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Triple spinal dural arteriovenous fistula.

BMJ Case Rep

January 2025

Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal vascular malformations. Multiple SDAVFs are unusual and can occur either synchronously or metachronously, as reported in the literature. We report on the unusual case of a woman with three separate SDAVFs, which were surgically treated within the same setting; the postoperative course was characterised by unexplained repeated haematoma formation within the surgical sites.

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Introduction: Dural arteriovenous fistulas (dAVF) are abnormal anastomoses between meningeal arteries and dural venous sinuses. Typically, dAVF treatment involves an endovascular or microsurgical approach. Anterior ethmoidal artery (AEA) dAVFs pose unique challenges due to their anatomy and location.

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A 54-year-old man presented with gait disturbances, urinary incontinence, and headache for 6 months. Head computed tomography indicated several high-density mass lesions in the quadrigeminal cistern, causing occlusive hydrocephalus. Digital subtraction angiography confirmed tentorial dural arteriovenous fistulae (AVF).

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Objective: Dural arteriovenous fistulas (DAVFs) with deep venous drainage (DVD) (DAVFs-DVD) are characteristically associated with non-hemorrhagic neurological deficits, most notably cognitive impairment. Large studies have yet to thoroughly characterize these DAVFs. We conducted an analysis of the largest cohort of DAVFs-DVD to provide a comprehensive characterization of this specific subset.

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