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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.
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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
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Hu X, Diao Y, Hao Z, Hao M, Xie M, Rong H, Zhu T. Histopathological analysis of the wall enhancement of the spinal dural arteriovenous fistulae's draining veins. Acta Neurol Belg 2024; 124:927-934. [PMID: 38430359 DOI: 10.1007/s13760-024-02483-3] [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: 09/18/2023] [Accepted: 01/18/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The mechanism behind SDAVF is still unclear. We discovered that the vessel wall of the SDAVF-DV occasionally showed enhancement in MRI, and this study assessed the relationship between the enhancement of the draining vein's wall and its histology. METHODS For histopathologic analysis, 16 draining vein samples from 16 patients with SDAVF were included, 3 normal arteries and 3 normal veins were chosen as comparison. We assessed the imaging and microscopic characteristics of the draining veins in SDAVF patients. The former included the presence of significant enhancement of the wall of the draining vein in MRI, and the latter included the adherence, aggregation, infiltration of pro-inflammatory factors and inflammatory cells. Immuno-histochemical staining was performed using IL-1β, IL-8, TGF-β as well as MPO and MMP-9, and positive results were counted. Multiple logistic regression analysis was used to determine whether the infiltration of inflammatory cells was connected to vessel wall enhancement in the SDAVF-DV. RESULTS Infiltration of inflammatory cells was significantly higher in SDAVF-DV compared to normal vessels, 7 out of 16 patients significantly had enhancement of the vessel wall of SDAVF-DV, and logistic regression analysis showed that samples with more infiltration of inflammatory cells were more likely to show enhancement of the SDAVF-DV walls. CONCLUSION There was considerable inflammatory cells infiltration in SDAVF-DV, and this may explain why their vessel wall had such a significant enhancement in MRI.
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Affiliation(s)
- Xiaojun Hu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuhang Diao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhenghao Hao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Mingyu Hao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Minghao Xie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongtao Rong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Tao Zhu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
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Zanin L, Di Bonaventura R, Agosti E, di Bergamo LT, Daniele D, Saraceno G, Auricchio AM, Sturiale CL, Bergui M, Mardighian D, Stura G, Pedicelli A, Bresciani E, Migliorati K, Yohan A, Marchese E, Albanese A, Gasparotti R, Bernat AL, Houdart E, Olivi A, Froelich S, Bresson D, Fontanella MM, Doglietto F. Surgery versus endovascular treatment for spinal dural arteriovenous fistulas: a multicenter experience and systematic literature review. Neurosurg Rev 2024; 47:206. [PMID: 38713376 DOI: 10.1007/s10143-024-02443-8] [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: 01/30/2024] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024]
Abstract
Surgery and endovascular therapy are the primary treatment options for spinal dural arteriovenous fistula (SDAVF). Due to the absence of a consensus regarding which therapy yields a superior outcome, we conducted a comparative analysis of the surgical and endovascular treatment of SDAVF through a multicenter case series and a systematic literature review. Patients with SDAVF, surgically or endovascularly treated at four neurosurgical centers from January 2001 to December 2021, were included in this study. Level of SDAVF, primary treatment modality, baseline and post-procedural neurological status were collected. The primary outcomes were failure, complication rates, and a newly introduced parameter named as therapeutic delay. A systematic review of the literature was performed according to PRISMA-P guidelines. The systematic review identified 511 papers, of which 18 were eligible for analysis, for a total of 814 patients, predominantly male (72%) with a median age of 61 and mainly thoracic SDAVFs (65%). The failure rate was significantly higher for endovascular therapy (20%) compared to surgery (4%) (p < 0.01). Neurological complications were generally rare, with similar rates among the two groups (endovascular 2.9%; surgery 2.6%). Endovascular treatment showed a statistically significantly higher rate of persistent neurological complications than surgical treatment (2.9% versus 0.2%; p < 0.01). Both treatments showed similar rates of clinical improvement based on Aminoff Logue scale score. The multicenter, retrospective study involved 131 patients. The thoracic region was the most frequent location (58%), followed by lumbar (37%). Paraparesis (45%) and back pain (41%) were the most common presenting symptoms, followed by bladder dysfunction (34%) and sensory disturbances (21%). The mean clinical follow-up was 21 months, with all patients followed for at least 12 months. No statistically significant differences were found in demographic and clinical data, lesion characteristics, or outcomes between the two treatment groups. Median pre-treatment Aminoff-Logue score was 2.6, decreasing to 1.4 post-treatment with both treatments. The mean therapeutic delay for surgery and endovascular treatment showed no statistically significant difference. Surgical treatment demonstrated significantly lower failure rates (5% vs. 46%, p < 0.01). In the surgical group, 2 transient neurological (1 epidural hematoma, 1 CSF leak) and 3 non-neurological (3 wound infections) complications were recorded; while 2 permanent neurological (spinal infarcts), and 5 non-neurological (inguinal hematomas) were reported in the endovascular group. According to the literature review and this multicenter clinical series, surgical treatment has a significantly lower failure rate than endovascular treatment. Although the two treatments have similar complication rates, endovascular treatment seems to have a higher rate of persistent neurological complications.
