Clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistulas : a prospective cohort study in two Chinese centres

Abstract

BackgroundThe short-term outcomes and prognostic factors of patients with spinal dural arteriovenous fistulas (SDAVFs) have not been defined in large cohorts.ObjectiveTo define the short-term clinical outcomes and prognostic factors in patients with SDAVFs.MethodsA prospective cohort of 112 patients with SDAVFs were included consecutively in this study. The patients were serially evaluated with the modified Aminoff and Logue’s Scale (mALS) one day before surgery and at 3 months, 6 months and 12 months after treatment. Univariate and multivariate analyses were performed to identify demographic, clinical and procedural factors related to favourable outcome.ResultsA total of 94 patients (mean age 53.5 years, 78 were men) met the criteria and are included in the final analyses. Duration of symptom ranged from 0.5 to 66 months (average time period of 12.7 months). The location of SDAVFs was as follows: 31.6% above T7 level, 48.4% between T7 and T12 level (including T7 and T12) and 20.0% below T12 level. A total of 81 patients (86.2%) underwent neurosurgical treatment, 10 patients (10.6%) underwent endovascular treatment, and 3 patients (3.2%) underwent neurosurgical treatment after unsuccessful embolisation. A total of 78 patients demonstrated an improvement in mALS score of one point or greater at 12 months. Preoperative mALS score was associated with clinical improvement after adjusting for age, gender, duration of symptoms, location of fistula and treatment modality using unconditional logistic regression analysis (p<0.05).ConclusionApproximately four fifths of the patients experienced clinical improvement at 12 months and preoperative mALS was the strongest predictor of clinical improvement in the cohort.

Treatment strategy to maximize the treatment outcome of spinal dural arteriovenous fistula after initial endovascular embolization attempt at diagnostic angiography

“…Owing to the technical advancement in EVTs that has been made over the last decades 22 , the use of EVT as a first treatment attempt is expected to be more common in the treatment of SDAVF considering its advantages over spinal surgery. For instance, first EVT attempt may be a reasonable option in elderly patients and patients with obesity or other comorbidities who have higher risk of postoperative complications such as deep vein thrombosis or surgical site infection 23 , 24 .…”

Progressive Paraplegia Due to Spinal Dural Arteriovenous Fistula: A Rare but Treatable Diagnosis That Should Not Be Missed

“…The spinal dural arteriovenous fistula was first described in 1926 by Foix and Alajouanine [1]. It is the most common vascular malformation of the spinal cord, albeit still rare, with an annual incidence of only five to ten cases per million [2]. SDAVFs are common in middle-aged and elderly populations with a reported mean age of approximately 60 years.…”

“…SDAVF has a variable prognosis but almost 90% of the patients experience either stabilization or improvement in their symptoms following treatment [2]. The treatment involves either microsurgery or endovascular embolization to close the abnormal vascular connection.…”

En mann i 50-årene med varierende kraftsvikt og gangvansker

“…Langtidsprognosen avhenger av preoperative symptomer. Bedring av motoriske utfall kan finnes hos 80 %, mens sensoriske utfall bedres hos under 50 % (16,17). Jo mer symptomer før kirurgi, jo dårligere er prognosen.…”