About Spinal Dural AV Fistula
A Spinal Dural AV Fistula (AVF) is an abnormal blood vessel that makes direct connection between the arteries and veins around your spinal cord. Arteries and veins are normally connected by tiny vessels, which are called capillaries. Capillaries have three functions, handling the transition from higher to lower pressure, helping supply nutrients from the blood to surrounding tissues, and helping remove waste products from the tissues. But in a Spinal Dural AVF, the capillaries are missing. The tissues involved with a Spinal Dural AVF become congested as the normal exit of blood is blocked by the increased pressure created in the veins by the direct attachment of an artery.
Spinal Dural AVF is essentially a plumbing problem where the veins that are supposed to drain blood away from your nerves experience abnormally high pressure. This can lead to a backing up of fluid in your spinal cord, like your sink or toilet backing up from a blockage in the pipes that should drain them. In the spinal cord this can produce swelling, leading to gradual nerve dysfunction or damage. Sometimes, the high pressure causes a vein to rupture, like a pipe bursting. This can lead to a sudden onset of neurological symptoms such as weakness and numbness. A Spinal Dural AVF is a rare vascular abnormality that can effectively be treated with surgery.
Common Symptoms of Spinal Dural AV Fistula
The symptoms of Spinal Dural AVF tend to be similar to symptoms of other problems that affect the spinal cord. The progress of the symptoms does vary, however often the development of problems takes place over an extended time period, sometimes years. Some of these symptoms are:
- Back Pain
- Numbness
- Weakness
- “Pins and Needles” sensation
- Clumsiness
- Difficulty Walking/Climbing stairs
- Impairment in bladder/bowel function
- Sexual Dysfunction
Diagnosis of Spinal Dural AV Fistula
Spinal Dural AVF’s are normally identified by an MRI (magnetic resonance imaging). Unfortunately MRI’s don’t reveal the exact location of the abnormal connection, but only the effects on the spinal cord such as swelling and enlarged blood vessels that are typical for a Spinal Dural AVF.
In order to accurately define the abnormal connection of a Spinal Dural AVF, an angiogram is needed. This study involved the injection of a dye into the blood vessels that allows an X-ray to show the specifies of the blood flow. An angiogram defines which vessels are invovled and where the abnormal connection is located.
Treatment Options for Spinal Dural AV Fistula
In most cases, treatment for Spinal Dural AVF is strongly recommended because if it is not, patients may experience spinal cord dysfunction and permanent neurological injury. Surgery is the definitive treatment of choice, where the abnormal connection is physically separated so that normal blood flow can resume.
Less often, endovascular embolization may be considered to treat a Spinal Dural AVF. This treatment involves passing a tiny catheter or tube into the vessels feeding into the fistula where it then releases a glue-like material or tiny particles that can seal off the fistula. Endovascular treatment is often reserved for patients who cannot tolerate surgery.
Spinal Dural AVF are very complex problems and that require the attention of major medical centers that are experienced in their treatment.