The Retrocorporeal Artery: An Alternative Route for Endovascular Treatment of Spinal Dural Arteriovenous Fistula

Endovascular treatment has emerged as the primary treatment option for the management of spinal dural arteriovenous fistula (SDAVF). The goal of endovascular embolization is to achieve embolic penetration into the nidus and proximal segment of the draining vein. Though less invasive, the successful obliteration of fistula is achieved in 70 to 90% of the patients and recurrence of fistula is observed in as high as 15 to 30% of the patients.1,2 Among the several factors that decide the outcome of endovascular treatment, difficult navigation and inability to place microcatheter close to the fistula remain important concerns that predict successful percolation of embolic agent into the venous side of the fistula. Recently, endovascular approach to fistula through retrocorporeal artery has been described as an alternative route to achieving successful embolization.3 We describe two cases of SDAVF that were completely obliterated through retrocorporeal route after an unsuccessful standard endovascular approach. The relevant anatomy of retrocorporeal artery and the technical nuances are discussed herein.