1
|
Ge Y, Lai Q, Guo W, Xu X. Risk factors for postoperative late deterioration in patients with spinal dural arteriovenous fistulas. Front Neurol 2024; 15:1412237. [PMID: 39040537 PMCID: PMC11260714 DOI: 10.3389/fneur.2024.1412237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Background Approximately 86% of patients with spinal dural arteriovenous fistulas (SDVAFs) exhibit clinical improvement after surgery. However, 12%-55.8% of these patients experience late deterioration (LD) after an initial period of improvement. The risk factors for LD remain unclear. The aim of this study was to explore the risk factors for LD in SDVAF patients. Methods The clinical data of patients who were admitted to two tertiary hospitals between June 2014 and May 2022 were reviewed. Patients were divided into two groups: the LD group and the no LD group. The severity of neurological dysfunction (NDF) was evaluated using the Modified Aminoff and Logue Scale. Univariable and multivariable Cox regression analyses were performed. Results A total of 105 eligible patients were enrolled, with a mean age of 57.55 ± 9.42 years. The LD group comprised 37 individuals, while the no LD group consisted of 68 individuals. According to the univariable analysis, preoperative NDF severity and treatment strategy were associated with the risk of LD. According to the multivariable analysis, patients who underwent microsurgery (MS) had a lower risk of LD than did those who underwent endovascular treatment (EVT; HR 0.197, 95% CI 0.085-0.457), and patients with severe NDF had a higher risk of LD than did those with mild NDF (HR 3.604, 95% CI 1.226-10.588), whereas the risk of LD in patients with moderate NDF was similar to that of patients with mild NDF (HR 1.352, 95% CI 0.519-3.524). Conclusion EVT and severe preoperative NDF are independent risk factors for LD.
Collapse
Affiliation(s)
- Yuanhong Ge
- Department of Neurosurgery, Chengdu Second People’s Hospital, Chengdu, China
| | - Qingjia Lai
- Department of Rehabilitation, Care Alliance Rehabilitation Hospital of Chengdu, Chengdu, China
| | - Wei Guo
- Department of Neurosurgery, Tangdu Hospital, Air Force Military Medical University, Xi’an, China
| | - Xuejun Xu
- Department of Neurosurgery, Chengdu Second People’s Hospital, Chengdu, China
| |
Collapse
|
2
|
Yan Z, Fan L, Xu D, Ma J, Hu Y, Li J, Liu Y. Knowledge, attitudes and practices regarding spinal vascular malformations among doctors in China: a cross-sectional study. BMJ Open 2024; 14:e077698. [PMID: 38387979 PMCID: PMC10882408 DOI: 10.1136/bmjopen-2023-077698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/28/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE Knowledge, attitude and practice (KAP) models are essential tools for assessing healthcare professionals' understanding, beliefs and behaviours towards specific health issues. This study aimed to explore the KAP of Chinese doctors in diagnosing and treating spinal vascular malformations (SVM). DESIGN A web-based cross-sectional survey. SETTING This study was conducted between October and December 2022 through a self-administered questionnaire. PARTICIPANTS Participants include full-time doctors who voluntarily participate. Doctors in advanced training, regular training or internships were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The KAP scores of Chinese doctors in diagnosing and treating SVM measured by the questionnaire. RESULTS A total of 517 doctors participated in the study, mostly in Shaanxi, China, working in SVM-relevant departments (n=396) or other departments (n=121). The doctors achieved an average knowledge score of 9.66±1.95 (range: 0-12), attitude score of 22.16±1.71 (range: 6-30) and practice scores of 46.13±5.35 for those in SVM-relevant departments (neurosurgery, orthopaedics and neurology) and 8.50±1.25 for those in other departments, respectively, revealing doctors have adequate knowledge, positive attitude and good practice, and those in SVM-relevant departments showing more adeptness compared with those in other departments. Moreover, multivariate logistic regression analysis showed that knowledge about SVM (OR=1.72, 95% CI 1.11 to 2.65, p=0.015), holding a master's degree (OR=1.85, 95% CI 1.14 to 3.00, p=0.013) and working in orthopaedics (OR=0.34, 95% CI 0.13 to 0.88, p=0.026) were independently associated with good attitude. CONCLUSION Chinese doctors showed adequate knowledge, moderate attitudes and good practice regarding SVM. A continuing education programme may improve clinical practitioners' ability to manage SVM.
