A Case of Angiographically Occult Spinal Dural Arteriovenous Fistula Detected Using CT Myelography

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  • CT myelographyが診断に有用であったangiographically occult spinal dural arteriovenous fistulaの1例

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Abstract

<p>  A spinal dural arteriovenous fistula (AVF) is rare and often misdiagnosed. Once identified, it can be treated with microsurgical exclusion or endovascular embolization. A spinal dural AVF is diagnosed using multiple approaches. Ideally, identification of a high-intensity lesion in the spinal cord with magnetic resonance imaging (MRI) should be followed by direct visualization of the fistula using spinal digital subtraction angiography (DSA). However, some cases show no apparent vascular lesion on DSA. We report a case of angiographically occult spinal dural AVF (occult spinal dural AVF) that was undetectable with MRI but was diagnosed using CT myelography (CTM).</p><p>  A 63-year-old man developed lumbar pain, followed by paraplegia, hypoesthesia, and urinary disturbance over the next 2 weeks. Notably, his symptoms were gradually progressive. MRI did not identify a high-intensity spinal cord lesion, but CTM revealed a vascular lesion inside the dura mater at T10. However, DSA failed to identify an abnormality. We diagnosed this patients’condition as occult spinal dural AVF and performed microsurgical resection. Perioperative findings confirmed the presence of an AVF shunt point and drainage vein within the dura mater.</p><p>  Occult spinal dural AVF is rare, with only 11 cases reported to date. The present report discussed the possible causes of impaired angiographic detection of AVF and concluded that slow moving or absent blood flow in an occluded drainage vein is below the detection limit of DSA. We therefore suggest that in addition to MRI, CTM is also suitable for the identification of occult spinal dural AVF.</p>

Journal

  • Spinal Surgery

    Spinal Surgery 32 (1), 61-65, 2018

    The Japanese Society of Spinal Surgery

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