Isolated contralateral radiculopathy in thoracic spinal dural arteriovenous fistula without myelopathy: illustrative case.

backgroundSpinal dural arteriovenous fistula (SDAVF) typically manifests as progressive myelopathy due to venous hypertension. Isolated radiculopathy without spinal cord edema is rare. To the authors' knowledge, cases presenting with symptoms solely contralateral to the shunt origin have not been previously reported. OBSERVATIONS: A 63-year-old man presented with a 1.5-year history of refractory right-sided scapular and anterior chest pain. MRI revealed no intramedullary T2-weighted hyperintensity or signs of myelopathy. Spinal angiography identified an SDAVF at the left T5-6 level. Intraoperatively, despite the left-sided shunt, the right T5 nerve root was found to be directly compressed by and adherent to an arterialized draining vein. Surgical disconnection of the fistula, combined with microsurgical decompression of the right T5 nerve root, resulted in complete resolution of symptoms. LESSONS: This case illustrates that SDAVF is capable of presenting as isolated radicular pain, and symptoms may occur contralateral to the shunt origin. SDAVF should be considered in the differential diagnosis of refractory truncal radiculopathy, even in the absence of spinal cord edema. Early diagnosis and intervention promote symptomatic recovery and prevent progression to irreversible myelopathy. https://thejns.org/doi/10.3171/CASE26163.