Surgical treatment for spinal dural arteriovenous fistulas: Outcome, complications and prognostic factors

Wojciechowski, Jakub; Kunert, Przemysław; Nowak, Arkadiusz; Dziedzic, Tomasz; Czernicki, Tomasz; Wójtowicz, Katarzyna; Leśniewski, Kamil; Marchel, Andrzej

doi:10.1016/j.pjnns.2017.07.001

Cited by 18 publications

(9 citation statements)

References 26 publications

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“…We also had similar experiences and therefore, we believe that interventional embolization is suitable for patients with advanced age, poor physical condition, unwillingness to undergo open surgery, or thicker and straighter blood supply arteries because this procedure is expected to reach the fistula and allow embolization of the proximal drainage vein ( 4 , 33 ). Most patients are candidates for microsurgery ( 34 - 36 ).…”

Section: Discussionmentioning

confidence: 99%

Imaging characteristics, misdiagnosis and microsurgical outcomes of patients with spinal dural arteriovenous fistula: a retrospective study of 32 patients

Zhang¹,

Zhai²,

Li³

et al. 2022

Ann Transl Med

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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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Section: Discussionmentioning

confidence: 99%

Imaging characteristics, misdiagnosis and microsurgical outcomes of patients with spinal dural arteriovenous fistula: a retrospective study of 32 patients

Zhang¹,

Zhai²,

Li³

et al. 2022

Ann Transl Med

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“…(1) SDAVF is a rare neurosurgical disease, with an annual incidence of only 5 to 10 cases per million ( 33 ), and some orthopedic surgeons lack adequate awareness of this disease. (2) The early symptoms for SDAVF patients are similar to those of degenerative spine diseases.…”

Section: Discussionmentioning

confidence: 99%

“…(1) SDAVF is a rare neurosurgical disease, with an annual incidence of only 5 to 10 cases per million (33), and some orthopedic surgeons lack adequate awareness of this disease.…”

Section: Analysis Of the Causes Of Misdiagnosismentioning

confidence: 99%

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

Yang

et al. 2022

Front. Neurol.

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ObjectiveSpinal dural arteriovenous fistula (SDAVF) is a rare disease that is often misdiagnosed by orthopedic surgeons. We analyzed the reasons for the misdiagnosis and proposed countermeasures.MethodsTwenty-two SDAVF patients who were initially treated in orthopedics were included. The patients were divided into a correct diagnosis group (A) and a misdiagnosis group (B). The clinical data and prognosis were evaluated.ResultsThere were 10 patients in group A and 12 patients in group B. The clinical manifestations included limb numbness, weakness, and bladder and bowel dysfunction. Among these patients without spinal degenerative diseases which had typical magnetic resonance imaging (MRI) features in Group A were more than Group B (P < 0.05). More patients had spinal degenerative diseases in group B. In group A, seven patients were primarily diagnosed with a SDAVF after multidisciplinary teamwork (MDT). In group B, five patients were misdiagnosed with lumbar spinal stenosis, four with lumbar disc herniation, two with thoracic spinal stenosis, and one with cervical spinal stenosis and lumbar spinal stenosis and underwent cervical spinal canal and lumbar spinal canal decompression. The length of time for confirming the diagnosis was 7 months longer in group B than in group A. All patients underwent microsurgery treatment. The average follow-up duration was 11 months. The modified Aminoff-Logue Disability Scale scores showed a statistically significant difference in improvement between the two groups (P < 0.05).Conclusionwhen patients with dysuria especially, have intermittent spinal nerve dysfunction, the possibility of SDAVF should be considered. Awareness of the specific clinical and spinal cord edema and flow voids on MRI of a SDAVF needs to be promoted for orthopedic surgeons. Timely MDT is an important measure for reducing misdiagnosis, and steroids or inappropriate surgery should be avoided until a SDAVF is completely excluded.

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“…Acquired SDAVFs are typically located in the thoracolumbar region, and the mean age at presentation is around 60 years ( 19 ). Sacral SDAVFs are rare, and the mean age of presentation of SDAVFs that coexist with a TCS is 41 years (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Coincidence of Tethered Cord, Filum Terminale Lipoma, and Sacral Dural Arteriovenous Fistula: Report of Two Cases and a Literature Review

et al. 2018

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Spinal dural arteriovenous fistula (SDAVF) is the most common vascular malformation of the spine in adults. However, the coincidence of tethered cord syndrome, lipoma, and SDAVF on the sacral level is exceptionally rare. We describe two patients, probably the fifth and sixth ever reported. The first was a 33 year-old female who underwent surgical cord de-tethering. Surprisingly, a sacral SDAVF was discovered intraoperatively, despite negative digital subtraction angiography (DSA). The second patient was a 30 year-old male with similar pathologies. After three failed embolizations, the fistula was surgically disconnected. Both patients recovered well. A review of patients with sacral SDAVF coexisting with spinal dysraphism, with an emphasis on the basis of symptoms was done. As a rule, in these coincident disorders, the SDAVF was the direct cause of increasing symptoms. Previous reports and our findings reveal that surgery might be superior to endovascular embolization for treating sacral SDAVFs with coexisting entities, because surgery offers a one-step treatment.

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Surgical treatment for spinal dural arteriovenous fistulas: Outcome, complications and prognostic factors

Abstract: Microsurgical closing of a SDAVF brings good and stable results over time. Aggressive treatment should be attempted even in cases of total loss of spinal cord function. Neurological condition before surgery and age may influence the outcome.

Cited by 18 publications

References 26 publications

Imaging characteristics, misdiagnosis and microsurgical outcomes of patients with spinal dural arteriovenous fistula: a retrospective study of 32 patients

Imaging characteristics, misdiagnosis and microsurgical outcomes of patients with spinal dural arteriovenous fistula: a retrospective study of 32 patients

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

Coincidence of Tethered Cord, Filum Terminale Lipoma, and Sacral Dural Arteriovenous Fistula: Report of Two Cases and a Literature Review

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