Management of spinal dural arteriovenous fistula in a child with myelopathy

Abstract

Background: Spinal dural arteriovenous fistulas (DAVF) are rare intradural spinal lesions. Patients with DAVF are typically in the 40's or 50's, and classically present with acute neurological deterioration. Notably, these lesions are exceedingly rare in the pediatric age group. Case Description: A 2-year-old child presented with the sudden onset of lethargy, and 4/5 weakness of the left lower extremity with accompanying ataxia. The cervicothoracic MR scan revealed central cord edema from C5 to T4. A DAVF was diagnosed based on the multiple dilated intradural perimedullary veins. Following endovascular treatment, the child markedly recovered and remained stable 2 years later. Conclusion: DAVFs are treatable lesions that rarely occur in the pediatric age group. They are associated with serious neurological morbidity. When suspected, they should be immediately diagnosed with magnetic resonance imaging/magnetic resonance angiography, and formal angiography. Prompt neurosurgical and neuroradiological/endovascular opinions and intervention should be sought to provide and the best treatment strategy.