Acquired lumbosacral spinal dural arteriovenous fistula in association with degenerative lumbosacral disc herniation and spinal canal stenosis: Report of two cases and review of the literature

Prasert Iampreechakul; Pongwat Polpong; Korrapakc Wangtanaphat; Punjama Lertbutsayanukul; Yodkhwan Wattanasen; Somkiet Siriwimonmas

doi:10.4103/ajns.AJNS_318_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 1059-1067
DOI: 10.4103/ajns.AJNS_318_20

Case Report

Acquired lumbosacral spinal dural arteriovenous fistula in association with degenerative lumbosacral disc herniation and spinal canal stenosis: Report of two cases and review of the literature

Prasert Iampreechakul

Department of Neurosurgery, Prasat Neurological Institute, Bangkok

,

Pongwat Polpong

Department of Neurosurgery, Prasat Neurological Institute, Bangkok

,

Korrapakc Wangtanaphat

Department of Neurosurgery, Prasat Neurological Institute, Bangkok

,

Punjama Lertbutsayanukul

¹Department of Neuroradiology, Prasat Neurological Institute, Bangkok

,

Yodkhwan Wattanasen

¹Department of Neuroradiology, Prasat Neurological Institute, Bangkok

,

Somkiet Siriwimonmas

²Department of Radiology, Bumrungrad International Hospital, Bangkok

› Author Affiliations

Abstract

The authors describe two cases harboring lumbosacral spinal dural arteriovenous fistulas (SDAVFs) manifested with nonspecific initial symptoms, leading to misdiagnosis and unnecessary procedures. A curvilinear flow void in the lumbar region and thoracic cord congestion with subtle perimedullary flow voids were detected on magnetic resonance imaging (MRI) in both patients. Contrast-enhanced magnetic resonance angiography and spinal angiography confirmed the SDAVFs in the lower lumbar and sacral region. Both fistulas were located at the same level of disc herniation and spinal canal stenosis and supplied by branches of the internal iliac arteries (i.e., iliolumbar and lateral sacral arteries) with cranial drainage from the dilated vein of the filum terminale, corresponding to a curvilinear flow void, to the perimedullary veins. The first case was successfully treated with embolization. Another case had recanalization of the fistula 4 months after endovascular treatment and was successfully treated with surgical interruption of the fistula. Our two case reports may provide additional evidence supporting an acquired etiology of SDAVFs, probably secondary to lumbosacral disc herniation and spinal canal stenosis. The authors also reviewed literature about preexistent lumbosacral SDAVFs associated with disc herniation and spinal canal stenosis. From our review, the level of SDAVFs in most patients is correlated with the level of disc herniation, spondylolisthesis, and/or spinal stenosis.

Key-words:

Acquired spinal dural arteriovenous fistula - degenerative lumbosacral spine - disc herniation - spinal canal stenosis

Full Text

References

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