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Affiliation(s)
- Luca Zanin
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Rina Di Bonaventura
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Edoardo Agosti
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy.
| | - Lodovico Terzi di Bergamo
- Department of Health Science and Technology, Swiss Federal Institute of Technology (ETH Zürich), Zurich, Switzerland
| | - Dino Daniele
- Neuroradiology Unit, Department of Neuroscience, University of Turin - Molinette Hospital, Turin, Italy
| | - Giorgio Saraceno
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Anna Maria Auricchio
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | | | - Mauro Bergui
- Neuroradiology Unit, Department of Neuroscience, University of Turin - Molinette Hospital, Turin, Italy
| | | | - Guido Stura
- Neuroradiology Unit, Department of Neuroscience, University of Turin - Molinette Hospital, Turin, Italy
| | - Alessandro Pedicelli
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Ettore Bresciani
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Karol Migliorati
- Neurosurgery Unit, Fondazione Poliambulanza di Brescia, Brescia, Italy
| | - Alexander Yohan
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Enrico Marchese
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore, Neurosurgery, Rome, Italy
| | - Alessio Albanese
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore, Neurosurgery, Rome, Italy
| | | | - Anne Laure Bernat
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | - Alessandro Olivi
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore, Neurosurgery, Rome, Italy
| | - Sebastian Froelich
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | - Marco Maria Fontanella
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Francesco Doglietto
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore, Neurosurgery, Rome, Italy
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Peng Y, Ren Y, Hou J, Zhang C, He M, Huang B, Chen T, Li J. Clinical outcomes and prognostic factors in the surgical treatment of spinal dural arteriovenous fistulas: a retrospective study of 118 patients. Sci Rep 2023; 13:18266. [PMID: 37880297 PMCID: PMC10600191 DOI: 10.1038/s41598-023-45599-x] [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: 08/13/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal vascular malformations (AVMs), constituting approximately 70% of all spinal AVMs. The impact of various clinical and radiologic features on the outcomes in patients with SDAVFs is still controversial. The purpose of the study is to investigate the clinical outcomes and prognostic factors in patients with surgically treated SDAVFs in a single center. A retrospective review was performed for all patients with SDAVFs from January 2013 to September 2021 who underwent surgery at our institution. Medical records and pre- and postoperative imaging data were analyzed. Neurological function status was evaluated by modified Aminoff-Logue Scale (mALS). Student's t-test, Wilcoxon rank sum test, χ2 test and logistic regression were used to find significant prognostic factors. P values < 0.05 were considered significant. One hundred and eighteen patients were ultimately included in the study. By comparing preoperative and postoperative mALS, 69 (58.5%) patients experienced improvement, and 49 (41.5%) patients showed no improvement (worse or unchanged). Wilcoxon rank sum test showed that there was a difference between the improvement group and the no improvement group in preoperative mALS Micturition score and preoperative mALS Defecation score. The logistic regression revealed that preoperative mALS Gait score was associated with clinical improvement after surgery in patients with SDAVFs. Surgical treatment of SDAVFs is a safe and effective procedure and can lead to symptom improvement or stabilization in most patients. Preoperative neurological function status was the only factor associated with clinical prognosis.
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Affiliation(s)
- Youheng Peng
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yanming Ren
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiguang Hou
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Changwei Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Min He
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bowen Huang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tengyun Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jin Li
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
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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.
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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.
