{
  "abstract": "Introduction Spinal epidural arteriovenous fistulas (SEDAVFs) are rare vascular lesions involving abnormal shunting between arterial inflow and the epidural venous plexus, often via paravertebral arteries. They are classified by venous drainage patterns; type A SEDAVFs, which demonstrate intradural or perimedullary drainage, commonly present with congestive myelopathy due to venous hypertension. We report a right-sided type A SEDAVF initially misdiagnosed as a type I spinal dural arteriovenous fistula (SDAVF) that persisted following surgical treatment, highlighting the importance of accurate diagnosis and post-treatment surveillance.Methods We present a retrospective review of a 73-year-old male presenting with recurrent left lower extremity hypertonia, spasticity, paresthesia, and gait instability two years after prior arteriovenous fistula treatment. Demographic, radiographic, procedural, and follow-up data were analyzed.Results The patient had previously undergone intradural coagulation and transection of early draining veins for a presumed right L3 SDAVF in 2023, with initial symptomatic improvement. One year later, symptoms recurred. Repeat spinal angiography demonstrated a persistent right L3 arteriovenous fistula with features consistent with a SEDAVF, including epidural venous plexus drainage and retrograde flow into the intrathecal venous system. Compared to prior imaging, inferior plexus drainage had decreased, but communication with the intrathecal venous plexus remained.Given recurrent symptoms and favorable anatomy, endovascular embolization was performed. Selective catheterization of the right L3 segmental artery with 3D rotational angiography localized the fistulous point without intramedullary arterial involvement (figure 1). Under roadmap guidance, 33% n-BCA glue was injected, achieving satisfactory penetration and complete occlusion. Post-embolization angiography confirmed obliteration of the fistula. The patient tolerated the procedure well and remained neurologically stable.Conclusion This case demonstrates persistence of a type A SEDAVF following treatment of a presumed SDAVF, with delayed symptom recurrence likely due to recanalization. Accurate characterization of venous drainage patterns is critical for appropriate management. Type A SEDAVFs may carry a higher risk of recurrence due to persistent perimedullary venous hypertension. Careful pre-procedural evaluation and routine post-treatment imaging are essential, and definitive endovascular or surgical strategies should be considered to minimize recurrence.Disclosures D. Napoletano: None. A. Reed: None. A. Higginbotham: None. E. Mickelson: None. B. Sharkey: None. L. Fry: None. J. Peterson: None.Abstract E-098 Figure 1",
  "authors": [
    {
      "affiliations": [
        "University of Kansas School of Medicine, Kansas City, KS"
      ],
      "name": "D Napoletano"
    },
    {
      "affiliations": [
        "University of Kansas School of Medicine, Kansas City, KS"
      ],
      "name": "A Reed"
    },
    {
      "affiliations": [
        "University of Kansas School of Medicine, Kansas City, KS"
      ],
      "name": "A Higginbotham"
    },
    {
      "affiliations": [
        "University of Kansas School of Medicine, Kansas City, KS"
      ],
      "name": "E Mickelson"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Kansas Medical Center, Kansas City, KS"
      ],
      "name": "B Sharkey"
    },
    {
      "affiliations": [
        "Department of Radiology, University of Kansas Medical Center, Kansas City, KS"
      ],
      "name": "L Fry"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Kansas Medical Center, Kansas City, KS"
      ],
      "name": "J Peterson"
    }
  ],
  "title": "E-098 When spinal epidural fistula disguises as a spinal dural fistula: a case report",
  "uid": "7bd97476-084d-5e4f-b8dd-7b335902501f"
}