An Alternative Approach to Treating Spinal Epidural Arteriovenous Fistula: A Case Report of Direct Puncture.

We present a case of a patient in their 50s with a spinal epidural arteriovenous fistula (SEDAVF) at L2 level with intradural venous reflux. Initial transarterial embolization was attempted but failed due to vessel tortuosity and vasospasm. The second embolization was carried out with percutaneous puncture of the epidural venous sac under cone-beam computed tomography angiography (CBCTA) guidance. Following the complete obliteration of the fistula, resolution of the venous congestion and significant improvement of the patient's symptoms were achieved. This case highlights the utility of the percutaneous approach as an alternative treatment strategy for SEDAVFs when traditional endovascular routes are not feasible. Advanced imaging techniques, such as CBCTA, facilitate precise navigation and successful embolization.