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Sturiale CL, Auricchio AM, Valente I, Maugeri R, Pedicelli A, Visocchi M, Albanese A. Spinal Dural Arteriovenous Fistulas: A Retrospective Analysis of Prognostic Factors and Long-Term Clinical Outcomes in the Light of the Recent Diagnostic and Technical Refinements. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:223-230. [PMID: 38153474 DOI: 10.1007/978-3-031-36084-8_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Spinal dural arteriovenous fistulas (dAVFs) are abnormal connections between the meningeal branches of segmental arteries and a radiculomedullary veins that result in a progressive myelopathy thanks to perimedullary coronal venous plexus congestion. Usually, dAVFs show nonspecific symptoms, thus leading to late clinical suspicion and a difficult MRI diagnosis.Several authors have tried to identify prognostic factors before treatment, but published studies results are often inconsistent and sometimes contradictory.In this study, we reviewed our recent experience of 30 dAVF patients where we collected all demographic, clinical and angioarchitectural features as well as radiological and treatment-related characteristics. The thoracic spine was the most common location, constituting 53.3% of cases, followed by the lumbar roots, comprising 30%. About 83% of patients showed motor deficits, urinary disturbances were present in 70%, and bowel symptoms in 50%.We treated 86.7% of patients with microsurgery and 13.3% with endovascular occlusion with a mean interval between clinical onset and intervention of 10.8 ± 14.2 months.A significant clinical improvement was observed at follow-up in 80% of patients, with a significant reduction in mean G-score, U-score and F-score at a mean follow-up of 105.89 ± 191.9 months.However, none among the principal demographic, clinical and radiological characteristics showed significant prognostic value to the clinical improvement observed at follow-up.
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Affiliation(s)
- Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Maria Auricchio
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Iacopo Valente
- Department of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP Paolo Giaccone, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Alessandro Pedicelli
- Department of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Zhang HB, Zhai XL, Li L, Wu DS, Zhuang GL, Xu QW, Guo H, Wang J. Imaging characteristics, misdiagnosis and microsurgical outcomes of patients with spinal dural arteriovenous fistula: a retrospective study of 32 patients. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:832. [PMID: 36034988 PMCID: PMC9403910 DOI: 10.21037/atm-22-3568] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
Background Spinal dural arteriovenous fistula (SDAVF) is an extremely rare spinal vascular malformation. As SDAVF exhibits no specific clinical manifestations nor diverse imaging results, it is easily misdiagnosed, resulting in delayed treatment and irreversible neurological damage. Most patients were initially misdiagnosed, but there were few reports on reducing misdiagnosis. Methods A total of 32 consecutive patients, who presented to our institution (Shanghai Deji Hospital) with SDAVF between June 2013 and January 2016 were retrospectively analyzed. Data were collected on demographics, clinical presentation, imaging findings, follow-up, and clinical outcomes. The Aminoff-Logue scale (ALS) was used to assess clinical outcomes. Results Of the 32 enrolled patients (3 females, mean age 59.1±3.8 years), 23 patients (71.9%) were misdiagnosed as acute myelitis (11 patients), intramedullary tumors (6 patients), lumbar disc herniation (4 patients), and other conditions (2 patients). All patients underwent surgical procedures under electrophysiological monitoring. Fistulas were found in all 32 patients and were successfully occluded. The mean follow-up period was 19.22±8.21 months (ranging from 2 weeks to 30 months). One year later, 20 patients underwent magnetic resonance imaging (MRI), and 14 showed no T2 edema, and the edema was relieved in 6 patients. A total of 10 patients underwent enhancement MRI and no enhancement signs were detected. Among the 27 patients with long-time follow-up, the fistula had no residual or recurrence, 21 patients showed decreased ALS scores (P<0.05). Six patients exhibited nonsignificant improvement. No aggravating patient was found. Prognosis differed significantly between patients with ALS <6 and those with ALS ≥6 (P<0.05). Conclusions Spinal angiography should be performed with full intubation, and microcatheter angiography can reduce misdiagnosis. SDAVF must be differentiated from acute myelitis, intramedullary tumor, and other spinal vascular malformations. Microsurgical treatment is effective with a low recurrence rate.
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Affiliation(s)
- Han-Bing Zhang
- Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China
| | - Xiao-Lei Zhai
- Department of Neurosurgery, Shuyang Hospital, Xuzhou Medical University, Xuzhou, China
| | - Lu Li
- Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China
| | - De-Shen Wu
- Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China
| | - Guang-Liang Zhuang
- Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China
| | - Qi-Wu Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hui Guo
- Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China
| | - Jie Wang
- Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China
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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: 5] [Impact Index Per Article: 2.5] [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.
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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.
