Surgical and endovascular treatment of spinal dural arteriovenous fistulas: long-term disability assessment and prognostic factors

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The authors assessed clinical outcomes of patients with treated spinal dural arteriovenous fistulas (DAVFs) and investigated prognostic factors.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Thirty consecutive patients with spinal DAVFs were treated at the authors' institution during the past 15 years: seven underwent surgery; seven underwent surgery after failed embolization; and 16 underwent embolization alone. The outcomes of gait and micturition disability were analyzed. Follow up averaged 3.4 years (range 1 month–11.8 years). Age, duration of symptoms, pre- and postintervention magnetic resonance (MR) imaging findings, and preintervention disability were correlated with outcome.</jats:p> <jats:p content-type="fine-print">Seventeen patients (57%) experienced improved gait, 12 (40%) were unchanged, and one (3%) was worse. In 11 patients (37%) micturition function was improved, in 15 (50%) it was unchanged, and in four (13%) it was worse. Gait disability, as measured by the Aminoff—Logue Scale, was significantly improved after treatment, from 3.4 ± 1.4 (average ± standard deviation) to 2.7 ± 1.5 (p = 0.007). Mean micturition disability scores decreased, but not significantly, from 1.9 ± 1 to 1.6 ± 1.1 (p = 0.20). Preintervention gait disability was not associated with improvement except for patients with Aminoff—Logue Scale Grade 4 disability (eight of nine improved; p = 0.024). For patients treated within 13 months of symptom onset, mean micturition disability decreased (p = 0.035). No association was found between clinical improvement and age, a symptom duration less than 30 months, or pre- and postintervention MR imaging—documented spinal cord edema.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Spinal DAVF treatment significantly improved patients' mean gait disability score by almost one grade at last follow up. The mean micturition disability score was not significantly improved, unless treatment was performed within 13 months of symptom onset. Longer and more uniform follow-up study is needed to determine if improved and stabilized clinical outcomes are sustained.</jats:p>

Treatment and outcome of spinal dural arteriovenous fistulas

“…Song et al [14] did not note any significant differences in clinical outcome among treatment groups -surgery alone (7 cases), embolization alone (16 cases), and embolization followed by surgery (7 cases).…”

“…Recurrence can occur by either recanalization of the embolized vessels, collateralization, or development of the new fistula [10]. In the series of Song et al [14], fistulas recurred in 15% of patients despite the use of a liquid embolization material. Westphal and Koch [16] reported on 12 of 47 patients surgically treated after embolization because of the recruitment of collateral vessels.…”

Spinal Dural Arteriovenous Fistulas: Clinical and Radiological outcome of Endovascular Treatment

“…30 In general, studies suggest that bladder function, if affected, does not recover. 6,17,32 In our study improvement in motor function after treatment was more likely to occur than improvement in micturition dysfunction.…”

“…These symptoms at clinical presentation are similar to those reported in other large series. 11,14,23,24,32 Development of upper motor neuron signs with gait and micturition impairment is usually seen late in the course of the disease process. Early diagnosis and successful treatment of the fistula correlates with improvement in clinical symptoms.…”

“…Studies have shown no significant correlation with duration of symptom onset and the extent of cord edema on MR imaging. 2,32 A trend has suggested that earlier exclusion of the fistula correlates with improved motor function. 30 In general, studies suggest that bladder function, if affected, does not recover.…”