Multiple synchronous spinal dural arteriovenous fistulas: A systematic literature review

ABSTRACT Background Multiple spinal dural arteriovenous fistulas (SDAVFs) are rare and account for only 1–2% of all SDAVF cases. The treatment for SDAVFs typically involves either direct surgy or endovascular treatment. Identifying the precise location of all fistulas is paramount for successful treatment procedures when multiple SDAVFs are present. They can be classified as synchronous (occurring simultaneously) or metachronous (occurring at different times), with each type differing with respect to etiology, diagnosis, and treatment. This study systematically reviewed the literature on multiple synchronous SDAVFs. Methods A comprehensive search was performed to identify all published multiple synchronous SDAVF cases. Overall, 23 patients with multiple SDAVFs were identified, including 21 from 19 articles and 2 from this study. Clinical presentation, lesion location, radiographic features, surgical treatment, and outcome were analyzed in each patient. Results All patients in this study were male individuals, and the duration from symptom onset to diagnosis in many of these patients was longer than that previously reported. Previous studies suggested that multiple SDAVFs typically occurred within three of fewer vertebral levels. However, >50% of examined patients had remote lesions separated by more than three vertebral levels. Patients with remote lesions had a significantly worse outcome (1/7 vs. 8/11, P=0.049). Therefore, accurate localization of fistulas before spinal angiography is critical for managing multiple remote SDAVFs. Conclusions Considering the possibility of multiple remote SDAVFs, careful interpretation of imaging findings is essential for accurate diagnosis and appropriate treatment planning. KEY MESSAGES What is already known on this topic Multiple spinal dural arteriovenous fistulas (SDAVFs) can be classified as synchronous (occurring simultaneously) or metachronous (occurring at different times), and they differ in etiology, diagnosis, and treatment. However, the differences between two conditions need to be better clarified. What this study adds Patients with remote SDAVFs tended to receive more treatments and had worse prognosis than those with non-remote SDAVFs. Therefore, correct localization of fistulas before spinal angiography is essential for managing multiple remote SDAVFs. How this study might affect research, practice or policy Multiple remote SDAVFs may occur in patients; therefore, careful interpretation of imaging results is critical for accurate diagnosis and appropriate treatment planning.