Metachronous spinal dural arteriovenous fistula: Case report and review of literature on implications for pathophysiology and management

Metachronous spinal dural arteriovenous fistulae (SDAVF) are two independent SDAVF, with the second lesion manifesting subsequently after treatment of the initial SDAVF. A 69-year-old male was found to have a new T6 metachronous SDAVF two years after successful treatment of a L1 SDAVF. The authors suggest that once successful treatment of a SDAVF is established, regular clinical and MRI follow-up every six months up to and possibly beyond two years should be considered. This may present an opportunity to prevent repeated insult to vulnerable patients via prompt identification and treatment of SDAVF, with an aim to improve prognosis in the event of recurrent, synchronous or metachronous lesions.