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Yang C, Ma Y, Tian A, Yu J, Chen S, Peng C, Yang K, Li G, He C, Ye M, Hong T, Bian L, Wang Z, Ling F, Zhang H. Long-term outcomes and prognostic factors in patients with treated spinal dural arteriovenous fistulas: a prospective cohort study. BMJ Open 2022; 12:e047390. [PMID: 34980604 PMCID: PMC8724715 DOI: 10.1136/bmjopen-2020-047390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To define the pattern of long-term clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistulas (SDAVFs). DESGIN Prospective cohort study based on constantly recruiting patients with SDAVFs in two medical centres in China. SETTING Patients with SDAVFs were recruited consecutively between March 2013 and December 2014 in two referral centres. PARTICIPANTS A prospective cohort of 94 patients with SDAVFs was included in this study, and 86 patients (mean age 53.0 years, 71 men) completed the study. Patients who had previously undergone endovascular or neurosurgical treatment or had neurological dysfunction caused by other diseases or refused treatment were excluded. INTERVENTIONS All patients underwent neurosurgery or endovascular embolisation. These patients were evaluated with the modified Aminoff and Logue's Scale (mALS) 1 day before and 3, 6, 12 and 72 months after treatments. RESULTS The duration of symptoms ranged from 0.5 to 66 months (average 12.8 months). The location of SDAVFs was as follows: 33.7% above T7, 50.0% between/include T7 and T12% and 16.3% below T12. 75 patients (87.2%) underwent neurosurgical treatment, and 9 patients (10.5%) underwent endovascular treatment. 58 patients (67.4%) exhibited an improvement in mALS of one point or greater at 72 months. Patients with less disability were more likely to improve at 72 months (p<0.05). 48 patients (55.8%) showed deterioration at 72 months compared with 12 months. 61% of the patients suffered numbness, and 22% had pain before treatment. However, 81% of patients had numbness, and 28% had pain after treatment. This deterioration was related to 1-year mALS and age. CONCLUSION Nearly two-thirds of the patients experienced clinical improvement at 72 months, and preoperative (1 day before treatment) mALS was the strongest predictor of clinical improvement. However, 55.8% of patients showed deterioration after temporary recovery. All patients with SDAVFs should accept treatment as soon as possible.
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Affiliation(s)
- Chengbin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - An Tian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiaxing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sichang Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Peng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kun Yang
- Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guilin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lisong Bian
- Department of Neurosurgery, Beijing Haidian Hospital, Beijing, China
| | - Zhichao Wang
- Department of Neurosurgery, Beijing Haidian Hospital, Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Oh Y, Heo Y, Jeon SR, Roh SW, Park JH. Microsurgery Versus Endovascular Treatment - Which Is Adequate for Initial Treatment of Spinal Dural Arteriovenous Fistula: A Case Series. Neurospine 2021; 18:344-354. [PMID: 34218615 PMCID: PMC8255761 DOI: 10.14245/ns.2040826.413] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/04/2021] [Indexed: 01/16/2023] Open
Abstract
Objective Considering the adverse natural history of spinal dural arteriovenous fistula (sDAVF), clinical outcomes may be worsened if the initial occlusive trial does not achieve complete fistula occlusion. We aimed to analyze the initial success rate of microsurgery and embolization and confirm the effects of initial treatment success on the clinical outcomes of sDAVF patients. In addition, we investigated the factors associated with initial treatment failure.
Methods A total of 38 patients treated for sDAVF at a single institution over a 14-year period were retrospectively reviewed. Clinical outcomes according to the initial treatment modality were quantitatively analyzed. Demographic characteristics and angioarchitecture data were evaluated to identify factors associated with initial treatment failure.
Results In the study population, 34 patients underwent embolization as the initial treatment, and complete occlusion of the fistula was achieved in 13 patients (38%). However, all patients who underwent microsurgery showed complete fistula occlusion. Among patients with initial treatment success, gait and micturition were improved with statistical significance (p < 0.001 each). However, in cases of initial treatment failure, only mild improvements in gait and micturition were observed, which were not statistically significant (p = 0.097 and p = 0.375, respectively). A narrow feeding artery diameter (p = 0.007) and embolization of the artery only (p = 0.002) were identified as factors associated with initial treatment failure.
Conclusion To achieve symptomatic improvement and prevent neurological deterioration due to recurrence, the initial definite occlusion of the fistula is important. Despite advances in endovascular techniques, microsurgical occlusion is still superior in terms of initial complete obliteration.
