LAUSR

Sir, Dural arteriovenous fistulas (dAVFs) are very rare lesions comprising the most common type of arteriovenous malformations (AVMs) in the spine. They usually present with progressive myelopathy in middle-aged adults resulting from venous congestion and hypoperfusion of the spinal cord. Thus, the diagnosis of dAVF is often delayed or even missed out due to the slow progression of symptoms. Treatment of arteriovenous fistulas (AVFs) involves occlusion of the fistula by surgery or embolization by interventional radiology.[1] The necessity of intraoperative neurophysiological monitoring (IOM) has been reported in endovascular procedures on the spinal cord during embolization by interventional radiology,[2,3] whereas neurophysiological data on usage, feasibility, and efficacy of IOM in spinal AVFs surgery have remained limited in the literature.[4]