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Endovascular treatment of a sacral dural arteriovenous fistula
  1. Mokshal H Porwal1,
  2. Sean Tutton2,
  3. Grant P Sinson1 and
  4. Raphael Sacho1
  1. 1Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
  2. 2Radiology, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
  1. Correspondence to Dr Raphael Sacho; rsacho{at}mcw.edu

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.

  • neurosurgery
  • interventional radiology

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Footnotes

  • Contributors MHP was responsible for compiling the patient information and writing the majority of the case report. RS was involved in conducting the care for the patient and provided technical assistance and interpretation of data. ST was involved in conducting the care for the patient and provided interpretation of the case along with technical assistance. GPS provided guidance and oversight for the project along with analysis of the case and interpretation. RS, ST and GPS together conceived the idea for the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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