Questions asked, some answers
I spoke to my neurologist today and summarized the situation and asked follow up questions.
First, in terms of the summary - my situation can more accurately be described as "in the MRI prominent blood vessels were seen". This could be normal, or it could be our friend, the AV fistula. The AV fistula would certainly account for the symptoms that I am seeing. However, the cause could still be unknown.
OK, on to my questions, please bear in mind that my doctor is a neurologist, she is not a vascular surgeon, but as my case manager, she will get answers to my questions for me.
1. I know that a spinal angiogram necessary before treatment or is it done during surgery?
She did not have a clear answer to this. My research indicates that the angiogram is usually done first to confirm the fistula, although if an MRA showed a very clear location, a more limited angiogram could be done during the embolization surgery.
2. If the spinal angiogram showed the fistula, I assume we would schedule treatment quickly.
Yes, it would not be urgent, but it would likely be done within a month.
3. So the big question is how likely is the angiogram to show the fistula? Could it be too small to see even through the angiogram?
Yes, that is possible.
4. Did the MRI show a high T2 signal - this is very strongly correlated to spinal dural AVFs that show up in a spinal angiogram. If no T2 signal, we probably won't see anything on the angiogram, so why do it?
This was the key question - and the answer is that the T2 signal was NOT high. This would lead me to conclude that the angiogram would not show anything at this point in time. That conclusion is heavily influenced by Spinal Dural Arteriovenous Fistulas: MR and Myelographic Findings. Also see my earlier decision algorithm.
5. Are there other techniques that would be less risky/invasive than the catheter angiography - in particular the MDCTA or the onld supine/spinal myelogram (I only hold out hope for the first).
Not clear - the MRA is usually considered the test to do - but the MDCTA is also somewhat new. She will be checking on this.
6. How long does the angiogram last? Can a general anesthetic be administered?
The length varies - typically a conscious sedation is done, but not intubation. With a conscious sedation, the patient is usually given a combination of pain medication and sedative through an IV. The patient remains conscious, but sleepy and relaxed. People do not usually remember what occurs. The two common drugs are Fentanyl (the pain medication) and Midazolam (the sedative). I get the sense that a two hour procedure would be fine with conscious sedation, but it is not clear to me if it could go much longer. Which might indicate the necessity to continue the angiogram into the next day.
Next update in two weeks as my doctor is off to various conferences.