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Treatment / Protected: Spinal Angiography and Spinal Dural Fistula Embolization

A spinal dural arteriovenous fistula (SDAVF) is an abnormal connection between arteries and veins in the dura, the outer lining of the spinal cord.

Normally, arteries and veins are connected by tiny vessels called capillaries. Capillaries handle the transition from higher to lower pressure, help supply nutrients from the blood to surrounding tissues, and help move waste products from the tissues to the blood. In an SDAVF, the capillaries are missing and arteries and veins are directly connected to each other.

The abnormal connection can lead to a number of problems. For example, without capillaries, high-pressure arterial blood rushes directly into veins. Veins are not equipped to handle this influx. They can swell, and blood flow through them can become congested. Ultimately, this leads to swelling, which places harmful pressure on the spinal cord. Additionally, without capillaries to handle nutrient exchange, the tissue around the SDAVF can have difficulty receiving nutrients like oxygen and glucose.

Any issues with blood flow, pressure, and nutrient delivery can cause injury to the tissues around the SDAVF, which can result in neurological dysfunction over time.

Diagnosis and Evaluation

A fistula is commonly discovered by MRI. An MRI of a patient with a dural fistula shows large veins surrounding the spinal cord. The cord may show evidence of swelling (edema) and enhancement if MRI contrast is given.

Once the diagnosis of a fistula is made, the next step is evaluation of the fistula using a spinal angiogram. In order to confirm the location of the fistula, a minimally invasive procedure called a spinal angiogram is necessary. Using image guidance a catheter is navigated into the aorta and other vessels which can give rise the fistula. Once the location is identified, the anatomy of the fistula is evaluated to see if it can be treated.

Spinal Dural Arteriovenous Fistula Treatment

The vast majority of fistulas can be treated through catheter embolization, sometimes at the same time as the spinal angiogram. This allows for both the diagnosis and treatment to be completed during the same procedure.

During an endovascular embolization, your neuro interventionalist will insert a tiny catheter (flexible tube) into an artery in your groin and guide it up to the fistula to block the blood flow between the artery and the vein. Platinum coils or other materials, such as surgical glue, may be used to block the blood flow.

If embolization treatment is not possible, the fistula can be closed surgically.

Recovery

Once the fistula is closed, spinal cord blood circulation improves, but usually does not go back to normal because a number of veins draining the spinal cord have already been damaged. Symptoms may go away completely, partially, or not at all. The extent of eventual improvement depends on duration and severity of pre-treatment symptoms, individual anatomy, and other considerations. The goal of treatment is to prevent further neurologic dysfunction and possibly improve some of the resulting neurologic deficits.

 

If you have been diagnosed with a spinal dural fistula and are exploring your options for treatment, call IVC today at 503-612-0498 to schedule an appointment for consultation.

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