Surgical Management of Spinal Dural Arteriovenous Fistulas

Indications

• Symptomatic spinal dural arteriovenous fistula (SDAVF) should be treated. Symptoms often develop insidiously and progress over time and include weakness, sensory loss, and bowel/bladder dysfunction. High cervical fistulas can even present with basilar insufficiency–like symptoms. Dermatomal and myotomal symptoms may be distant from the actual level of the fistula. Surgery or embolization should be pursued in a timely manner to halt and potentially to reverse neurologic symptoms.

• Incidental finding of SDAVF is quite rare, but treatment is usually warranted when present, since spontaneous occlusion tends to not occur. Yet treatment of totally asymptomatic patients is controversial. In the pediatric population, presentation can be subtle as a part of cardiomegaly or pulmonary congestion with only murmur as a sign.