Collapse
Affiliation(s)
- Zhongjun Yan
- Department of Neurosurgery, Air Force Medical University Tangdu Hospital, Xi'an, Shaanxi, China
| | - Lingling Fan
- Department of Neurology, Xi'an First Hospital Affiliated to Xi'an Medical University, Xi'an, Shaanxi, China
| | - Dongwei Xu
- Department of Neurosurgery, 78th Group Army Hospital of Chinese PLA, Mudanjiang, Heilongjiang, China
| | - Jie Ma
- Department of Neurosurgery, Air Force Medical University Tangdu Hospital, Xi'an, Shaanxi, China
| | - Yan Hu
- Department of Neurosurgery, Air Force Medical University Tangdu Hospital, Xi'an, Shaanxi, China
| | - Jiang Li
- Department of Neurosurgery, Air Force Medical University Tangdu Hospital, Xi'an, Shaanxi, China
| | - Yufeng Liu
- Department of Neurosurgery, Air Force Medical University Tangdu Hospital, Xi'an, Shaanxi, China
| |
Collapse
|
3
|
Parat D, Granger B, Shotar E, Premat K, Reina V, Drir M, Gerschenfeld G, Talbi A, Lenck S, Sourour N, Clarençon F. 'Pressure cooker' and 'balloon pressure' techniques significantly increase 3-month complete occlusion rate after spinal arteriovenous fistula embolization as compared to glue: single center evaluation on 38 consecutive patients. J Neurointerv Surg 2023:jnis-2023-020621. [PMID: 37611938 DOI: 10.1136/jnis-2023-020621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Spinal arteriovenous fistulas can be treated either by surgery or by endovascular means, using different strategies. The main drawback of embolization is the risk of recurrence. Our objective is to evaluate the angiographic occlusion rate and the predictive factors of angiographic cure of spinal arteriovenous fistulas at 3 months or more after embolization. METHODS This is a retrospective single-center study including 38 consecutive patients with spinal arteriovenous fistulas treated by embolization as first-line treatment. We reviewed clinical and imaging data, complications, and the immediate angiographic occlusion rate of the fistulas, and at 3 months or more after the embolization. RESULTS A total of 45 embolization procedures were performed: 30 procedures using glue, 15 using Onyx by 'pressure cooker' or 'balloon pressure' techniques. We observed no statistically significant difference between the two groups concerning the immediate angiographic occlusion rate (87% in both groups; P>0.9), as well as for periprocedural complication rates. The angiographic occlusion rate at 3 months or more was higher in the Onyx 'combined' techniques treated group (87% vs 40%, P=0.007). The use of Onyx 'combined' techniques was independently associated with angiographic cure at 3 months after embolization (P=0.029). No other factors were identified as predictive of angiographic cure and clinical recovery after embolization procedures, nor were any predictive factors identified for the occurrence of periprocedural complications. CONCLUSION Embolization of spinal arteriovenous fistulas with Onyx using 'combined' techniques appears to be safe and associated with a higher rate of angiographic occlusion at 3 months than regular embolization with glue.
Collapse
Affiliation(s)
- Damien Parat
- Radiologie, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Benjamin Granger
- Department of Public Health, APHP, Paris, France
- Sorbonne University, Paris, France
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Kevin Premat
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Vincent Reina
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Mehdi Drir
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | | | - Atika Talbi
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Stephanie Lenck
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Nader Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Frédéric Clarençon
- Sorbonne University, Paris, France
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
- GRC BioFast, Sorbonne University, Paris, France
| |
Collapse
|
4
|
Mamaril-Davis J, Aguilar-Salinas P, Avila MJ, Dumont T, Avery MB. Recurrence Rates Following Treatment of Spinal Vascular Malformations: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 173:e250-e297. [PMID: 36787855 DOI: 10.1016/j.wneu.2023.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Spinal vascular malformations (SVMs), including arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs), are a varied group of vascular lesions that can be subclassified according to localization, vascular structure, and hemodynamics. Early intervention is necessary to halt progression of disease and minimize irreversible dysfunction. We sought to characterize initial treatment success and recurrence rates following interventional treatment of various types of SVMs. METHODS A systematic review and meta-analysis were performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. SVMs were categorized into 4 groups: dural AVFs, perimedullary AVFs, intramedullary AVMs, and extradural-intradural AVMs (e.g., epidural, paraspinal). Initial occlusion, recurrence, and complication rates were compared using random-effects analysis. RESULTS There were 112 manuscripts included, with a total of 5626 patients with SVM. For treatment, 2735 patients underwent endovascular embolization, 2854 underwent surgical resection, and 37 underwent stereotactic radiosurgery. The initial treatment success and overall recurrence rates following surgical resection of all SVMs were 89.5% (95% CI: 80.5%-98.5%) and 2.3% (95% CI: 0.9%-3.7%), respectively. Those rates following endovascular embolization were 55.9% (95% CI: 30.3%-81.5%) and 27.7% (95% CI: 11.2%-44.2%), respectively. Higher rates of initial treatment success and lower rates of recurrence with surgery were observed in all subtypes compared to embolization. Overall complication rates were higher after embolization for each of the SVM categories. CONCLUSIONS Surgical resection of SVMs provided higher rates of initial complete occlusion and lower rates of recurrence than endovascular techniques. Attaining technical success through obliteration must still be weighed against clinical impact and natural history of the specific vascular malformation.
