Multiple synchronous spinal dural arteriovenous fistulas: A systematic literature review

Abstract

ABSTRACTBackgroundMultiple spinal dural arteriovenous fistulas (SDAVFs) are rare and account for only 1–2% of all SDAVF cases. The treatment for SDAVFs typically involves either direct surgy or endovascular treatment. Identifying the precise location of all fistulas is paramount for successful treatment procedures when multiple SDAVFs are present. They can be classified as synchronous (occurring simultaneously) or metachronous (occurring at different times), with each type differing with respect to etiology, diagnosis, and treatment. This study systematically reviewed the literature on multiple synchronous SDAVFs.MethodsA comprehensive search was performed to identify all published multiple synchronous SDAVF cases. Overall, 23 patients with multiple SDAVFs were identified, including 21 from 19 articles and 2 from this study. Clinical presentation, lesion location, radiographic features, surgical treatment, and outcome were analyzed in each patient.ResultsAll patients in this study were male individuals, and the duration from symptom onset to diagnosis in many of these patients was longer than that previously reported. Previous studies suggested that multiple SDAVFs typically occurred within three of fewer vertebral levels. However, >50% of examined patients had remote lesions separated by more than three vertebral levels. Patients with remote lesions had a significantly worse outcome (1/7 vs. 8/11, P=0.049). Therefore, accurate localization of fistulas before spinal angiography is critical for managing multiple remote SDAVFs.ConclusionsConsidering the possibility of multiple remote SDAVFs, careful interpretation of imaging findings is essential for accurate diagnosis and appropriate treatment planning.KEY MESSAGESWhat is already known on this topicMultiple spinal dural arteriovenous fistulas (SDAVFs) can be classified as synchronous (occurring simultaneously) or metachronous (occurring at different times), and they differ in etiology, diagnosis, and treatment. However, the differences between two conditions need to be better clarified.What this study addsPatients with remote SDAVFs tended to receive more treatments and had worse prognosis than those with non-remote SDAVFs. Therefore, correct localization of fistulas before spinal angiography is essential for managing multiple remote SDAVFs.How this study might affect research, practice or policyMultiple remote SDAVFs may occur in patients; therefore, careful interpretation of imaging results is critical for accurate diagnosis and appropriate treatment planning.