Dural arteriovenous fistula (SDAVF for short) belongs to a group of spinal vascular malformations with a high disability rate, but because of its low incidence, most physicians are not fully aware of it.
However, because of its low incidence, most doctors do not have sufficient knowledge of it, and it is very easy to diagnose it as “disc herniation”, “myelitis”, “prostate hypertrophy” and other more common diseases, and if the treatment for these diseases is taken, the lighter one is the use of If the treatment for these diseases is taken, the lighter ones are not effective after using a lot of drugs, and the heavier ones
In some cases, the patient’s symptoms worsen sharply even after surgical treatment, or even after the use of hormones. In addition, because dural arteriovenous fistula is a non-self-limiting disease, once the disease is developed, the symptoms will progressively worsen and eventually lead to an uncontrollable neurological condition.
In addition, because dural arteriovenous fistula is a non-self-limiting disease, once the disease is developed, the symptoms will be progressively aggravated and eventually lead to irreversible damage to the nervous system. Therefore, early diagnosis, early treatment, and early recovery are the decisive factors in determining the outcome of treatment and postoperative recovery! According to our experience of treating thousands of clinical cases
According to our experience in thousands of clinical cases, professional diagnosis, professional treatment and professional postoperative rehabilitation measures play the most crucial role in improving the quality of life of patients after surgery! Li Guilin, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University
The artery supplying the dura mater in the spinal canal communicates with the normal veins on the surface of the spinal cord through an abnormal access in the dura mater (i.e., fistula), resulting in the arterial blood with higher pressure entering the veins with lower pressure directly, causing the normal veins in the spinal cord to have higher pressure.
This causes the normal venous pressure in the spinal cord to rise, resulting in impaired venous return and edema or even ischemic necrosis of the spinal cord. The symptoms are gradually increasing weakness, numbness and pain in the lower extremities, effort to urinate and defecate, and constipation. The left diagram shows the normal spinal cord arteries and veins; the middle diagram shows the obstruction of the return of normal spinal cord veins and mild edema of the spinal cord in the early stage of the disease; the right diagram shows the spinal cord with significant edema and necrosis in the more advanced stage of the disease. Based on our center’s experience, the disease should be highly suspected if the patient presents with: (1) age > 40 years, especially in male patients; (2) sensory, motor, and bowel dysfunction in both lower extremities, with progressive worsening of symptoms and developing signs; (3) a wide range of unexplained edema in the spinal cord with abnormal vascular flow signals around the spinal cord on MRI scan; (4) a short period of time after treatment with hormones. (4) Sharp worsening of symptoms within a short period of time after treatment with hormones. Since the natural course of the disease is progressive and the neurological damage is irreversible in the late stages, it should be treated early and the principle of treatment is to cut off the abnormal fistula. The treatment methods are embolization or surgery: domestic and foreign literature and our center’s experience suggest that surgical treatment to cut the abnormal fistula or drainage vein is a simple and reliable method, and the cure rate and long-term recurrence rate are lower than interventional embolization. Therefore, we currently advocate active surgical treatment for this disease if the patient can tolerate surgery. Interventional embolization should only be used for patients with poor general condition who cannot tolerate or do not want to accept surgical treatment. If
If detected early, the surgical treatment and rehabilitation of the disease are relatively simple and the postoperative recovery is generally good. However, because this is a rare disease that is not recognized by most physicians, these patients are often seen late, with the spinal cord already intact.
The spinal cord has already undergone irreversible degeneration. Even with surgery, recovery is slow or even difficult. This can result in timely surgical treatment of the causative lesion, but the irreversible spinal cord injury that has developed requires prolonged rehabilitation exercises and therapy to promote recovery. In summary, middle-aged and elderly patients with progressively increasing lower extremity weakness, numbness, and chills with urinary and fecal dysfunction and unexplained spinal cord edema suggested by MRI should be alerted to the possibility of dural arteriovenous fistula. You should actively consult a professional team for diagnosis and treatment to prevent irreversible ischemic necrosis of the spinal cord resulting in irreversible functional damage to the spinal cord!