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Case Report: Spinal Dural Arteriovenous Fistula With Metastatic Kidney Cancer

By: Anna Nowogrodzki
Posted: Wednesday, September 1, 2021

The first case study of a patient with spinal metastatic renal cell carcinoma who presented with a spinal dural arteriovenous fistula (SDAVF) was reportedly published in Cureus. Rimas V. Lukas, MD, of Northwestern University, Chicago, and colleagues noted that the patient’s leg strength returned after the fistula was embolized.

“Associations between renal cell carcinoma and SDAVF have not yet been reported, although renal cell carcinoma is commonly associated with extracranial arteriovenous malformations,” the authors wrote. This “paves the path for further investigations into [the] angiogenesis in the pathogenesis of SDAVF.”

The patient, a 69-year-old man, presented with 6 months of progressive weakness in both legs and a recent onset of weakness in his left arm. Three years previously, he had a recurrence of his metastatic clear cell renal carcinoma, with metastasis to the liver, lungs, and thoracic vertebrae; he was treated with pazopanib and then nivolumab. The cancer had initially been locally resected.

First, brain and spinal cord MRIs revealed a bone metastasis in the upper thoracic vertebrae. It extended into the left spinal foramina and compressed the C7–T1 ventral nerve roots, causing motor polyneuropathy. Second, a spinal angiography revealed a type I SDAVF, whose blood supply came from the left T11 intercostal artery. Third, the authors found epidural metastases with concentric enhancement at the T6 level, but they did not cause spinal cord compression.

The authors catheterized the patient’s left T11 intercostal artery and embolized the SDAVF using n-butyl cyanoacrylate glue, “with penetration of the proximal draining vein.” The patient’s leg strength started to show signs of improvement 1 month after hospitalization.

Disclosure: The study authors reported no conflicts of interest.

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