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Affiliation(s)
- Younggyu Oh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Heo
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Clinical and Imaging Features of Spinal Dural Arteriovenous Fistula: Clinical Experience of 15 Years for a Major Tertiary Hospital. World Neurosurg 2020; 138:e177-e182. [DOI: 10.1016/j.wneu.2020.02.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/23/2022]
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12
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Zhang L, Qiao G, Shang A, Yu X. Long-term surgical outcomes of patients with delayed diagnosis of spinal dural arteriovenous fistula. J Clin Neurosci 2020; 77:25-30. [PMID: 32451215 DOI: 10.1016/j.jocn.2020.05.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/29/2020] [Accepted: 05/03/2020] [Indexed: 12/27/2022]
Abstract
Spinal dural arteriovenous fistula (dAVF) is an extremely rare vascular entity that is usually misdiagnosed. We sought to determine the long-term clinical outcomes of patients undergoing microsurgical treatment for delayed diagnosis of spinal dAVF. This retrospective study identified patients with delayed diagnosed spinal dAVF at our institution from 2009 to 2018. Patients' data, including demographics, imaging, and follow-up data, were evaluated. This cohort included 65 consecutive patients with 68 dAVFs and a male-to-female ratio of 4:1 and a mean age of 53.5 ± 13.7 years. The presenting symptoms consisted of limb weakness (n = 42, 64.6%), paraparesis (n = 34, 52.3%), sphincter disturbances (n = 8, 12.3%), and pain (n = 13, 20.0%). The proportion of patients with each symptom significantly increased and patients experienced increased disability when the diagnosis was finalized. The mean length of delay of diagnosis was 20.7 ± 30.0 months. Surgery resulted in complete occlusion of the fistula on the first attempt in all patients. Three patients developed recurrent fistulas, and three died in the follow-up period. Improved motor function was achieved in 38 patients (59.5%). Other symptoms, such as sensory disorders, sphincter dysfunction, and pain, improved by 37.3%, 32.3%, and 66.7%, respectively. Patients with spinal dAVF usually exhibit progressive ascending myelopathy and often remain misdiagnosed for months to years. Some patients' increased disability cannot be reversed through surgery.
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Affiliation(s)
- Liang Zhang
- Medical School of Nankai University, No. 94, Weijin Road, Naikai District, Tianjin 300071, Tianjin, People's Republic of China; Department of Neurosurgery, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, People's Republic of China
| | - Guangyu Qiao
- Department of Neurosurgery, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, People's Republic of China
| | - Aijia Shang
- Department of Neurosurgery, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, People's Republic of China
| | - Xinguang Yu
- Medical School of Nankai University, No. 94, Weijin Road, Naikai District, Tianjin 300071, Tianjin, People's Republic of China; Department of Neurosurgery, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, People's Republic of China.
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Ghadirpour R, Nasi D, Iaccarino C, Romano A, Motti L, Farneti M, Pascarella R, Servadei F. Intraoperative Neurophysiological Monitoring in Surgical Treatment of Spinal Dural Arteriovenous Fistulas: Technique and Results. Asian J Neurosurg 2018; 13:595-606. [PMID: 30283511 PMCID: PMC6159052 DOI: 10.4103/ajns.ajns_209_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective and Background: Data on intraoperative neurophysiological monitoring (IOM) during surgery of spinal dural arteriovenous fistulas (SDAVFs) are lacking. The purpose of this study was to evaluate the role of IOM during microsurgery for SDAVFs. Materials and Methods: From March 2007 to March 2013, 12 patients had microsurgery with IOM for SDAVFs. The IOM included somatosensory-evoked potentials, motor-evoked potentials (MEPs), and – in selected cases – D-Waves. All patients were evaluated at admission and at follow-up (6, 12, and 24 months) with Aminoff–Logue Disability Scale for Gait-Aminoff–Logue Disability Scale (G-ALS) and Micturition-Aminoff–Logue Disability Scale (M-ALS). Statistical Analysis Used: Logistic regression was used for detecting the clinical risk factors influencing neurological functions after the treatment. Results: During surgery, we registered the absence of significant modifications of evoked potentials in nine cases (75%), while improvement of MEPs occurred in three cases (25%). No false-negative case was registered, and IOM predicted the absence of new postoperative neurological deficit in all patients. At 24-month follow-up, nine patients improved their overall neurological status, while three patients remained stable. At univariate analysis, Aminoff–Logue Disability Scales for Gait and Micturition (G + M-ALS) score at 24-month follow-up was directly associated with the duration of symptom before the surgery (P = 0.024), preoperative G-ALS (P = 0.02), M-ALS (P = 0.022), and G + M-ALS scores (P = 0.045), and improvement of IOM after occlusion of the fistula (P = 0.025). Conclusions: In our series, no significant worsening of evoked potentials occurred and subsequently the surgical strategy was not changed by IOM. However, no false-negative case was registered, and IOM predicted the absence of new postoperative neurological deficit in all patients. Patients with improvement of IOM parameters after occlusion of the fistula had greater chances of postsurgical improvement at the univariate analysis.
