporeal artery may provide a safe alternative approach to spinal DAVFs in cases in which a conventional endovascular approach failed, thus avoiding invasive surgical treatment.
*Department of Interventional Neuroradiology, Dupuytren University Hospital, Limoges, France; ‡Department of Radiology, Maribor Teaching Hospital, Maribor, Slovenia.
Benjamin
B
Gory
Suzana
S
Saleme
David
D
Ayoub
Aymeric
A
Rouchaud
Tomaz
T
Seruga
Marie Paule
MP
Boncoeur Martel
Charbel
C
Mounayer
D020785:Central Nervous System Vascular Malformations / Q000628:therapy*; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000098:blood supply*