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World Neurosurg. 2017 Nov;107:488-494. doi: 10.1016/j.wneu.2017.07.140. Epub 2017 Jul 31.

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

Author information

1
Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom. Electronic address: adurnford@gmail.com.
2
Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom.
3
Department of Neuroradiology, Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom.

Abstract

BACKGROUND:

Long-term outcomes following occlusion of spinal dural arteriovenous fistula (SDAVF) are poorly understood and are based on small series reporting predominantly short-term outcomes. The degree and duration of improvement remain unclear. In this study, we analyzed long-term outcomes following occlusion in a cohort of patients with SDAVF.

METHODS:

This was a single-center cohort study of patients with SDAVF identified from a prospective database. Outcomes were assessed using a modified Aminoff and Logue Disability (ALD) Scale, the modified Rankin Scale (mRS), and patient-reported outcomes at presentation and long-term follow-up. Both angiographic recanalization and idiopathic functional recurrence rates were calculated.

RESULTS:

Of the total of 67 patients with SAVDF identified, 59 were eligible for inclusion in this study. Fifty-seven of these 59 (97%) underwent occlusion. Twenty-two patients underwent initial embolization; 12 were occluded. Two patients recanalized. Eleven patients underwent surgery after attempted embolization; 10 were occluded. Thirty-seven patients treated by surgery only were occluded. The median duration of follow-up was 63 months (range, 12-240 months). After occlusion, the ALD gait and urinary scores improved by a median of 1 point. Although the median mRS score was unchanged, 49% of the patients experienced improvement, most by 1 point. There was no difference between the patients occluded by embolization or surgery, but those requiring both approaches had worse gait and urinary scores (P = 0.005 and 0.03, respectively). The duration of symptoms by itself had no effect on outcomes (P = 0.61). Following occlusion, 5 patients experienced an idiopathic late functional deterioration. Of 16 patients presenting with paraplegia, 13 (81%) improved, with a median mRS improvement of 1 point.

CONCLUSIONS:

Following occlusion, patients with SDAVF experienced a modest improvement in symptoms, most commonly by 1 point on the ALD scale. Idiopathic late deterioration was seen in 9.1% of patients.

KEYWORDS:

Dural arteriovenous fistula; Embolization; Endovascular; Outcome; Paraplegia; Spine; Surgery

PMID:
28774761
DOI:
10.1016/j.wneu.2017.07.140
[Indexed for MEDLINE]

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