Spinal arteriovenous fistulae (SDAVF) is a spinal vascular malformation with a high disability rate. It is very harmful to patients and families, and it is difficult to diagnose. Since many people do not know this disease very well, it is often easy to miss or misdiagnose it. At present, with the deepening of people’s understanding of SDAVF and the wide application of MRI and DSA, more and more SDAVFs are found. 1, the main pathogenesis of SDAVF: dural arteriovenous fistula patients with spinal cord injury symptoms is mainly due to the arterial blood through the fistula through the spinal cord surface normal venous drainage, resulting in the medulla normal arteriovenous pressure gradient disorders, venous dilatation, increased pressure, resulting in the normal venous reflux obstacles in the spinal cord, spinal cord congestion, capillary stagnation, ultimately leading to ischemia of the small arteries, interstitial edema, ischemia and necrosis of spinal cord. Necrosis. 2, the clinical manifestations of SDAVF This disease is most common in middle-aged and elderly men (over 40 years old), thoracolumbar segment, the ratio of men to women is 7:1. This disease is a non-self-limiting disease, once the disease, the symptoms will be aggravated, and finally lead to irreversible damage to neurological function. Symptoms can be alleviated or disappear after treatment, but they can also worsen and recur. Its onset is slow and its course is long. Progressive neurologic dysfunction at the level of the thoracolumbar segment usually occurs in 6 months to 2 years. It often begins with a single sensory, motor, or sphincter dysfunction. For example, asymmetric burning sensation, ant walking sensation, intermittent claudication in both lower limbs, and urinary, defecation and sexual dysfunction can be seen. The main symptoms vary depending on the location of the lesion, with the most common being cone syndrome, followed by cauda equina symptoms, and then spastic paraparesis. Since the affected plane is mainly in the thoracolumbar segment, the sensory plane is usually below chest 10. Imaging characteristics and diagnosis of SDAVF (1) Characteristic manifestations of MR: ①MR is the most sensitive method to show spinal vascular malformation, and SDAVF is mainly manifested as bead-like or tubular signal-less flow shadow on T1 and T2 weights, which is its characteristic sign. ②The thick drainage vein is commonly found in a longer segmental range or even in the whole spinal cord, and it is relatively concentrated and thick in one segment, which often suggests that this area is the segment where the fistula is located. In MRI T2 weighted image, due to the surrounding high signal cerebrospinal fluid background, the flow phenomenon is more clear, and the sagittal image can well show the high signal of the spinal cord and the flow signal of the dorsal side, which suggests that the spinal cord is edematous and vascular malformation. ④No vascular flow and hemorrhagic signals are seen in the spinal cord. ⑤ It shows subacute and chronic hemorrhage of the spinal cord and softening edema of the spinal cord, which are difficult to be shown by other examination methods, and corresponding gliosis, in which the spinal cord edema is not obvious on the T1 weighting image, and the T2 weighting image exhibits a long T2 abnormal signal. (2) Characteristic performance of DS A: Selective spinal angiography can not only accurately provide the site of SDAVF fistula, but also determine the source of blood-supplying arteries and the direction of the draining veins and other important information, which is a prerequisite for embolization therapy and also provides the necessary basis for surgical treatment, and has become an indispensable examination method for the diagnosis and treatment of SDAVF. Characteristic manifestations of SDAVF spinal angiography include: 1) direct traffic between the dural arteries and spinal surface veins, no hairpin-like spinal arteries are visible; 2) blood supply arteries are mainly from the intercostal arteries and lumbar arteries, which hardly occur in the cervical segment, but the whole spinal cord vessels must be examined by selective angiography; 3) fistulae are mostly one, occasionally more than one, and they are located mainly in the thoracic 3 and lumbar 2 vertebral body between the planes, and the number of fistulae is 82.1% in this group. (4) blood flow through one or several perforating dural arteries through the tiny fistula to introduce arterial blood directly into the spinal cord coronary venous plexus, and finally into the tortuous expansion of the spinal cord surface veins, drainage veins through the entire length of the spinal cord; (5) blood flow is slow, to the dorsal side of the spinal cord to the upward drainage of the spinal cord, spinal veins need to be completely filled with the spinal cord in the left 40s. The diagnostic criteria are: ① age > 40 years old, male ② bilateral lower extremity sensory, motor and sphincter function abnormalities, and progressive aggravation of symptoms, signs and symptoms of continuous development; ③ selective spinal arteriography found dural arteriovenous fistula. 4, Treatment of SDAVF Since the natural course of the disease is progressive and the neurological damage is irreversible in the late stage, SDAVF should be treated with early surgery. Due to the high recurrence rate of embolization, it should be treated surgically first. We used transsphenoidal approach ventriculoscopy-assisted leaky port electrocautery excision to treat more than ten patients with ideal results. Surgery is mainly to solve the short circuit between A-V. However, the tortuous blood vessels on the surface of the spinal cord cannot be removed; these tortuous blood vessels are draining veins, which may cause damage to the spinal cord if removed or cauterized. The key to treatment is accurate localization by myelography. More importantly, it depends on the timing and mode of surgery chosen. Early diagnosis and treatment is the only way to achieve a satisfactory outcome. Postoperative anticoagulation is required. Because when the fistula is occluded, the perimedullary coronary venous plexus pressure drops by 38,3% on average, making it difficult for the dorsal draining vein of the spinal cord, which has been adapted to the high pressure state, to restore its own circulatory power in a short period of time, and thus it is very easy to form a thrombus, which affects the venous reflux of the whole spinal cord. Practice has proved that the lower the location of the fistula, the higher the probability of thrombus formation. Therefore, anticoagulation is extremely important.