Surgical Treatment of Type I Spinal Dural Arteriovenous Fistulas

Alexander E. Ropper, M.D; Bradley A. Gross, M.D; Rose Du, M.D., Ph.D.


Neurosurg Focus. 2012;32(5):e3 

In This Article

Abstract and Introduction


Object Type I spinal dural arteriovenous fistulas (SDAVFs) are low-flow vascular shunts fed by radicular arteries in patients who most often present with myelopathy. Although some fistulas are amenable to endovascular embolization, nearly all can be treated with direct microsurgical obliteration.
Methods The authors reviewed their experience in treating 214 craniospinal arteriovenous malformations and/or fistulas over the last 8 years. Of these, 19 were spinal (9%), of which 15 (79%) were Type I SDAVFs. The authors reviewed the patients' epidemiological characteristics, presenting symptoms, and SDAVF angioarchitecture in all cases. They subsequently analyzed surgical obliteration rates and outcomes of all 11 patients who underwent fistula microsurgical obliteration.
Results In all patients who underwent microsurgical treatment, complete angiographic obliteration of the fistula was achieved. At follow-up, 10 (91%) of 11 patients exhibited improvement, 1 patient (9%) was the same, and no patients were worse. Specifically, 8 (73%) of 11 patients had improvement in strength and sensation, 5 (71%) of 7 had improvement of bowel/bladder function, and 3 (60%) of 5 had improvement of preoperative paresthesias. There were no wound infections, CSF leaks, or permanent neurological deficits.
Conclusions Microsurgical treatment of SDAVF provides direct access to the fistula point, allowing for high obliteration rates with excellent long-term improvement of preoperative deficits and limited periprocedural complications.


Spinal dural arteriovenous fistulas are the most common vascular malformation of the spinal cord and its surrounding dura mater.[1] They are distinct entities from true intramedullary AVMs[24] and warrant different diagnostic and treatment algorithms. Regardless of the therapeutic approach, clinical outcome after treatment is correlated with preoperative functional status, and hence, prompt diagnosis and therapy are key to optimizing patient outcomes.[36] Although some groups advocate endovascular therapy,[27,28,31,35] we most often employ microsurgical obliteration as the first-line treatment option,[16,30,33,34] given the ability to reliably visualize and gain direct access to the fistula point. We review our experience with this modality, illustrating its reliability in the context of minimal surgical morbidity.