Collapse
Affiliation(s)
- James Mamaril-Davis
- College of Medicine, The University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Pedro Aguilar-Salinas
- Department of Neurosurgery, Banner University Medical Center / The University of Arizona, Tucson, Arizona, USA
| | - Mauricio J Avila
- Department of Neurosurgery, Banner University Medical Center / The University of Arizona, Tucson, Arizona, USA
| | - Travis Dumont
- Department of Neurosurgery, Banner University Medical Center / The University of Arizona, Tucson, Arizona, USA
| | - Michael B Avery
- Department of Neurosurgery, Banner University Medical Center / The University of Arizona, Tucson, Arizona, USA.
| |
Collapse
|
5
|
Mohammad Hosseini E, Rasekhi A, Vahdat N, Eghbal K, Jamali M, Rahmanian A, Sourani A, Foroughi M, Baradaran Mahdavi S. Dorsal intradural spinal arteriovenous fistula associated with giant intradural spinal aneurysm, a case report. Clin Case Rep 2023; 11:e7202. [PMID: 37064730 PMCID: PMC10099199 DOI: 10.1002/ccr3.7202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023] Open
Abstract
Arteriovenous fistula and spinal aneurysms like other vascular malformations can mimic radiculopathy and low back pain. Precise imaging work combined with a hybrid endovascular-microsurgical approach is the key element for the best clinical outcome.
Collapse
Affiliation(s)
| | - Alireza Rasekhi
- Department of RadiologyShiraz University of Medical SciencesShirazIran
| | - Noushin Vahdat
- Department of RadiologyUniversity of California San Diego (USCD) HealthCaliforniaSan DiegoUSA
- Department of RadiologyVeteran Administration Healthcare SystemSan DiegoCaliforniaUSA
| | - Keyvan Eghbal
- Neurosurgery DepartmentShiraz University of Medical SciencesShirazIran
| | - Mohammad Jamali
- Neurosurgery DepartmentShiraz University of Medical SciencesShirazIran
| | | | - Arman Sourani
- Department of NeurosurgeryIsfahan University of Medical SciencesIsfahanIran
| | - Mina Foroughi
- Student Research CommitteeIsfahan University of Medical SciencesIsfahanIran
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‐Communicable DiseaseIsfahan University of Medical SciencesIsfahanIran
| |
Collapse
|
6
|
Ehresman J, Catapano JS, Baranoski JF, Jadhav AP, Ducruet AF, Albuquerque FC. Treatment of Spinal Arteriovenous Malformation and Fistula. Neurosurg Clin N Am 2022; 33:193-206. [PMID: 35346451 DOI: 10.1016/j.nec.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
With the rapid advancements in endovascular therapy over previous decades, the treatment of spinal arteriovenous malformations (AVMs) continues to evolve. The decision to use endovascular versus surgical therapy largely depends on the type of lesion and its anatomic location. Recent studies demonstrate that endovascular treatment is effective for extradural arteriovenous fistulas (AVFs), intradural ventral (perimedullary) AVMs, and intramedullary spinal AVMs. Treatment of intradural dorsal (dural) AVFs remains largely surgical because of lower recurrence rates, although recent studies demonstrate equivocal outcomes. Extradural-intradural (juvenile) AVMs and conus AVMs remain difficult-to-treat lesions.
Collapse
Affiliation(s)
- Jeff Ehresman
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Ashutosh P Jadhav
- Department of Interventional Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
| |
Collapse
|