Case Report
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2014; 2(12): 907-911
Published online Dec 16, 2014. doi: 10.12998/wjcc.v2.i12.907
Tentorial dural arteriovenous fistula presenting as myelopathy: Case series and review of literature
Robert Gross, Rushna Ali, Max Kole, Curtis Dorbeistein, Mahesh V Jayaraman, Muhib Khan
Robert Gross, Muhib Khan, Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
Rushna Ali, Department of Neurosurgery, Henry Ford Hospital, Detroit, MI 48202, United States
Max Kole, Departments of Neurosurgery and Radiology, Henry Ford Hospital, Detroit, MI 48202, United States
Curtis Dorbeistein, Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
Mahesh V Jayaraman, Departments of Diagnostic Imaging and Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
Author contributions: Kole M, Dorbeistein C, Jayaraman MV, Gross R and Khan M developed the idea and contributed the cases for the manuscript; Ali R and Khan M performed the literature search and wrote the manuscript.
Correspondence to: Muhib Khan, MD, Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States. mkhan2@lifespan.org
Telephone: +1-401-4445055 Fax: +1-401-4448781
Received: June 20, 2014
Revised: August 10, 2014
Accepted: September 23, 2014
Published online: December 16, 2014
Processing time: 181 Days and 1.4 Hours
Abstract

Dural arteriovenous fistula (DAVF) is a rare type of cerebral arteriovenous malformation. Common presenting symptoms are related to hemorrhage. However, rarely these patients may present with myelopathy. We present two cases of DAVF presenting as rapidly progressive myelopathy. Two treatment options are available: microsurgical interruption of the fistula and endovascular embolization. These treatment options of DAVFs have improved significantly in the last decade. The optimal treatment of DAVFs remains controversial, and there is an ongoing debate as to whether primary endovascular or primary microsurgical treatment is the optimal management for these lesions. However, despite treatment a high percentage of patients are still left with severe disability. The potential for functional ambulation in patients with DAVF is related to the time of intervention. This emphasizes the important of early diagnosis and early intervention in DAVF. The eventual outcome may depend on several factors, such as the duration of symptoms, the degree of disability before treatment, and the success of the initial procedure to close the fistula. The usage of magnetic resonance imaging and selective angiography has significantly improved the ability to characterize DAVFs, however, these lesions remain inefficiently diagnosed. If intervention is delayed even prolonged time in rehabilitation does not change the grave prognosis. This review outlines the presentation, classication and management of DAVF as well as discussing patient outcomes.

Keywords: Dural arteriovenous fistula; Myelopathy; Vascular malformation; Cognard classification; Microsurgery; Onyx embolization

Core tip: Tentorial dural arteriovenous fistulas (DAVF) are an uncommon entity, and myelopathy as a result of these AV fistulas is even more uncommon. We present two cases of myelopathy as a result of dural AV fistulas. This review highlights the classification of dural AV fistulas, the various diagnostic modalities available for diagnosis and management strategies employed for the treatment of DAVF. We also stress the importance of a timely diagnosis and its impact on patient outcomes and recovery.