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Affiliation(s)
- Reza Ghadirpour
- Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.,Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy
| | - Davide Nasi
- Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.,Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy
| | - Corrado Iaccarino
- Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.,Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy
| | - Antonio Romano
- Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.,Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy
| | - Luisa Motti
- Department of Neurophysiology, IRCCS "Arcispedale Santa Maria Nuova," Reggio Emilia, Italy
| | - Marco Farneti
- Department of Neurosurgery, "S. Anna" University Hospital, Ferrara, Italy
| | - Rosario Pascarella
- Department of Neuroradiology, IRCCS "Arcispedale Santa Maria Nuova," Reggio Emilia, Italy
| | - Franco Servadei
- Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.,Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy
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Ma Y, Chen S, Peng C, Wang C, Li G, He C, Ye M, Hong T, Bian L, Liu J, Wang Z, Qureshi AI, Ling F, Zhang H. Clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistulas : a prospective cohort study in two Chinese centres. BMJ Open 2018; 8:e019800. [PMID: 29331977 PMCID: PMC5781161 DOI: 10.1136/bmjopen-2017-019800] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The short-term outcomes and prognostic factors of patients with spinal dural arteriovenous fistulas (SDAVFs) have not been defined in large cohorts. OBJECTIVE To define the short-term clinical outcomes and prognostic factors in patients with SDAVFs. METHODS A 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. RESULTS A 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). CONCLUSION Approximately four fifths of the patients experienced clinical improvement at 12 months and preoperative mALS was the strongest predictor of clinical improvement in the cohort.
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Affiliation(s)
- Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute, Beijing, China
| | - Sichang Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute, Beijing, China
| | - Chao Peng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute, Beijing, China
| | - Chunxiu Wang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guilin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute, Beijing, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute, Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute, Beijing, China
| | - Lisong Bian
- Department of Neurosurgery, Beijing Haidian Hospital, Beijing, China
| | - Jiang Liu
- Department of Neurosurgery, Beijing Haidian Hospital, Beijing, China
| | - Zhichao Wang
- Department of Neurosurgery, Beijing Haidian Hospital, Beijing, China
| | | | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute, Beijing, China
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15
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Babichev KN, Orlov VP, Stanishevskiy AV, Savello AV, Svistov DV. [Spinal dural arteriovenous fistulas. A series of clinical cases and an analysis of the literature data]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 81:33-44. [PMID: 28914869 DOI: 10.17116/neiro201781433-42] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spinal cord, causing segmental lesions of the spinal cord due to venous ischemia. Functional outcomes of treatment in SDAVF patients are favorable, but the rate of improvement varies from 25 to 100%, which complicates prediction of the treatment outcome. AIM the study aim was to identify a relationship between fistula localization and clinical manifestations and evaluate the effect of disease duration and severity of neurological impairments on immediate and long-term treatment outcomes, based on analysis of the literature and own data. MATERIAL AND METHODS In September 2016, we performed a PubMed search for publications using keywords 'spinal arteriovenous fistula', 'treatment', and 'outcome'. We selected publications containing information on the patient's age, fistula location, disease duration, and evaluation of symptom severity (Aminoff-Logue scale) preoperatively, postoperatively, and at least 3 months after surgery. The analysis also included data on patients operated on at the clinic. A total of 187 patients were included in the analysis. RESULTS The fistula was most often located at the T6, T7, and T9 level, with motor disorders being more severe for fistulas located at or below the T9 vertebra. Surgical isolation of the fistula improved the functional state of patients, with patients under the age of 60 years having a better prognosis for recovery of impaired functions. Motor disorders significantly regressed in the early postoperative period in all patients, but in the long-term period, there was worsening of motor disorders in patients with a better baseline functional state.
