Spinal dural arterio-venous fistula with multiple points of shunt

A 45-year-old man presented with a history of dysaesthesiae, sensory impairment of the legs and sphincter disturbances. Selective angiography showed a mid-thoracic dural arterio-venous fistula with five shunt points. The venous plexuses were demonstrated by injections at T5 on the right side and T6 on the left, but the venous pattern on the two sides did not overlap. Angiography did not unquestionably point to any single location of a fistula, as would normally be expected. During surgery five dorsal locations of shunt were identified. We have not found any publication describing a spinal dural arterio-venous fistula with multiple venous drainage channels at the same level.