Rare Spinal Dural Arteriovenous Fistula with Double Draining Veins: 1 Draining Vein Mimicking Artery of Adamkiewicz: Case Report and Review of Literature.

Abstract

Spinal dural arteriovenous fistula (DAVF) typically has a single intradural drainage vein, abnormally connecting with the radiculomeningeal artery at the dura root sleeve. Multiple intradural draining veins are extremely rare. To date, only 1 case of spinal DAVF with multiple draining veins has been reported. A 62-year-old woman presented with a 2-year history of progressive weakness and numbness in her lower extremities. Spinal magnetic resonance imaging showed extensive edema of the cord and prominent vascular flow voids. Spinal angiography demonstrated a right L3 DAVF with supply from the left L3 lumbar artery. The feeding artery was also thought to give rise to the artery of Adamkiewicz. The spinal DAVF was surgically treated, and the artery of Adamkiewicz was retained. Her postoperative symptoms gradually improved. Eight months after the surgery, her symptoms gradually worsened. Repeat spinal angiography revealed a right L3 DAVF at the same location of the first fistula. In retrospect, the draining vein identified on the second angiography was mistakenly considered as the artery of Adamkiewicz at the first angiography. Therefore the initial fistula was drained through double draining veins, 1 of them mimicking the artery of Adamkiewicz. The fistula was coagulated and divided. Postoperatively, the patient's symptoms gradually improved. Three months after the second surgery, she was able to walk independently. Spinal DAVF is a rare disease, but clinicians should be cautious of possible multiple drainage veins in diagnosis and treatment.