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Affiliation(s)
- K N Babichev
- Military medical Academy named after S. M. Kirov, Saint-Petersburg, Russia
| | - V P Orlov
- Military medical Academy named after S. M. Kirov, Saint-Petersburg, Russia
| | - A V Stanishevskiy
- Military medical Academy named after S. M. Kirov, Saint-Petersburg, Russia
| | - A V Savello
- Military medical Academy named after S. M. Kirov, Saint-Petersburg, Russia
| | - D V Svistov
- Military medical Academy named after S. M. Kirov, Saint-Petersburg, Russia
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16
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Lee J, Lim YM, Suh DC, Rhim SC, Kim SJ, Kim KK. Clinical presentation, imaging findings, and prognosis of spinal dural arteriovenous fistula. J Clin Neurosci 2016; 26:105-9. [DOI: 10.1016/j.jocn.2015.06.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/14/2015] [Indexed: 12/28/2022]
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17
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Bakker NA, Uyttenboogaart M, Luijckx GJ, Eshghi OS, Mazuri A, Metzemaekers JDM, Groen RJM, Van Dijk JMC. Recurrence Rates After Surgical or Endovascular Treatment of Spinal Dural Arteriovenous Fistulas: A Meta-analysis. Neurosurgery 2016; 77:137-44; discussion 144. [PMID: 25790071 DOI: 10.1227/neu.0000000000000727] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is an increasing tendency to treat spinal dural arteriovenous fistulas (SDAVFs) endovascularly despite the lack of clear evidence favoring embolization over surgery. OBJECTIVE To compare the initial failure and recurrence rates of primary treatment of SDAVFs by surgery and endovascular techniques. METHODS A meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standard was performed. All the English literature from 2004 onward was evaluated. From each article that compared the 2 treatment modalities, the odds ratio (OR) was calculated. Combined ORs were calculated with Review Manager 5.3 of The Cochrane Collaboration. RESULTS A total of 35 studies harboring 1112 patients were assessed. Initial definitive fistula occlusion was observed in 588 of 609 surgical patients (96.6%; 95% confidence interval [CI], 94.8-97.8) vs 363 of 503 endovascularly treated patients (72.2%; 95% CI, 68.1-75.9; P < .001). The combined OR from 18 studies that assessed both treatment modalities (730 patients) was 6.15 (95% CI, 3.45-11.0) in favor of surgical treatment. Late recurrence (13 studies, 480 patients) revealed an OR of 3.15 (95% CI, 1.66-5.96; P < .001) in favor of surgery. In a subgroup, recurrence was reported in 10 of 22 patients (45%) treated with Onyx vs 8 of 35 (23%) treated with n-butyle-2-cyanoacrylate (OR, 2.51; 95% CI, 0.75-8.37; P = .13). CONCLUSION Although hampered by inclusion of poor quality studies, this meta-analysis shows a definite advantage of primary surgical treatment of SDAVF over endovascular treatment in initial failure rate and late recurrences. The often-used argument that endovascular techniques have improved and therefore outweigh surgery is not supported by this meta-analysis.
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Affiliation(s)
- Nicolaas A Bakker
- From the Departments of *Neurosurgery, ‡Radiology, and §Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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18
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Single center experience with treatment of spinal dural arteriovenous fistulas. Neurosurg Rev 2015; 38:683-92. [DOI: 10.1007/s10143-015-0645-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/23/2015] [Accepted: 04/25/2015] [Indexed: 11/27/2022]
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19
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Shin DA, Park KY, Ji GY, Yi S, Ha Y, Park SW, Yoon DH, Kim KN. The use of magnetic resonance imaging in predicting the clinical outcome of spinal arteriovenous fistula. Yonsei Med J 2015; 56:397-402. [PMID: 25683987 PMCID: PMC4329350 DOI: 10.3349/ymj.2015.56.2.397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) has been used to screen and follow-up spinal dural arteriovenous fistulae (SDAVF). The purpose of this study was to evaluate the association between MRI findings and neurologic function in SDAVF. This study also investigated clinical features and treatment results of SDAVF. MATERIALS AND METHODS A total of 15 consecutive patients who underwent embolization or surgery for SDAVF were included. We treated seven (60%) patients with embolization and six (40%) with surgery. We analysed clinical features, MRI findings, treatment results, and neurologic function. Neurologic function was measured by the Aminoff-Logue disability scale (ALS). RESULTS Patients with longer levels of intramedullary high signal intensity in preoperative T2-weighted images (T2WI) exhibited worse pre- and postoperative ALS scores (r=0.557, p=0.031; r=0.530, p=0.042, Pearson correlation). Preoperative ALS score was significantly correlated with postoperative ALS score (r=0.908, p=0.000, Pearson correlation). The number of levels showing intramedullary high signal intensity in T2WI decreased significantly postoperatively (5.2±3.1 vs. 1.0±1.4, p=0.001, Wilcoxon ranked test). CONCLUSION The number of involved levels of high signal intensity in preoperative T2WI is useful for predicting pre- and postoperative neurologic function in SDAVF.
