True metachronous multiple spinal dural arteriovenous fistulas: case report and review of the literature

Spinal dural arteriovenous fistulas (DAVFs) are the most common type of spinal vascular disorders. Multiple spinal DAVFs are very rare, and the majority of them appear synchronously. True metachronous multiple spinal DAVFs occur even more rarely. We report a case of true metachronous multiple spinal DAVFs. A 61-year-old male presented with progressive paraparesis. Spinal MRI showed extensive edema of the spinal cord from T5 to the conus and prominent vascular flow voids. MR angiography showed a left T10 DAVF. The fistula was treated surgically and the clinical symptoms gradually resolved. Recurrence of symptoms occurred 4 months after surgery. A second angiography showed a new fistula located at the right L1. The second fistula was treated surgically and the symptoms again gradually improved. Metachronous multiple spinal DAVF may present within 4 months of each other.