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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
1   Department of Neuroradiology, Prasat Neurological Institute, Bangkok
,
Yodkhwan Wattanasen
1   Department of Neuroradiology, Prasat Neurological Institute, Bangkok
,
Somkiet Siriwimonmas
2   Department of Radiology, Bumrungrad International Hospital, Bangkok
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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

Financial support and sponsorship

Nil.




Publication History

Received: 28 June 2020

Accepted: 24 July 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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