Delayed deterioration after surgical treatment of a spinal dural arteriovenous fistula detected by three spinal angiographies: Case report.

Spinal dural arteriovenous fistulas (DAVFs) are the most common subtype of spinal arteriovenous malformations, and they often cause progressive myelopathy. Early detection and intervention are critical to preventing irreversible neurological deficits. Selective spinal angiography remains the gold standard for diagnosing this condition. However, for some patients with typical clinical features and magnetic resonance imaging (MRI) findings consistent with DAVF, the initial angiography may fail to detect the lesion. In this article, we report a case of T4 low-flow spinal DAVF that was only identified after three rounds of spinal angiography. The fistula was successfully occluded via surgery, and the patient's symptoms gradually improved postoperatively. Nevertheless, the patient later developed recurrent, aggravated symptoms. The delayed deterioration of previously resolved symptoms was attributed to venous thrombosis, and the condition improved after systemic anticoagulation therapy with heparin. The patients fluctuating symptoms stabilized one month after combined therapy with anticoagulants and antiplatelet drugs. For patients with a high clinical suspicion of spinal DAVF, required to confirm the final diagnosis. Delayed deterioration can occur secondary to progressive venous thrombosis, so preventive anticoagulation is indicated for selected patient's, and this intervention should be individualized.