Degree and Duration of Functional Improvement on Long-Term Follow-Up of Spinal Dural Arteriovenous Fistulae Occluded by Endovascular and Surgical Treatment

Durnford, Andrew; Hempenstall, Jonathan; Sadek, Ahmed; Duffill, Jonathan; Mathad, Nijaguna; Millar, John S.; Sparrow, Owen; Bulters, Diederik

doi:10.1016/j.wneu.2017.07.140

Cited by 16 publications

(12 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The inflammatory factors and autoantibodies released by necrotic neurons cause local inflammatory reactions, which persist for a long time, eventually leading to late deterioration of the patient. Durnford et al 25 believed that these patients had a reduced neural reserve, and any future neuronal loss that might have been subclinical in normal individuals may result in clinically overt neurologic deterioration.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes and prognostic factors in patients with treated spinal dural arteriovenous fistulas: a prospective cohort study

Yang

Tian

et al. 2022

BMJ Open

View full text Add to dashboard Cite

ObjectiveTo define the pattern of long-term clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistulas (SDAVFs).DesginProspective cohort study based on constantly recruiting patients with SDAVFs in two medical centres in China.SettingPatients with SDAVFs were recruited consecutively between March 2013 and December 2014 in two referral centres.ParticipantsA 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.InterventionsAll 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.ResultsThe 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.ConclusionNearly 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.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term outcomes and prognostic factors in patients with treated spinal dural arteriovenous fistulas: a prospective cohort study

Yang

Tian

et al. 2022

BMJ Open

View full text Add to dashboard Cite

show abstract

“…On the other hand, the rate of complete obliteration by surgical treatment is reported to be 83–100%, stably higher than endovascular treatment. 4,5,10,11,13,14) Treatment-related complications are reported to be low, ranged from 3.7 to 7.7%. 14,15) The rate of improvement or stabilization in neurological symptoms after surgical treatment is reported to be high with 89–93% of SDAVF cases.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Endovascular Treatment for Spinal Dural Arteriovenous Fistula in Japan: Japanese Registry of Neuroendovascular Therapy 2 and 3

Tsuruta

Matsumaru

Iihara

et al. 2019

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

A subgroup analysis of spinal vascular lesions registered in the Japanese Registry of Neuroendovascular Therapy 2 (JR-NET2) and JR-NET3 was performed. About 172 analyzable cases of spinal dural arteriovenous fistula (SDAVF) were assessed, including the characteristics, treatment strategy, and treatment outcome. SDAVF was more common in middle-aged and older males. The most commonly affected area was the thoracolumbosacral region (83.7%), and most cases had a non-hemorrhagic onset (89.0%). Complete obliteration was achieved in 54.7%. Treatment-related complications occurred in three patients (7.0%). Post-treatment neurological improvement was achieved in 48.3%. The primary endpoint [modified Rankin Scale (mRS) score of 0-2 on postoperative day 30] was achieved in 60.5% of the cases. As a new discovery, the incidence of cervical SDAVF increased from 1.8% in JR-NET2 to 19.7% in JR-NET3. Compared with non-cervical SDAVF, cervical SDAVF was characterized by a higher proportion of hemorrhagic onset (P <0.01), incomplete obliteration of the shunt (P <0.01), and embolization-related complications (P = 0.01). Overall, a mRS of 0-2 on postoperative day 30 was correlated with a pre-treatment mRS of 0-2 (P <0.01) in a univariate analysis. Complete obliteration of the shunt was the only predictor of postoperative neurological improvement (P = 0.001) in a multivariate analysis. Endovascular treatment for SDAVF has been safely administered in Japan. The incidence of cervical SDAVF, which has more aggressive features, appears to be increasing. Early diagnosis and complete obliteration of the shunt are important for improving the treatment outcomes of patients with SDAVF.

show abstract

“…2 Noninvasive imaging techniques (such as MRI or computed tomography angiography) may be useful to narrow down the vertebral segments requiring DSA. 4 Segments T6 to L2 are the most affected, being responsible for around 80% of SDAVFs, 2 11 23 as represented by the T9 fistula in the case herein reported.…”

Section: Discussionmentioning

confidence: 60%

Spinal Dural Arteriovenous Fistula, a Rare and Frequently Misdiagnosed Cause of Mielopathy – Case Report and Review of the Literature

Souza,

Silva,

Paula

et al. 2024

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

View full text Add to dashboard Cite

Spinal dural arteriovenous fistulas (SDAVFs) are rare vascular malformations with unspecific clinical manifestations, which often lead to misdiagnosis and delay in the establishment of effective therapies. Since the neurological prognosis depends on symptom duration and pretreatment neurological status, rapid identification and obliteration of the fistula are key to provide patients with a better quality of life. We herein describe an illustrative case of an elderly patient presenting with progressive myelopathy, with a definitive diagnosis of SDAVF after 18 months of the initial symptoms. We also review the core concepts regarding this condition and discuss strategies to prevent misdiagnosis and worsening of the neurological outcome.

show abstract

Degree and Duration of Functional Improvement on Long-Term Follow-Up of Spinal Dural Arteriovenous Fistulae Occluded by Endovascular and Surgical Treatment

Cited by 16 publications

References 29 publications

Long-term outcomes and prognostic factors in patients with treated spinal dural arteriovenous fistulas: a prospective cohort study

Long-term outcomes and prognostic factors in patients with treated spinal dural arteriovenous fistulas: a prospective cohort study

Clinical Characteristics and Endovascular Treatment for Spinal Dural Arteriovenous Fistula in Japan: Japanese Registry of Neuroendovascular Therapy 2 and 3

Spinal Dural Arteriovenous Fistula, a Rare and Frequently Misdiagnosed Cause of Mielopathy – Case Report and Review of the Literature

Contact Info

Product

Resources

About