De Novo Spinal Dural Arteriovenous Fistula in a Patient with a Lipomyelomeningocele: Case Report.

BACKGROUND

Spinal dural arteriovenous fistula (AVF), the most common type of spinal vascular malformation, tends to manifest as progressive myelopathy over several years. Spinal dural AVFs are considered an acquired lesion and, in contrast to spinal arteriovenous malformations, are not often associated with other anomalies. The presence of a spinal dural AVF in the setting of a lipomyelomeningocele and tethered cord is extremely rare. Both lesions tend to cause similar symptoms, and patients with concomitant lesions generally require surgical intervention for both.

CASE DESCRIPTION: A 57-year-old female with lifelong urinary incontinence and mild weakness in the left lower extremity presented with progressive worsening of left lower extremity weakness as well as worsening bowel and bladder incontinence. Magnetic resonance imaging (MRI) performed 4 years before our evaluation revealed a lipomyelomeningocele and a tethered cord; a new MRI demonstrated a new additional finding of flow voids suspicious of an underlying vascular malformation. Diagnostic angiography revealed a dural AVF fed by a left lateral sacral artery. Onyx embolization of the dural AVF was performed, and the patient improved steadily postoperatively without the need for surgically addressing the tethered cord.

CONCLUSION

In this case report, we present evidence of de novo development of a spinal dural AVF associated with a lipomyelomeningocele. In addition, this is the second documented patient in the literature with a lipomyelomeningocele and concomitant dural AVF who did not undergo detethering of the cord as part of treatment.