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Affiliation(s)
- Dong Ah Shin
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.; Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Young Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Gyu Yeul Ji
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.; Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.; Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seoung Woo Park
- Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.; Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.; Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Hamdan A, Padmanabhan R. Intramedullary hemorrhage from a thoracolumbar dural arteriovenous fistula. Spine J 2015; 15:e9-16. [PMID: 25463404 DOI: 10.1016/j.spinee.2014.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 09/19/2014] [Accepted: 10/07/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal dural arteriovenous fistulas (AVFs) are acquired lesions presenting typically with neurologic deficits secondary to chronic congestive myelopathy. The low-flow and low-volume nature of these lesions makes hemorrhage very unlikely, and intramedullary hemorrhage caused by thoracolumbar dural AVFs is exceedingly rare. PURPOSE The purpose of this study was to report a case of intramedullary hemorrhage caused by a thoracolumbar dural AVF. STUDY DESIGN/SETTING The study design included a case report and review of literature. METHODS A case of intramedullary hemorrhage from a thoracolumbar dural AVF was reported, and the literature regarding hemorrhagic presentations of dural AVF was reviewed. RESULTS A 66-year-old woman presented with a sudden onset of abdominal pain, paraplegia, sensory loss below the costal margins, and urinary retention. Magnetic resonance imaging scan showed intramedullary hemorrhage with abnormal flow voids raising suspicion of an intramedullary AV malformation. However, subsequent selective spinal angiography demonstrated a spinal dural AVF fed by the T7 intercostal artery and a varix within the draining vein. Complete obliteration of the dural AVF and the varix was achieved via embolization. As far as we are aware, there are only two other similar cases in the literature. Literature review revealed that presentation of thoracolumbar dural AVFs with hemorrhage is frequently associated with accelerated venous flow and the presence of a venous varix. CONCLUSIONS Although very unusual, a spinal dural AVF may present with intramedullary hemorrhage, and hemorrhage in such conditions may be associated with an accelerated venous flow and the presence of a venous varix.
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Affiliation(s)
- Alhafidz Hamdan
- Department of Neurosurgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough TS4 3BW, UK
| | - Rajeev Padmanabhan
- Department of Neuroradiology, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough TS4 3BW, UK.
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Gokhale S, Khan SA, McDonagh DL, Britz G. Comparison of surgical and endovascular approach in management of spinal dural arteriovenous fistulas: A single center experience of 27 patients. Surg Neurol Int 2014; 5:7. [PMID: 24575322 PMCID: PMC3927093 DOI: 10.4103/2152-7806.125628] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 11/21/2013] [Indexed: 12/26/2022] Open
Abstract
Background: Spinal dural arteriovenous fistula (SDAVF) is a rare spinal vascular malformation with an annual incidence of 5-10 cases per million. The data on efficacy, recurrence rates and complications of endovascular versus surgical treatment of SDAVF is limited. Methods: We conducted a retrospective chart review of 27 adult patients with a diagnosis of SDAVF and who underwent treatment at Duke University Hospital between January 1, 1993 and December 31, 2012. We compared the outcome measures by Aminoff–Logue score (ALS) in patients who underwent treatment with endovascular embolization versus surgical ligation of fistula. We compared complication rates, recurrence rates as well as data on long-term follow up in these patients. Results: Out of 27 patients in the study, 10 patients underwent endovascular embolization (Onyx was used in 5 patients and NBCA in 5 patients) as the first line therapy. Seventeen patients underwent surgical ligation as initial therapeutic modality. Patients in both groups showed significant improvement in clinical status (ALS) after treatment. One patient in endovascular group developed spinal infarction due to accidental embolization of medullary artery. Three patients in embolization group had recurrence of fistula during the course of follow up requiring surgical ligation. Two patients in surgical group developed local wound infection. None of the patients in surgical group had recurrence of fistula during the course of follow up. Conclusions: Endovascular embolization and surgical ligation are effective treatment strategies for SDAVF. Our observations show that surgical ligation may offer permanent cure without any recurrence. Endovascular approach is associated with higher incidence of recurrence, especially with use of onyx.
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Affiliation(s)
- Sankalp Gokhale
- Division of Neurocritical Care, Department of Neurology, Duke University Hospital, Duke University School of Medicine, Durham, NC 27710, USA
| | - Shariq A Khan
- Division of Neuro-anesthesia, Department of Anesthesiology, Duke University Hospital, Duke University School of Medicine, Durham, NC 27710, USA
| | - David L McDonagh
- Department of Anesthesiology and Neurology, Chief, Division of Neuro-anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Gavin Britz
- Department of Neurosurgery, Methodist Hospital of Houston, University of Texas -Houston, 6560 Fannin St. Suite 944, Houston, TX 77030, USA
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Factors determining the success of endovascular treatments among patients with spinal dural arteriovenous fistulas. Neuroradiology 2013; 55:1389-95. [DOI: 10.1007/s00234-013-1285-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/23/2013] [Indexed: 11/26/2022]
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Marcus J, Schwarz J, Singh IP, Sigounas D, Knopman J, Gobin YP, Patsalides A. Spinal Dural Arteriovenous Fistulas: A Review. Curr Atheroscler Rep 2013; 15:335. [DOI: 10.1007/s11883-013-0335-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kirsch M, Berg-Dammer E, Musahl C, Bäzner H, Kühne D, Henkes H. Endovascular management of spinal dural arteriovenous fistulas in 78 patients. Neuroradiology 2013; 55:337-43. [DOI: 10.1007/s00234-013-1134-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 01/03/2013] [Indexed: 01/03/2023]
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