Treatment and diagnosis of spinal epidural arteriovenous fistula: report of 2 cases and review of literature

doi:10.13798/j.issn.1009-153X.2019.09.004

Abstract：To investigate the clinical characteristics, diagnosis and treatment of spinal epidural arteriovenous fistula (SEDAVF), and to analyze the the causes and countermeasures of misdiagnosis of rare SEDAVF. Methods The clinical data of 2 patients with SEDAVF who received interventional and surgical treatment in our department from September 2017 to December 2018 were retrospectively analyzed. The literatures related to SEDAVF were reviewed. Results Both 2 patients showed progressive weakness of lower extremities with defecation dysfunction, but they did not be difinitely diagnosed by DSA in external hospital and then were transferred to our hospital. Based on the neural location diagnosis, we found SEDAVF in the 5th thoracic segment of spine with the formation of epidural vein lake by prolonging the time of spinal cord angiography. Both 2 patients were treated using interventional embolization of the blood supply arteries and fistulas combined with operation to occlude the extradural vein lake. One patient was cured, and the other was only partially recovered due to the misdiagnosis for more than 2 years. Conclusions The SEDAVF is a rare spinal vascular disease which results in myelopathy by intraspinal venous hypertension or compression of spinal cord. The clinical manifestation of SEDAVF lacks specificity, resulting in misdiagnosis and missed diagnosis in clinc. The extension of exposure time during DSA or selective angiography of apparently irrelative artery combined with clinical symptoms may improve the accuracy of diagnosis. The fistula can be eliminated by interventional or hybrid surgery. The clinical symptom improvement rates are negatively correlated with the duration between the symptom onset and difinite diagnosis.