Kaku Yasuyuki, Ohmori Yuki, Kawano Takayuki, Takeshima Yuki, Kuratsu Jun-Ichi
Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
World Neurosurg. 2017 Sep;105:1037.e13-1037.e16. doi: 10.1016/j.wneu.2017.06.065. Epub 2017 Jun 17.
Spinal dural arteriovenous fistula (DAVF) is a rare disease, and multiple concurrent lesions are extremely rare. Such multiple spinal DAVFs have similar outflow routes at neighboring levels. However, there have been no reported cases of remote lesions of multiple spinal DAVFs. The authors herein report a case of double synchronous cervical and sacral DAVFs.
A 56-year-old man with no previous history of disease presented with progressive myelopathy, and spinal magnetic resonance imaging showed extensive edema of the spinal cord from the conus to T7. The initial angiography incidentally revealed a C1 DAVF, but the sacral DAVF was not diagnosed. The C1 DAVF was treated surgically, because of the risk of subarachnoid hemorrhage. A second angiography was performed 2 months after the first surgery because of high clinical suspicion, and the sacral DAVF was diagnosed at that time. The sacral DAVF was treated surgically, and the symptoms gradually resolved within 6 months after surgery.
Spinal DAVF is a rare disease, but clinicians should be aware of the possibility of the concurrence of multiple spinal fistulas located at different levels in the same patient.
脊髓硬脊膜动静脉瘘（DAVF）是一种罕见疾病，多个并发病变极为罕见。此类多发性脊髓DAVF在相邻节段具有相似的引流途径。然而，尚无多发性脊髓DAVF远处病变的报道病例。本文作者报告一例同时发生的颈段和骶段DAVF病例。
一名既往无疾病史的56岁男性出现进行性脊髓病，脊髓磁共振成像显示从圆锥至T7节段脊髓广泛水肿。初次血管造影偶然发现C1节段DAVF，但骶段DAVF未被诊断。由于存在蛛网膜下腔出血风险，对C1节段DAVF进行了手术治疗。首次手术后2个月，因临床高度怀疑，进行了第二次血管造影，此时诊断出骶段DAVF。对骶段DAVF进行了手术治疗，术后6个月内症状逐渐缓解。
脊髓DAVF是一种罕见疾病，但临床医生应意识到同一患者可能并发不同节段的多发性脊髓瘘。
