Endovascular and Surgical Treatment of Spinal Dural Arteriovenous Fistulas: Assessment of Post-treatment Clinical Outcome

Abstract

Spinal dural arteriovenous fistulas (DAVFs) are the most commonly encountered vascular malformation of the spinal cord and a treatable cause of progressive para- or tetraplegia. It is an elusive pathology that tends to be under-diagnosed, due to lack of awareness among clinicians, and affects males more commonly than females, typically between the fifth and eighth decades. Early diagnosis and treatment may significantly improve outcome and prevent permanent disability and even mortality. The purpose of our retrospective, single-center study was to determine the long-term clinical and radiographic outcome of patients who have received endovascular or surgical treatment of a spinal DAVF. In particular, during a 6-year period (2009–2014) 14 patients with a spinal DAVF were treated at our department either surgically (n = 4) or endovascularly (n = 10) with detachable coils and/or glue. There was no recurrence in the follow-up period (mean: 36 months, range 3–60 months) after complete occlusion with the endovascular treatment (n = 9; 90%), while only one patient (10%) had residual flow both post-treatment and at 3-month follow-up. All four surgically treated patients (100%) had no signs of residual DAVF on follow-up magnetic resonance angiography (MRA) and/or angiography (mean follow-up period of 9 months). Since improvement or stabilization of symptoms may be seen even in patients with delayed diagnosis and substantial neurological deficits, either endovascular or surgical treatment is always justified.

Delayed Diagnosis of Spinal Dural Arteriovenous Fistula: A Case Report and Scoping Review

“…Of these, SDAVF location was clearly defined in 825. SDAVF was thoracic in 561 of these 825 cases (68%) [1][2][3][5][6][7][8][10][11][12][13][14][15][16][17][18]. Most of the included cases were male (71.8-100%) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…SDAVF was thoracic in 561 of these 825 cases (68%) [1][2][3][5][6][7][8][10][11][12][13][14][15][16][17][18]. Most of the included cases were male (71.8-100%) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The mean patient age ranged from 53.5 to 71.0 years [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…The mean duration from onset of symptoms to diagnosis was 10.15 months (median, 10-24 months; range, 1-120 months) [3,4,6,8,[10][11][12][15][16][17]. The mean time from the first radiologic findings of DAVF to confirmed diagnosis was 9.2-20.7 months (range, 1-168 months) [2,5,9].…”

“…Post-treatment outcomes were reported in 16 of the studies. These were measured by Aminoff-Logue scores in 13 [1][2][3][4][6][7][8][9][10][11][12][13][14][16][17][18], manual muscle testing in 1 [16], the modified Rankin Scale in 1 [10], and the American Spinal Injury Association Impairment Scale in 1 study [14]. The posttreatment increases in the Aminoff-Logue score ranged from 42.3 to 85.0% overall [6][7][8]12,13], from 32.0 to 59.5% for gait [2][3][4]6,[9][10][11]13,14,[16][17][18], and from 0 to 35% for micturition [2][3][4]6,13].…”

Spinal dural arteriovenous fistula: A rare but treatable disease that should not be missed by orthopedic surgeons

“…The surgical procedure showed good results in terms of neurologic improvement (26)(27)(28)(29)(30). There is also a study that says that the improvement was non-significantly associated with younger age, acute onset, ambulant status and fistula below T9.…”