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

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  • 1 Section of Neurovascular Surgery, Division of Neurosurgery, Department of Surgery; and Division of Interventional Neuroradiology, Department of Radiology, University of California at Los Angeles, School of Medicine, Los Angeles, California
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Object. The authors assessed clinical outcomes of patients with treated spinal dural arteriovenous fistulas (DAVFs) and investigated prognostic factors.

Methods. 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.

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.

Conclusions. 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.

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  • 1.

    Afshar JK, , Doppman JL, & Oldfield EH: Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas. J Neurosurg 82:196200, 1995 Afshar JK, Doppman JL, Oldfield EH: Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas. J Neurosurg 82:196–200, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Aminoff MJ, , Barnard RO, & Logue V: The pathophysiology of spinal vascular malformations. J Neurol Sci 23:255263, 1974 Aminoff MJ, Barnard RO, Logue V: The pathophysiology of spinal vascular malformations. J Neurol Sci 23:255–263, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Aminoff MJ, & Logue V: Clinical features of spinal vascular malformations. Brain 97:197210, 1974 Aminoff MJ, Logue V: Clinical features of spinal vascular malformations. Brain 97:197–210, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Aminoff MJ, & Logue V: The prognosis of patients with spinal vascular malformations. Brain 97:211218, 1974 Aminoff MJ, Logue V: The prognosis of patients with spinal vascular malformations. Brain 97:211–218, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Barth MO, , Chiras J, & Rose M, et al: [Results of embolization of spinal dural arteriovenous fistulas with perimedullary venous drainage.] Neurochirurgie 30:381386, 1984 (Fr) Barth MO, Chiras J, Rose M, et al: [Results of embolization of spinal dural arteriovenous fistulas with perimedullary venous drainage.] Neurochirurgie 30:381–386, 1984 (Fr)

    • Search Google Scholar
    • Export Citation
  • 6.

    Behrens S, & Thron A: Long-term follow-up and outcome in patients treated for spinal dural arteriovenous fistula. J Neurol 246:181185, 1999 Behrens S, Thron A: Long-term follow-up and outcome in patients treated for spinal dural arteriovenous fistula. J Neurol 246:181–185, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Gobin YP, , Houdart E, & Casasco A, et al: Endovascular therapy for arteriovenous malformations and fistulae in the spinal cord. Semin Intervention Radiol 10:227242, 1993 Gobin YP, Houdart E, Casasco A, et al: Endovascular therapy for arteriovenous malformations and fistulae in the spinal cord. Semin Intervention Radiol 10:227–242, 1993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Krayenbuhl H, , Yaşargil MG, & McClintock HG: Treatment of spinal cord vascular malformations by surgical excision. J Neurosurg 30:427435, 1969 Krayenbuhl H, Yaşargil MG, McClintock HG: Treatment of spinal cord vascular malformations by surgical excision. J Neurosurg 30:427–435, 1969

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Merland JJ, , Riche MC, & Chiras J: Intraspinal extramedullary arteriovenous fistulae draining into the medullary veins. J Neuroradiol 7:271320, 1980 Merland JJ, Riche MC, Chiras J: Intraspinal extramedullary arteriovenous fistulae draining into the medullary veins. J Neuroradiol 7:271–320, 1980

    • Search Google Scholar
    • Export Citation
  • 10.

    Mourier KL, , Gelbert F, & Rey A, et al: Spinal dural arteriovenous malformations with perimedullary drainage. Indications and results of surgery in 30 cases. Acta Neurochir 100:136141, 1989 Mourier KL, Gelbert F, Rey A, et al: Spinal dural arteriovenous malformations with perimedullary drainage. Indications and results of surgery in 30 cases. Acta Neurochir 100:136–141, 1989

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Niimi Y, , Berenstein A, & Setton A, et al: Embolization of spinal dural arteriovenous fistulae: results and follow-up. Neurosurgery 40:675683, 1997 Niimi Y, Berenstein A, Setton A, et al: Embolization of spinal dural arteriovenous fistulae: results and follow-up. Neurosurgery 40:675–683, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Oldfield EH, , Di Chiro G, & Quindlen EA, et al: Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula. J Neurosurg 59:10191030, 1983 Oldfield EH, Di Chiro G, Quindlen EA, et al: Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula. J Neurosurg 59:1019–1030, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Symon L, , Kuyama H, & Kendall B: Dural arteriovenous malformations of the spine. Clinical features and surgical results in 55 cases. J Neurosurg 60:238247, 1984 Symon L, Kuyama H, Kendall B: Dural arteriovenous malformations of the spine. Clinical features and surgical results in 55 cases. J Neurosurg 60:238–247, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Tacconi L, , Lopez Izquierdo BC, & Symon L: Outcome and prognostic factors in the surgical treatment of spinal dural arteriovenous fistulas. A long-term study. Br J Neurosurg 11:298305, 1997 Tacconi L, Lopez Izquierdo BC, Symon L: Outcome and prognostic factors in the surgical treatment of spinal dural arteriovenous fistulas. A long-term study. Br J Neurosurg 11:298–305, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Westphal M, & Koch C: Management of spinal dural arteriovenous fistulae using an interdisciplinary neuroradiological/neurosurgical approach: experience with 47 cases. Neurosurgery 45:451458, 1999 Westphal M, Koch C: Management of spinal dural arteriovenous fistulae using an interdisciplinary neuroradiological/neurosurgical approach: experience with 47 cases. Neurosurgery 45:451–458, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Willinsky RA, , terBrugge K, & Montanera W, et al: Posttreatment MR findings in spinal dural arteriovenous malformations. AJNR 16:20632071, 1995 Willinsky RA, terBrugge K, Montanera W, et al: Posttreatment MR findings in spinal dural arteriovenous malformations. AJNR 16:2063–2071, 1995

    • Search Google Scholar
    • Export Citation

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