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Case series
Concomitant conus medullaris arteriovenous shunts and sacral dural arteriovenous fistulas: pathophysiological links related to the venous drainage of the lesions in a series of five cases
  1. Andrea Rosi1,
  2. Arturo Consoli2,
  3. Stéphanie Condette-Auliac2,
  4. Oguzhan Coskun2,
  5. Federico Di Maria2,
  6. Georges Rodesch2
  1. 1Residency Program in Radiology, Department of Experimental and Clinical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
  2. 2Department of Diagnostic and Therapeutic Neuroradiology, Hopital Foch, Suresnes, France
  1. Correspondence to Dr Andrea Rosi, Residency Program in Radiology, Department of Experimental and Clinical Sciences, Careggi University Hospital, Florence 50134, Italy; andrea.rosi87{at}


Background Spinal cord arteriovenous shunts (scAVSs) are a group of lesions located in the spinal cord itself or in the surrounding structures. The most common scAVSs are spinal dural arteriovenous fistulas (sDAVFs), which are acquired lesions. The pathogenesis of sDAVFs involves thrombosis and venous hypertension as trigger factors. Intradural scAVSs such as spinal cord arteriovenous nidus type malformations (AVMs) and pial arteriovenous fistulas are less common than sDAVFs and are considered to have a so-called ‘congenital’ origin. The association between different concomitant scAVSs is very rare and the association of sDAVFs with intradural scAVSs has been described in only a few case reports.

Methods We describe a case series of five patients presenting with a conus medullaris AVS associated with a lower lumbar or sacral DAVF.

Results Three of our patients were <30 years old at presentation. In four of these five cases the intradural scAVS drained caudally, engorging the epidural plexus in the same location as the sDAVF. In only one case, who presented with thrombosis of the drainage of the main compartment of a conus medullaris pial AVF, was the location of the DAVF opposite to the location of the residual drainage.

Conclusion We discuss the pathophysiological link between scAVS and sDAVF on the basis of the rarity of the DAVF, the uncommon association between scAVS and sDAVF, the presence of sDAVF in young patients, and the venous hypertension created by the venous drainage towards the sacral area responsible for angiogenesis creating the dural shunt.

  • arteriovenous malformation
  • lumbosacral
  • spinal cord
  • vascular malformation
  • fistula

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  • Contributors AR (guarantor) performed the literature search, collected data and images of the cases and wrote the article. GR (guarantor) had the idea of the paper and was its promoter, and also revised the cases and the paper. AC, SC-A, OC, and FDM revised the cases and the paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.