Endovascular treatment of a sacral dural arteriovenous fistula. BMJ Case Rep 2021 Feb 05;14(2)
Date
02/07/2021Pubmed ID
33547130Pubmed Central ID
PMC7871243DOI
10.1136/bcr-2020-239256Scopus ID
2-s2.0-85100646726 (requires institutional sign-in at Scopus site)Abstract
Spinal dural arteriovenous fistula (SDAVF) is a rare pathological communication between arterial and venous vessels within the spinal dural sheath. Clinical presentation includes progressive spinal cord symptoms including gait difficulty, sensory disturbances, changes in bowel or bladder function, and sexual dysfunction. These fistulas are most often present in the thoracolumbar region. Diagnoses of SDVAFs are commonly missed, possibly due to the low index of suspicion, non-specific symptoms and challenging imaging. In this case report, we describe a rare presentation of a sacral SDAVF which was detected by collective efforts between endovascular neurosurgery and interventional radiology. We outline the diagnostic and imaging challenges we faced to discover the fistula. In particular, mechanical pump injection instead of hand injection during angiography was required to reveal the fistula. Following identification, the fistula was successfully treated endovascularly by using onyx (ethylene vinyl alcohol glue), a less invasive alternative to surgical intervention.
Author List
Porwal MH, Tutton S, Sinson GP, Sacho RAuthor
Grant P. Sinson MD Associate Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AngiographyCentral Nervous System Vascular Malformations
Diagnosis, Differential
Embolization, Therapeutic
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Sacrum
