Localization drives the diagnostic cost
Spinal MRI can strongly suggest SDAVF but may not reveal the exact shunt level. Time-resolved or contrast-enhanced MRA may narrow the search, while selective spinal DSA can require catheterization of multiple segmental arteries. The number of vascular territories studied, procedural time and need for additional angiographic runs affect the diagnostic episode.
Repeat angiography may be necessary when the first study was incomplete
A prior report saying 'no fistula found' is not always sufficient if the MRI pattern remains suspicious and the original DSA did not comprehensively evaluate relevant feeders. Supplying the actual angiographic images lets the German team judge whether the study is complete before repeating an invasive test.
Microsurgery and embolization have different resource profiles
Microsurgical disconnection uses neurosurgical operating-room time, anesthesia, microscope and often intraoperative vascular confirmation or neurophysiological monitoring. Endovascular treatment uses an angiography suite, microcatheters and embolic material. The less invasive option is not automatically the cheaper or more durable option because retreatment risk and anatomy differ.
Endovascular material and complexity can change the quote
When embolization is appropriate, the price depends on access anatomy, number of arterial territories treated, microcatheter use, liquid embolic material and whether the embolic agent can safely cross the fistulous point into the draining vein. A technically incomplete embolization may require later surgery or another endovascular procedure.
Advanced myelopathy can increase inpatient and rehabilitation costs
A patient who is still independently mobile may need a relatively short postoperative stay, whereas severe gait impairment, bladder dysfunction or deconditioning can create additional nursing, physiotherapy, urology or inpatient rehabilitation needs. These costs should be separated from the price of fistula closure itself.
Post-treatment confirmation may be a separate line item
Depending on the center and procedure, durable closure may be checked with postoperative angiography, MRI/MRA or later interval imaging. Ask whether the estimate includes confirmation of fistula obliteration and the first follow-up visit.
Send these records before requesting a quote
A hospital can estimate more accurately when it knows whether the diagnosis and fistula level are already secure.
- Spinal MRI source images and report
- Contrast-enhanced or time-resolved spinal MRA if available
- Complete spinal DSA series and report
- Exact angiographic fistula level and side if identified
- Neurological examination documenting gait and leg strength
- History of bladder, bowel or sexual dysfunction
- Prior diagnoses and treatments for myelitis, spinal stenosis or neuropathy
- Any previous embolization or surgery report
- Current mobility level and rehabilitation requirements
- Requested service: diagnosis confirmation, repeat angiography, microsurgery, embolization, residual-fistula treatment or follow-up
Official sources
Last source-reviewed 2026-09-02. Cost procedures and published service fees can change, so confirm current terms directly with the provider before transferring money or booking travel.
- Dural arteriovenous fistulas – spinal disease and treatment — Heidelberg University Hospital ↗
- Dural arteriovenous fistula — University Medical Center Freiburg ↗
- Comparative efficacy and safety of endovascular versus surgical SDAVF treatment — PubMed ↗
- Diagnostic accuracy of MRA versus DSA for SDAVF — Neurosurgical Review / PubMed ↗